Historically, the global maternal health community has largely focused on access to high quality maternity care during pregnancy, labor and delivery. The postnatal or postpartum period, defined as the six weeks following delivery, is equally important.
A groundbreaking 1996 literature review found that greater than 60% of global maternal deaths occur during the postnatal period. According to that review, 45% of postpartum maternal deaths occur within one day of delivery, approximately 65% occur within one week and roughly 80% occur within two weeks. Postpartum hemorrhage is a leading cause of maternal deaths around the world. While the risk of maternal death is greatest during labor, delivery and within the first few days following birth, some evidence indicates that women are vulnerable up to six months postpartum. The postnatal period is critical for newborns as well: More than a third of child deaths occur during the neonatal period, and approximately three quarters of neonatal deaths occur within the first week of life.
Timely, high quality postnatal care is crucial for maximizing maternal and newborn health. Postnatal visits represent an opportunity for providers to facilitate healthy breastfeeding practices, screen for postpartum depression, monitor the newborn’s growth and overall health status, treat childbirth-related complications, counsel women about their family planning options and refer the mother and baby for specialized care if necessary, among other services. The World Health Organization recommends that all women and newborns receive at least three postnatal contacts following delivery—the first between 48 and 72 hours, the second between days 7 and 14 and the third at six weeks postpartum.
According to the most recent country-level data, an average of 58% of women around the world attend postnatal visits for themselves, ranging from 9% to 98%, and an average of 28% of women bring their infants for a postnatal check-up, ranging from 5% to 99%. In low- and middle-income countries, women who live in urban areas, are wealthier and have higher levels of education are significantly more likely to access postnatal care than their counterparts.
While there have been innovative efforts to improve the availability and quality of postnatal care in low-resource settings, additional research to identify the most effective models is needed. Continuity of care from pregnancy through the postpartum period is essential for preventing maternal and newborn deaths.
- WHO recommendations on postnatal care of the mother and newborn
World Health Organization | October 2013
- Committee opinion: Optimizing postpartum care
American College of Obstetricians and Gynecologists | June 2016
- Inequities in postnatal care in low- and middle-income countries: A systematic review and meta-analysis
Bulletin of the World Health Organization | April 2015
- Clinical guidelines for postpartum women and infants in primary care: A systematic review
BMC Pregnancy and Childbirth | January 2014
- NICE quality standard: Postnatal care
National Institute for Healthcare and Excellence | June 2015
- Antenatal and postnatal care: A review of innovative models for improving availability, accessibility, acceptability and quality of services in low-resource settings
BJOG | March 2016
- The postpartum period: The key to maternal mortality
International Journal of Gynecology & Obstetrics | July 1996