Postnatal care in crisis: utilization and determinants during the Tigray conflict (2023)

Tigray’s previously strong health system and high postnatal care (PNC) utilization were devastated by the November 2020 conflictct. This brought drastically increased maternal and newborn mortality rates, exceeding national figures, and this also led to a lack of evidence on current PNC service use. This study therefore aims to assess the extent of PNC service utilization and its determinants among mothers who gave birth during the conflict. A community-based, cross-sectional study was conducted, using multi-stage cluster sampling to select 3,747 participants aged 15–49 from 19 districts. Continuous variables were described using means and standard deviations, while categorical variables were described using frequencies and percentages. To identify factors influencing postnatal care utilization, count regression models (Negative binomial, Modified poisson, and Quasi poisson) were employed in STATA version 14. The analysis used a 95% confidence interval, and a p-value < 0.05 was used to declare its statistical significant. This study found a low postnatal care utilization rate of only 20% (95% CI: 18.7, 21.3) among participants for their recent births. Several factors were identified as determinants of this low utilization. Women who attended antenatal care (aPR = 1.6, 95% CI: 1.18, 2.16) and delivered at a health facility (aPR = 3.7, 95% CI: 3.05, 4.47) were more likely to utilize postnatal care. Conversely, women with limited transport access (aPR: 0.77, 95% CI: 0.64, 0.94), those in host communities (aPR: 0.64, 95% CI: 0.51, 0.8), and rural residents (aPR: 1.53, 95% CI: 1.2, 1.96) were less likely. Younger age, occupation, and administrative zone also influenced postnatal care utilization. The conflict in Tigray is associated with a catastrophic decline in postnatal care (PNC) utilization, which dropped from 81 to 20%. With only 14.5% of women completing recommended four visits, mothers and neonates face significantly heightened health risks. Our findings suggest this decline is linked to facility destruction, displacement, and transport barriers, alongside demographic factors like urban residence and unemployment. These results underscore the urgent need for targeted interventions, including infrastructure renovation and integrated PNC education. Addressing these multifaceted barriers is likely essential to restoring service uptake and maternal health outcomes. This study examined postnatal care (PNC) use among 3,747 women in Tigray, Ethiopia, during the recent conflict. They found a shockingly low PNC utilization rate of only 20%, a steep decline from pre-conflict rates. The war devastated the region’s healthcare system, with widespread damage to facilities and a mass exodus of healthcare workers. This drastically limited access to care. The study identified several factors associated with PNC use. Women with better transport access were more likely to receive PNC. Internally displaced women used PNC more than host community women, possibly due to targeted aid. Rural women surprisingly used PNC more than urban women, likely due to mobile clinics operating in rural areas. Women who had more antenatal care visits and those who delivered in health facilities were also much more likely to receive PNC. Younger women and women employed by the government were also more likely to use PNC. The conflict created immense barriers to PNC, including fear and insecurity, damaged infrastructure, displacement, and a breakdown of the health system. The study highlights the urgent need to rebuild the health system, improve access to care, and provide targeted education about PNC, especially for urban, displaced, and older women. The researchers acknowledge limitations, including potential recall bias and the exclusion of some areas due to security concerns.