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Assessing The Determinants of Postnatal Care Service Utilization in
Saboba District, Northern Region, Ghana
Parmaak, Justice Badam
BSC. PH (CUG), MPH (KNUST-PG6175616)
DOI: https://dx.doi.org/10.51244/IJRSI.2025.12110132
Received: 22 November 2025; Accepted: 28 November 2025; Published: 18 December 2025
ABSTRACT
Postnatal care plays an important role in promoting the health of women and children. Despite the enormous
benefits, the uptake of postnatal care in developing countries is reported to be low, with increased maternal and
child deaths during pregnancy and within the postnatal period. Maternal and child deaths within the postnatal
period account for two-thirds of nursing mothers, and two-thirds of babies die within the first to the seventh day
of life in the postnatal period.
The study sought to assess the factors influencing utilization of postnatal services in Saboba District. From the
study, the majority of the participants were between 20-29 years. Antenatal care utilization was found to be high
(96.7%), and low second postnatal care services of 19.5% since over 60% of those who delivered in the health
facilities would have received the first PNC service, which is given within the first 24 hours after delivery.
Nursing mothers’ postnatal service utilization in the district was reported to be low (19.5%). Factors that
predisposed mothers to the uptake of postnatal care were: mother age at first delivery, place of residence, whether
living in urban or rural areas, place of recent delivery, either TBA or health facility, and cultural practices like
performing a child naming ceremony were strong predictors in determining women's utilization of postnatal care
services.
MOH/GHS through the district health directorate should organize regular educational campaigns on PNC and
other maternal and child services to educate expectant nursing mothers on postnatal care and as well as certain
cultural practices that inhibit PNC practices among mothers.
Definition of Terms
Antenatal care- A Care given during pregnancy. Parity- The number of times a woman has given birth Postnatal
care- This is care given to both mother and child immediately after childbirth for about six weeks.
Traditional Birth Attendant (TBA) - refers to a lay person in the community who provides healthcare services
during pregnancy and childbirth.
INTRODUCTION
Background of the study
The first day of life is the highest risk period for both mother and baby. The postnatal period is the period that
begins immediately after childbirth to about six weeks (WHO, 2016). During this period, the mother goes
through many physical and emotional changes while learning to care for her newborn. Postnatal care services
include management of normal puerperium, identification and management of any complications, micronutrient
supplementation, immunization of baby and mother, counselling, health education, birth registration, among
others.
Despite these benefits, the uptake of postnatal care is disproportionately high in developed countries as compared
to developing countries. The risk of death of the mother and the child due to pregnancy and childbirth is almost
1 in 7 in the developing countries as compared to 1 in 30,000 in developed countries (Senait et al, 2016). Most
of these deaths occur within the postnatal period as two-thirds of babies die within the first week of life whilst
two-thirds of nursing mothers die within the postnatal period (Sines et al., 2007).
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Statement of the problem
1. They are predisposing determinants that affect postnatal service uptake.
2. A lot of factors enable postnatal service utilization.
3. There are need reasons which influence the uptake of postnatal services
Aim
To assess the factors influencing utilization of postnatal services in Saboba District of the Northern region,
Ghana.
Objectives
1. To assess the predisposing factors that affect postnatal service uptake in the Saboba District.
2. To identify the enabling factors of postnatal service utilization.
3. To determine the need factors that influence the uptake of postnatal services.
Research questions
1. What are the predisposing factors that affect postnatal services in the district?
2. What is the extent of the influence of enabling factors on postnatal care?
3. Do factors such as need affect postnatal service?
Rationale of the study
There have been so many studies conducted all over the world, including Africa, and most of these studies
included predisposing, enabling, and need factors as their variables of interest in their quest to finding reasons
for not so impressive utilization of postnatal services. This poor PNC utilization coverage occurs mostly in
African countries despite the various interventions and relatively higher uptake of antenatal care services.
