How women's experiences and perceptions of care influence uptake of postnatal care across sub-Saharan Africa: a qualitative systematic review

Background: The burden of maternal and neonatal morbidity and mortality is a global health concern with the highest burden documented after childbirth in women and babies living in sub-Saharan Africa. To date, there is limited
information on the quality of postnatal care and/or whether evidence-based interventions to improve postnatal care
in a way that meets the specifc health needs of each mother and her baby have been lacking. There is also limited
data related to how quality of care (respectful or disrespectful) infuences women’s decision to access postnatal care.
Objective: To systematically review available qualitative evidence for how quality of care (respectful or disrespectful)
infuences perceptions and experiences of, and decisions to, access postnatal care for women living in sub-Saharan
Africa.
Search strategy: CINAHL plus, Cochrane library, Global Health, Medline, PubMed, Web of Science were searched
from 2009—2019. Grey literature was searched on Google Scholar.
Selection criteria: Qualitative literature in English describing women’s perceptions and experiences of the quality of
care they received after childbirth and how this infuenced their perceptions of and decisions to access postnatal care.
Data analysis: Thematic analysis was performed to extract subthemes and themes. Outcomes were themes from
the qualitative data used to form a thematic synthesis.
Results: Fifteen studies were included with data from 985 women interviewed face-to-face across eight countries.
Descriptions of respectful care included healthcare providers being kind, supportive and attentive to women’s needs.
Women described preferring healthcare services where the healthcare providers communicated in a respectful
and caring manner. Descriptions of disrespectful care included verbal and/or physical abuse and power imbalances
between women and healthcare providers. Some women were denied postnatal care when attending a healthcare
facility after giving birth at home. There is evidence to suggest that vulnerable women (adolescents; women with
poor socioeconomic status; women who are HIV positive) are more likely to receive disrespectful care.
Conclusions: This systematic review describes how aspects of respectful and disrespectful maternity care infuence women’s perceptions and experiences of, and decisions to access postnatal care services. There is a need for a renewed focus to prioritise respectful maternity care and to sustainably provide good quality postnatal care to all
women and their babies in a way that meets their expectations and health needs.