Rural-urban differences in the use of postnatal care services in Malawi

In Malawi, women's postpartum care services often remain underutilized despite the efforts of the government to promote the use of maternal healthcare. Consequently, maternal mortality and morbidity are persistently high.

The aim of the study is to examine the factors associated with women's use of postpartum care services in urban areas as compared with the rural areas in Malawi.

The study used data from the 2010 Malawi Demographic and Health Survey. A two-staged approach was used in data analysis where the logistic regression and multinomial regression methods were used first to identify the determinants of use and second to classify the determinants associated with timing of women's use of postpartum care service in the country.

Of the 13776 women that constituted the sample, 7018 (50.9%) reported to use postpartum care services. Caesarean delivery in both urban [odds ratio (OR)=3.98; 95% confidence interval (CI): 2.27- 6.98] and rural settings (OR=3.56; 95% CI: 2.91-4.36) greatly increased women's likelihood of using postpartum care. On the contrary, problems of availability of health services decreased women's likelihood of using postpartum care services in both urban (OR=0.75; 95% CI: 0.57-0.97) and rural settings (OR=0.87; 95% CI: 0.80-0.93). Furthermore, pregnancy complications, lower levels of women's education, difficulties in accessing available healthcare facilities and low media exposure were significantly associated with women's delay in using postpartum care services in rural Malawi compared with their counterparts who used the services within 24 h after childbirth.

In both urban and rural settings, women's use of postnatal care services remains low. The influence of low socioeconomic and service quality factors was prominent in rural areas more than in urban areas. This information is significant for health policy stakeholders to understand ways which can be adopted in order to enhance the quality and the use of postnatal care services. Therefore, there is a need to promote women-centred and community-based awareness in order to enhance the use of postnatal care in urban and rural areas, if maternal health outcomes are to improve in Malawi.