Utilization of Postnatal Healthcare Services Delivered through Home Visitation and Health Facilities for Mothers and Newborns: An Integrative Review from Developing Countries.

Despite evidence about the value of high quality postnatal services for the survival, health and wellbeing of the mother and neonate, sub-optimal use of the available services delivered through public sector remains a persistent challenge in India and most low-middle income countries. An extensive search till Dec 31, 2017 in databases including PubMed, Scopus and Science Direct was conducted and selected studies were organized, categorized and summarized for integrated review. Of the 3463 studies screened, 47 relevant studies were identified through integrated systematic process. The 'nexus' framework consisting of four domains namely: social-cultural, educational, organizational and economic-physical were used to determine the promoters and inhibitors of postnatal care-utilization. The important inhibitory factors at household and community context were myths-cultural practices, gaps in the awareness of mother and families regarding danger signs and postnatal complications and hesitancy to contact health workers due to trust deficit. There were lack of clarity about job responsibilities, poor quality of training, skills building and supervision of front line workers. Quality of home visits, and irregular incentives to health workers were other factors. The facilitating factors were mother's autonomy, young mothers, access to media and repeated and timely contact with the health worker, antenatal care (ANC) attendance and institutional deliveries, conditional cash transfer and availability of health insurance. Several factors like social mobilization, skill building and training cut across the domains of the nexus framework. The review suggested a multi-dimensional focus on implementing integrated continuum of care models covering prenatal-postnatal and infancy period.