Correlates of postpartum care visit non-attendance among low-income women: Insights from the Andersen Behavioral Model

Timely postpartum care is critical for the detection and treatment of pregnancy-related conditions and complications, thereby reducing maternal morbidity and mortality. However, attending postpartum care visits can be particularly challenging for low-income individuals. This study examined the correlates of postpartum care visit non-attendance among low-income women using the Andersen Behavioral Model of Health Services Use. Data were analyzed from 671 women enrolled during pregnancy in the South Carolina Midlands Healthy Start Program (2019–2024), a federally-funded program with the aim of improving perinatal outcomes through enhanced care coordination and case management for underserved pregnant and postpartum women. Multiple logistic regression models were used to identify correlates of postpartum visit non-attendance. Participants were predominantly non-Hispanic Black (87.5%) and low-income (90.9% receiving Medicaid). Overall, 27.0% did not attend a postpartum care visit within 12 weeks of delivery. Compared to non-Hispanic White participants, non-Hispanic Black (adjusted odds ratio (AOR): 0.48; 95% confidence interval (CI): 0.25, 0.94) and Hispanic participants (AOR: 0.12; 95% CI: 0.02, 0.66) had lower odds of non-attendance. Participants with a high school diploma/GED or less had higher odds of non-attendance (AOR: 1.83; 95% CI: 1.23, 2.71). Lack of partner involvement (AOR: 1.95; 95% CI: 1.14, 3.32) and frequent experiences of discrimination (AOR: 2.79; 95% CI: 1.22, 6.38) measured using the Everyday Discrimination Scale were also associated with increased odds of non-attendance. This study identified key factors associated with postpartum visit non-attendance among low-income women, including race, education level, partner involvement, and experiences of discrimination. These findings highlight the need to address individual, familial, and contextual factors to improve postpartum care engagement.