Replication of this study in Saboba District will further give credence to those findings and also, identify missing
gaps in the available literature.
Scope of study
The study participants included breastfeeding mothers who had stayed not less than 6 months in rural and peri-
urban areas prior to the study in the selected sub-Districts in Saboba District of the northern region of Ghana. It
is a ten (10) month study using a cross-sectional design.
LITERATURE REVIEW
CONCEPTUAL FRAMEWORK
Figure 1.1: conceptual framework
©Source: Adapted from Anderson and Newman as cited by Haque, 2011.
Need factors
1. Perceived need
2. Evaluated need
Enabling factors
1. Income
2. Accessibility
3. Occupation
Predisposing factors
1. Age 5. Place of delivery
2. Religion 6. ANC visits
3. Cultural practices
4. Parity
5. Education
Increased postnatal care service utilization
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Empirical review
Predisposing factors
According to Andersen and Newman, (1995) as cited in Hague (2011, predisposing factors include age, sex,
education, occupation, ethnicity, social networks, social interactions, culture, attitudes, values, among others,
but this study focused on age, education, culture, parity, ANC attendance, religion, and place of delivery to suit
the setting of the study.
Age at birth
Several studies are pointing to the fact that the mother's age at childbirth influences their decision to utilize
postnatal services. According to Haque, (2011)Only one-third of the young nursing mothers received postpartum
care. However, research findings by Khanal et al., 2014 revealed decreasing utilization of postnatal service with
the increasing age of the mother, and this was strengthened by research findings in India by Tej et al, (2011) .
Some research findings showed women between the ages of 20-35 years as more likely to utilize postnatal
services than other age brackets Paudel et al., (2013). Research conducted in Uganda showed that the younger
(below 20 years) and the older (above 34 years) women had the least attendance, while mothers of the age-group
25-29 years attended postnatal services most 67, 20.3%) Oluwaseyi, (2014). A study in Ghana by Abor et al,
(2011) also revealed that utilization of maternal health services, especially postnatal services, is influenced by
the age of the mother.
Education
Studies have shown a strong relationship between the levels of education of both the nursing mother and her
spouse and postnatal service usage. A study by Dhakal et al. ( 2007) affirms the importance of the education of
women in the utilization of post-natal care, and even added that the educational level of their husbands influenced
them greatly in seeking PNC services. A study in Nepal also revealed the influence of the educational level on
the utilization of PNC services. The study indicated that 50% of the research participants who had secondary
education and above utilized PNC, while only 22.7% and 23.6% received PNC services for primary and illiterate
participants, respectively, during the same period (Paudel et al., 2013). Somefun and Ibisomi (2016) in their
study in Nigeria observed that 51.24% of those who patronized appropriate PNC services had secondary
education and above, yet only 22.19% and 26.57% of primary and illiterate nursing mothers, respectively,
received appropriate PNC services. Ghana Demographic and Health Survey GDHS) (2014) also supported these
findings that women with higher education turn to access PNC services more than the uneducated (2014).
Antenatal care
A lot of studies have documented a strong relationship between Antenatal care (ANC) attendance and postnatal
care (PNC) utilization. Dhakal et al., (2007) in Nepal, indicated a strong influence of antenatal visits to the
utilization of postnatal care services. A study by Oluwaseyi, (2014) in Nigeria indicated that more than half
(56.3%) of the mothers of children who did not use ANC services did not go for postnatal care either. According
to Paudel et al., (2013),mothers who utilized ANC services were more likely to seek PNC services than those
who did not.
Parity
Parity can be explained as the number of times that a woman has given birth to a fetus with a gestational age of
28 weeks or more, regardless of whether the child was born alive or was stillborn. A study in Bangladesh by
Khanal et al.,( 2014) revealed that women were more likely to patronize the services of postnatal care with their
first childbirth (Para 1) than the subsequent deliveries. A similar study in Addis Ababa in Ethiopia, indicated
that women with their first child) were using postnatal services as compared to multi-parity ( Asefa & Giru,
2016).
