The postnatal period, defined as the first six weeks after birth, is critical to the health and survival of mother and newborn (1). The majority of maternal deaths, mainly due to hemorrhage, and many newborns deaths, mostly due to asphyxia, occur during the first day of birth (2, 3). Furthermore, lack of care during this period may result in disability as well as create missed opportunities for promoting healthy behaviors affecting women, newborns and children (1, 4).
Although global maternal deaths have decreased by 43% from 532,000 in 1990 to 303,000 in 2015(5), maternal morbidity and mortality remain a major challenge to health care systems. Worldwide, the maternal mortality rate is 216 per 100,000 live births with a large proportion of deaths due to early preventable or treatable pregnancy and childbirth complications. Low- and middle-income countries (LMIC) account for 99% of maternal deaths, with sub-Saharan African countries alone accounting for 66% (6, 7). In Ethiopia, in 2016 the maternal mortality ratio (MMR) remains high with 412 maternal deaths per 100,000 live births (8).
In the continuum of maternal health care, antenatal care (ANC) and postnatal care (PNC) are the key strategies required to reduce the maternal and new-born deaths (9). ANC is an entry point for maternal and child care service utilization, and as such, has the capability of reducing both maternal and neonatal mortality by detecting at-risk pregnancy and managing the risk associated. ANC provides opportunity to adequately prepare mothers birth and for appropriate care of children by addressing relevant information and education concerning to promoting the health, prevention of disease (10). Therefore, all pregnant women are recommended to have their first ANC visit within the first trimester of pregnancy at or before 16 weeks of gestation and to have minimum four ANC visits during pregnancy (10). ANC is an important opportunity to identify and manage any medical complications (11). Globally 86% of pregnant women access ANC with skilled health personnel at least once and only 65% receive at least four ANC visits. Whereas, in sub-Saharan Africa only 52% and South Asia only 49% of women and had received at least four ANC visits (12). In Ethiopia, in 2016 only 62% of women had any ANC visits during pregnancy, 32% of women had at least four ANC visits, and only 20% of women had their first ANC visit during the first trimester (8).
The World Health Organization (WHO) recommends that mothers and newborns should receive PNC in health facilities within at least 24 hours after birth if birth occurs in a health facility. For home births, the first postnatal contact should be as early as possible within 24 hour of birth. Additionally, at least three postnatal visits, on day 3 (48–72 hours), between 7–14 days, and at six weeks after birth are recommended for all mothers and newborns (13). Safe motherhood programmers recommend that all women receive a health check within 2 days after delivery (8).
For both the mother and infant, early postnatal care is vital for providing essential information as well as detecting and treating childbirth-related complications. Most of the maternal and neonatal deaths occur during or immediately after childbirth (1, 8, 14). Around half of the maternal and newborn deaths occur in the first 24 hours (15, 16). The majority of maternal deaths can be reduced through increasing antenatal care, skilled care during childbirth, emergency obstetric care and postnatal care services (17, 18). In Ethiopia, receiving appropriate postnatal care in the recommended time could avert neonatal mortality by 10–27% ( 14). However, in spite of its potential role in reducing newborn and maternal deaths, postnatal care has been poorly utilized for the health and survival of both the mother and the newborn (14). For instance in Ethiopia, only 17% of women and 13% of newborns received their postnatal checkup within the first two days of delivery (8).
Improving the quality of antenatal care services is likely to contribute to rapid increases in postnatal care utilization and results in better health outcomes for women and newborns (20). As a result, ANC utilization and timely initiation of PNC considered critical to maternal health services to improve health outcomes for women and newborns. The objective of this research was to determine the association between antenatal care and timely postnatal care checkup among reproductive age women in Ethiopia. We hypothesized that Ethiopian women who had timely and at least four ANC visits were more likely to have a timely PNC checkup.