Demographic and socio-economic information of respondents
There were 150 women included in the study. The number of study subjects represented from each village 'C' (56%) and village 'D' (44%) was almost equal. The majority of women was 20 to 24 years old and also had their first pregnancy in this age group. Two thirds of women had one or two children and an almost similar proportion was living in families with 5–8 members (Table ).
Association between demographic, socio economic factors & postnatal check up
Half of the women were illiterate and of the remaining women, equal numbers had primary education and secondary education or above. Three quarters of the women (72%) were farmers and the rest were housewives (25%) with a negligible proportion having formal sector work (3%).
Half of the husbands were educated to secondary school level and above, and a small proportion was illiterate (14%). Half of the husbands were involved in farming and the others in formal sector work such as in education or the civil service (38%), whilst some worked abroad (4%), e.g. in the Middle East or Malaysia. Other occupations (8%) included students and causal work such as painter or goldsmith.
Utilisation of postnatal care
The prevalence of postnatal care was 34% (95% CI = 27% – 42%) within 42 days after delivery (Figure ), and 19% within 48 hours. Women reported that they had postnatal care from a doctor (65%) rather than a nurse (20%) or other health workers (16%). Similarly, the majority of women (78%) had received their care in hospital.
Timing of postnatal health check.
Association between demographic/socio-economic factors and postnatal care
An attempt was made to find which socio-demographic factors were associated with postnatal care (Table ). Postnatal care prevalence was not different among different age groups (p = 0.21). The 'Tamang' ethnic group was less likely to have had postnatal care than Brahmin-chhetri (p = 0.001). The occupation of women was associated with having received postnatal care. Housewives were 7.25 times (95% CI = 2.94–18.18) more likely to have had postnatal care than women who reported farming as their main occupation. It was observed that as education of women increases so did the likelihood of having postnatal health care. Women with secondary school education had 6.49 times (95% CI= 2.5 – 17.2) more chance of receiving postnatal care than illiterate women (p = 0.001). Similarly women with a husband educated to secondary school level (OR = 6.3; 95% CI = 1.55 to 29.95) had a significantly greater chance of having postnatal care than those with an illiterate husband (p = 0.001). The husband's occupation is associated with postnatal care uptake (p = 0.001). Husbands with a formal-sector job such as teaching or civil servant (OR = 3.23; 95% CI = 1.43 – 7.32) were more likely to have wives who attended postnatal care. The number of family members was not associated with postnatal care uptake. However, women with three or more children were less likely to have had postnatal care (OR = 0.16; 95% CI = 0.04–0.51) than a woman with one or two children. Similarly, having had more pregnancies was associated with a lower chance of postnatal care utilisation (p = 0.001). Women who had attended antenatal care were more likely to attend postnatal care (OR = 24.6; 95% CI 3.39 to 500.92). Women who delivered in the hospital were ten times (95% CI= 4.64 to 23.7) more likely to have received postnatal care than the women who delivered at home.
Perceived barriers to access to postnatal care in the community
All women were asked to give their opinion on barriers to access to postnatal care in their community. Table lists these main barriers: a lack of awareness or no perceived need for postnatal care by women and their families (47%), distance to health facility (39%) and lack of transportation or good roads (23%), lack of money (17%), and lack of skilled health workers in the community (14%).
Association between perceived barriers for health care & postnatal check up
None of the expected barriers: health facilities being far (p = 1.0), having no skilled female worker (p = 0.12), no money (p = 0.89), women and family member not being aware (p = 1.00), no postnatal care at local level (p = 0.40), no time due to need to work at home (p = 1.00) and no transportation (p = 0.74) were statistically associated with postnatal care uptake.
Health problems during postnatal period and seeking care
All women were asked about health problems they may have had in the postnatal period, only one in ten reported such problems. However, having such health problem was significantly associated with having postnatal care (p = 0.030). The common health problems perceived by women during the postnatal period were weakness (27%), mastitis (27%), vaginal bleeding (20%), fever (13%), vaginal pain (13%) and a prolapsed uterus (7%).
Women, who did not seek care for their health problems during postnatal period, were asked the reason why not. Their main reasons were distance to the health facility followed by inability to walk/travel to such facility.
Suggestions of women for the improvement of postnatal care
The majority of women recommended that there should be better postnatal care services and skilled health workers in their community, as well as an increased awareness of the availability and importance of postnatal care (Table ).
Suggestions given by women for improvement of postnatal care (n = 150)
The factors which were significantly associated with postnatal health care at 20% level of significant: ethnicity, education of women and their husbands, occupation of women and their husbands, number of children, having had antenatal care, place of delivery, age at pregnancy, having no female health care workers and having a health problem after delivery were entered into multivariate model with backward elimination method to find independent effects on postnatal care. Multivariate logistic regression analysis identified woman and husbands having formal sector jobs or husbands working abroad, having had antenatal care, delivery in hospital and women who reported having health problem after delivery as significantly associated with postnatal care (Table ).
Association between demographic, socio economic, antenatal health check & post natal check up using multivariate logistic regression analysis