Integrative Review of Factors That Affect the Use of Postpartum Care Services in Developing Countries.

OBJECTIVE: To identify factors that affect the use of postpartum care services in developing countries. DATA SOURCES: PubMed, CINAHL, Global Health, EMBASE, and grey literature were searched for relevant articles in 2015 and 2016 with no publication date limit imposed. STUDY SELECTION: Thirteen studies met inclusion criteria and were assessed for quality with the use of a checklist developed by Fowkes and Fulton (1991) and a checklist developed by the Critical Appraisal Skills Programme (2017). DATA EXTRACTION: The integrative review framework of Whittemore and Knafl (2005) guided the conduct of the review. DATA SYNTHESIS: Results were synthesized based on the three delays model of Thaddeus and Maine (1994). Factors that negatively affected women's decisions to seek postpartum care (Phase I delays) included lack of women's autonomy, lack of exposure to mass media, no pregnancy/birth/postpartum complications, lack of awareness of postpartum care, negative provider attitude, lower levels of women's and husbands' education, women's and husbands' farming occupations, increasing number of children, and lower level of household income. Perceived easy access to a health care facility was associated with lesser odds of using postpartum care (Phase II delay). Hospitals, public health care facilities, and long queuing at a health care facility were associated with decreased postpartum care use (Phase III delays).
CONCLUSION: The most common determinants of how women used postpartum care were complications and the education levels and occupations of the women and their husbands. Further research is needed to identify health facility and accessibility factors that affect postpartum care use to develop effective interventions to improve the use of postpartum care.