FACTORS ASSOCIATED WITH LOW UTILIZATION OF POSTNATALCARE (PNC) AT WARDAK AND LAGHMAN PROVINCIAL HOSPITALS OF AFGHANISTAN.

Research Abstract/Summary Rational: The ultimate goal of health sector is to provide quality services and reduce maternal and infant mortality rates. Afghanistan has been recognized as one of the highest levels of maternal mortality in the neighboring countries. It has been estimated that 40% to 50% of women’s deaths during the childbearing years are related to complications during pregnancy and childbirth . Objective: The study objectives was to identify factors associated with low utilization of postnatal care (PNC) among mothers in Wardak and Laghman provincial hospitals Method: A cross sectional qualitative and quantitative study design was chosen in order to give a detailed description of factors that influence women to attend or not attend postnatal care services. Quantitative data was obtained from maternal and child registers. The qualitative data was collected through individual interviews of mothers and focus group discussions (FGDs). Total six FDGs and twenty individual’ interviews with mothers (3 FDGs in 10 interview in each hospital) were conducted in two provinces. Population: Target population were mothers delivered at two provincial hospitals in Laghman and Wardak Time Frame: The data has been collected between Feb to May 2017. Total Results: The quantitative data indicated that first postnatal care coverage received within first six hours of delivery was 98 % at Laghman Provincial Hospital and 89 % at Wardak Provincial Hospital. While the PNC 2 visit recorded at two hospitals were between 2 % to 11 % and PNC coverage 3 and PNC 4 were between 0 % to 1 %. The qualitative data showed that low community awareness, lower level of education among pregnant mothers, unavailability of transport facilities, socio- economic disparities, fragile insecurity situation, poor hospital staff behavior, wrong traditional practices, lack of empowerment and limited autonomy of women in decision making and poor medical records and record keeping standards were major factors behind low utilization of PNC services. Conclusion and Recommendation: The study highlighted that the prevalence of the postnatal care coverage at two provincial hospitals are extremely low especially PNC 2, PNC 3 and PNC 4. In order to increase the PNC coverage, reduce pregnancy related mortalities and improve mother and child health , the policy makers and health care providers need to come up with a sustainable and long term policies and measures to improve overall maternal and child health care and develop a framework that will aid in improving postnatal care coverage in Afghanistan.