Place of delivery
Studies have shown that women who give birth in health facilities are more likely to patronize postnatal care,
especially the first twenty-four hours after delivery, than those who deliver at home. Workineh and Hailu, (2014)
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conducted research in Jabitenah District in Ethiopia on factors affecting utilization of postnatal care service
revealed place of delivery was significantly associated with postnatal care service utilization. An earlier study
by Tsegay et al., (2013) on determinants of antenatal and delivery care utilization in Tigray region, Ethiopia,
showed that health institutional delivery was directly linked to the usage of postnatal services.
Cultural beliefs and norms
Several studies have evidenced that cultural beliefs and practices in a particular society influence the uptake of
postnatal services. A study in Nepal by Paudel et al.,( 2013) indicated that there was a culture of separation of
the mother and the newborn for around 12 days after delivery in Nepalese societies. Within this period, mother
and newborn were not supposed to be touched by other people, and they were not permitted to go outside the
home; they were always kept in an isolated area within the house. As they were limited to the home environment
during these periods, the utilization of PNC service remained a major challenge, thus not allowing them the
chance to have contact with health service providers. A review of factors associated with the utilization of
healthcare services and strategies for improving postpartum care in Africa by Belemsaga et al., (2015) showed
how mothers in their quest to apply concoction on the umbilical cords, with the claims of aiding the healing of
the cord, which was against the medical advice of leaving it clean, prevented them from attending PNC services.
Religion
Religion has also been proven to have a relationship with PNC service by several researchers. One of such
studies was conducted by Oluwaseyi, (2014) In Nigeria, on determinants of postnatal care non-utilization among
women showed that Muslim mothers were about two times more likely not to patronize PNC services, and the
association was significant. This has supported earlier studies by Singh et al.,( 2012) in rural India, which
revealed that Muslim women are less likely to avail themselves of PNC services. A study in Ghana by Abor et
al, (2011) showed that women of the Roman Catholic faith and other Christian sects are more likely to use
postnatal care services as compared to the women of Islamic or indicated no religious beliefs.
Enabling factors
These are logistical aspects of obtaining care, such as income, accessible health services, available healthcare
services, travel, availability of health personnel, waiting time, and quality of social relations (Andersen, 1995)
as cited in Hague, 2011. This research considered income, accessible health services, and available healthcare
services.
Income
Many studies have documented evidence that economic and income levels of the nursing mothers and or spouses
influence the utilization of PNC services. Lack of money for medical and transportation costs to the health
facility was a reason for the non-utilization of postnatal services. Household income was positively correlated
with the adoption of the infant immunization schedule. Female income was connected to individual autonomy
in deciding to go for health services (Belemsaga et al., 2015).
Accessible health service
Available literature shows that the distance the mother has to cover to access PNC services is a demotivating
factor to its utilization. Distance was shown to have a significant association with the low utilization of postnatal
care services in Nigeria (Somefun & Ibisomi, 2016).
Tao et al., (2011) found that transport problems appear to have influenced the provision of postnatal care in
Anhui province, China. It was not easy for township doctors and village health workers to do postnatal visits for
women at home when there was no health facility vehicle, and they had to depend on public or private transport.
In that same study by Tao et al., (2011) Poor road networks and mountainous terrain all affected the ability of
the doctors to visit women at home for postnatal care.
Occupation
Occupation of the husbands tend to influence their decision to utilize PNC service. A study conducted by Khanal
et al.,( 2014) in Nepal revealed mothers who indicated agricultural occupation, and whose partners did
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agricultural occupation were less likely to have received at least one postnatal care. Women whose husband’s
occupation was professional, technical, and managerial other than manual, agricultural or self-employed were
observed utilizing PNC services more (Haque, 2011; Jat, Ng & Sebastian, 2011; Regassa, 2011).
