Revisiting Postpartum Care

 

The international approach to securing maternal health has mainly focused on antenatal services and intrapartum care centred on the skilled birth attendant. Historically, many opportunities in the postpartum period to improve maternal health have been missed. Drawing on data from Demographic and Health surveys, a report summing coverage of postpartum services in 30 countries from across the world found that 40% of women had not received any postpartum care at all. Only 13% of women who had a non-institutional birth received postpartum care, often provided by a traditional birth attendant.

Yet there remains much uncertainty about what services are needed in the postpartum. This uncertainty is partly reflected in the marked variations in the way that "postpartum" and "postnatal" are defined. Some use the term postpartum to mean only the traditional six-week postpartum period, while others prefer this to signify the first year after childbirth and some even the first two years. Similarly, the term postnatal encompasses a range of time periods after childbirth, varying with the condition being described.

Our focus on the first year after childbirth is deliberate: women remain at increased risk of death for a considerable period of time after delivery, which can be reduced. In addition, the common morbidities experienced by women throughout the first year after childbirth are mostly reversible through a few relatively low-technology interventions. For example, a study among 500 women within a year of childbirth in Mombasa, Kenya found over half had anaemia (265/489) and a third had an unmet need for contraception (187/475). Similarly in Durban, South Africa around 20% of women less than six weeks after childbirth had infectious morbidities such as endometritis or breast abscess. Among rural Zambian women as many as 84% of them reported having a health problem in the postpartum. HIV-infected women in the postpartum, in addition to the marked mortality risks they face, have a considerable burden of reversible morbidities.