Percent of newborns receiving a postnatal care check within two days of birth

The percent of newborns attended by a health care pro­vider during the first 48 hours following birth.

This indicator is calculated as:

# of newborns attended during by a health care provider during the first 48 hours following birth  x 100
___________________________________________________________
 Total # of live births

 

The postnatal period begins one hour after the birth of the placenta and ends 6 weeks later (WHO, 2001b). Although not officially defined, the period of interest for the purposes of this indicator is up to the late postnatal period.


Numbers of newborns who are attended during their first two days of life (the numerator should specify whether new­borns are seen for the first or subsequent visit); all live births in the same period


Service statistics; population-based surveys

Routine HIS may collect data for this indicator to ob­tain estimates of early postnatal coverage. Routine health ser­vice data generally lacks information on pregnancies or births that take place outside the public sector, for ex­ample in homes or in private sector facilities, and there­fore should serve to estimate a denominator.

Where data on the numbers of live births for the de­nominator are unavailable, evaluators can calculate to­tal estimated live births using census data for the total population and crude birth rates in a specified area. To­tal expected births = population x crude birth rate


The main purpose of an indicator for early postnatal care is to provide information on the use of early postnatal services and to provide a measure of access to services for new­borns in this critical period.

Current measurement of postnatal care contacts does not provide information on the content of care provided.  The inter-agency Newborn Indicators Technical Working Group came to consensus on five signal functions for newborn postnatal care that can be performed during a postnatal check at a facility or at home by all levels of workers, including community health workers, and that mothers are likely to recall. Consensus is still needed on postnatal care signal functions for women.  These are:

  1. Checking the cord.
  2. Counseling on danger signs.
  3. Assessing temperature.
  4. Counseling on breastfeeding.
  5. Observing breastfeeding.
  6. Weighing the baby (where applicable).

Many routine HIS and population-based surveys col­lect data on postnatal care coverage. Annual statistics are only possible through HIS. Surveys of postnatal care cover­age every three to five years are sufficient. More fre­quent measurement is inappropriate because sampling errors make it difficult to assess whether small changes are real or due to chance variation.

Early postnatal care coverage should respond to program in­terventions aimed at increasing coverage in the short term.


Several additional points concerning the interpretation of this indicator are worth emphasizing.

First, the lack of an agreed-upon operational definition of early postnatal care makes valid international comparisons difficult. Early postnatal care is a package of services and not one single intervention. Because the content and qual­ity of care are likely to vary between settings, similar coverage rates do not necessarily reflect similar levels of care.

Second, early postnatal coverage rates should make explicit whether care was provided principally for the mother or baby, or both mother and baby, because this detail may be difficult to determine retrospectively. The cur­rent DHS questionnaire, for example, asks about post­partum care for the mother, but not for the baby, and routine HIS may not make such distinctions.  However, in 2014 the Newborn Indicators Technical Working Group recommended including a question about postnatal care signal functions to national and sub-national surveys in countries interested in tracking newborn care.

Third, early postnatal care coverage should ideally be strati­fied by the age of the baby after birth to get a better measure of access to services in the immediate postna­tal period. Routine HIS usually collects data on postna­tal coverage without specifying when this visit took place.

Finally, surveys relying on a woman‘s recall of events are subject to a recall bias likely to increase with the length of the recall period.


quality, newborn (NB)

WHO. 1998a. Postpartum Care for the Mother and Newborn: a Practical Guide. Maternal and Newborn Health/ Safe Motherhood Unit. Division of Reproductive Health (Technical Support). Geneva: WHO/RHT/MSM/ 98.3

WHO. 1998b. WHO Recommended Standards for Surveillance of Selected Vaccine-preventable Diseases. Global Programme for Vaccines and Immunisation. Expanded Programme on Immunisation. Geneva: WHO.

WHO. 2001a. "Fifty-fourth World Health Assembly": May 14-22, 2001. Geneva: WHO.

WHO. 2001b. Essential Care Practice Guide: Pregnancy, Childbirth and Newborn Care. Integrated Management of Pregnancy and Childbirth. Geneva. (Unpublished)

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