Percent of women receiving postpartum care by a skilled health personnel within two days of childbirth

The percent of pregnant women seen by a skilled health provider within the first 48 hours following delivery.

This indicator is calculated as:

# of women attended during the first 48 hours postpartum by skilled personnel x 100
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Total # of live births

 


Number of women within the early postpartum period who are attended by skilled health personnel during the first 48 hours following delivery; all live births during the same time period.

The number of live births is a proxy for the numbers of all women who need postnatal care. Evaluators generally count all births, but usually use only live births to calculate this indicator because of the difficulty in obtaining information about non-live births (Graham and Filippi, 1994).

Where data on the numbers of live births 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.


Routine health service data; population-based surveys.  Routine health service data typically lack information on pregnancies or births that take place outside the public health sector, for example in homes or in private sector facilities.


The main purpose of an indicator for postpartum care is to provide information on women's use of postpartum services in the postpartum period.

Although most maternal and newborn deaths occur around the time of delivery and in the immediate postpartum period, postpartum care (PPC) has been a relatively neglected area of maternity-services provision. Recent WHO guidelines recommend that the first postpartum visit take place within the first week, preferably within the first two to three days, with a second visit at four to six weeks. The visit should include the early detection and treatment of complications and preventive care for both mother and baby7 (WHO, 1998a; WHO, 2001b).

Because pregnancy complications occur unpredictably, the likelihood is low that one postpartum visit of unspecified content, quality, and timing may influence maternal mortality. A postnatal care visit may reduce the likelihood of severe morbidity if pregnancy complications are detected early and if effective treatment is available (Child Health Research Project, 1999). Further research in this area is required.

Some large surveys such as DHS routinely collect data on postpartum care. Routine HIS may also collect data, although historically more programs have collected data on postnatal care for the baby (for immunization coverage) than for the mother.

This indicator is responsive to change in the short term. Annual monitoring is only feasible when the data are derived from routine data sources. For international comparisons, periods of three to five years are probably sufficient. Frequent surveys are probably undesirable because sampling error makes it difficult to assess whether small changes are real or due to chance variation.

Postpartum care is a package of services instead of one single intervention. Because no widely accepted operational definition of postpartum care exists and because the content and quality of care are likely to vary between settings, similar coverage rates between countries do not reflect similar levels of care.

Furthermore, after delivery, the two individuals need very different care and attention. Postpartum care statistics should make explicit whether care was provided principally for the mother or baby or both mother and baby, because this information may be difficult to determine retrospectively. The current DHS questionnaire, for example, specifies postpartum care for the mother. WHO distinguishes between care for the mother and for the baby by using the term postpartum to refer to care exclusively for the mother and the term postnatal care for the baby.

Some surveys present only postpartum coverage for women who delivered outside a facility on the assumption that women who deliver in facilities receive some degree of postpartum care (Rutstein, 1999).

In settings where postnatal coverage is relatively high, evaluators can stratify this indicator by time of visit (e.g., within two or three days, one week or later) to better measure women's use of services.


This indicator does not assess the content of the quality of the postpartum care itself, only that care was provided.

Furthermore, after delivery, the care and attention needed by mothers and babies can vary considerably. Postpartum care statistics should make explicit whether care was provided principally for the mother or baby or both mother and baby, because this information may be difficult to determine retrospectively. The current DHS questionnaire, for example, specifies postpartum care for the mother. WHO distinguishes between care for the mother and for the baby by using the term postpartum to refer to care exclusively for the mother and the term postnatal care for the baby.

Some surveys present only postpartum coverage for women who delivered outside a facility on the assumption that women who deliver in facilities receive some degree of postpartum care (Rutstein, 1999).

A related indicator would be Percent of women attended during the postpartum period by skilled personnel. Evaluators could then stratify this indicator by time of visit (e.g., within two or three days, one week or later) to better measure women's use of services.


access, quality, safe motherhood (SM)

WHO Technical Consultation on Postnatal and Postpartum Care, 2006.

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