Need factors
Based on this perspective, medical need is influenced by both the presence of physical disease and the cultural
perception of illness. The need factor is the most direct cause of health service use. Studies by Haque (2011)
showed a significant relationship between the perceived need for postnatal care and its utilization.
Perceived need
Perceived need for the care influences the mothers’ decision to go for PNC service evidenced in many research
findings. Counseling on danger signs, experience of PNC, and PNC counseling and provision of appointment,
which increased their perceived need for the care, showed a statistically significant association for their PNC
service uptake in Addis Ababa, Ethiopia (Senait et al, 2016).
A lot of studies have shown a positive correlation between a perceived need for postnatal care by the nursing
mothers and the utilization of its services. This was emphasized by research conducted by Paudel et al., (2013)
which observed that women who did not have information about PNC were the main obstacle to the utilization
of postnatal care. The study found that educated women, those who have ever attended postnatal care and
antenatal care, had higher perceived benefits of postnatal care; hence majority of them utilized the service no
matter their place of delivery. A similar study in Mulago and Mengo hospitals in 2004 showed more than half
of the women who partook in the research (53.9%) were unaware of postnatal services( Sr, Asefa & Giru,2016)
found that most of those who did not patronize postnatal services gave reasons as not being counseled and given
an appointment for postnatal care.
Evaluated need
Mothers who are assessed by a health professional and given knowledge of postpartum obstetric danger signs
were observed utilizing the postnatal care service when they witnessed those signs (Workineh and Hailu, 2014).
The inability to recognize the danger signs of obstetric complications during the postpartum period influenced
their utilization of PNC services in this study (Hales et al.,2016; Dhakal et al., 2007).
METHODOLOGY
Study methods and design
The study was a quantitative and cross-sectional survey that assessed determining factors influencing utilization
of postnatal services in the Saboba District of the Northern region of Ghana using an analytic cross-sectional
design.
Description of the study area
The Saboba District is one of several Districts located along the eastern corridor belt of the northern region,
Ghana. The District is bounded to the west by Gushiegu and Karaga Districts, Yendi to the South-West, River
Oti, an international boundary for Ghana and the Republic of Togo, and the Tatali District to the East, Chereponi
District to the North, and Zabzugu to the South(Population and Housing Census, 2010). According to the 2010
Population and Housing Census, the District population is 65,706representing 2.7 percent of the Northern
region’s total population. Females constitute 50.8 percent, and 49.2 percent are males. Approximately ninety-
one percent of the population is rural (90.55%) according to the census. The district population is projected to
be 80,666 in 2017. According to the District Health Information Management System (DHIMS), the district has
one medical centre, four health centres, twenty-eight functional Community-based Health Planning and
Services (CHPS), and 25 demarcated CHPS.
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Population for the study
The selection of the sample was based on those who had given birth to a baby seven (7) weeks prior to the survey
and were living within the sub-districts selected and met the inclusion criteria.
Sample and Sampling technique
Appropriate sample size determination was done using the formula for single population proportion, assuming
a 95% confidence interval, 5% margin of error, 57% estimated prevalence PNC coverage (GDHS, 2014) for the
Northern Region, and 10% non-response rate.
n=
𝑧
2
𝑝𝑞
𝑒
2
Where n = sample size
z=95% confidence interval (1.96)
p=estimated prevalence (0.57)
q=1-p= 1-0.57=0.43
e=level of precision (0.05)
n=
1.96
2
(0.57)(0.43)
0.05
2
= 377
10% non-response=0.1*377=38
n = 377+38 = 415
The overall sample size was 415 participants which was then adjusted to 423 participants to take care of designed
effect and losses. A total of 423 participants were interviewed in the field.
Nature/Sources of Data.
Data collection was done using primary sources by interviewing the beneficiary of the PNC services
Methods of Data Collection and Instrumentation
The data was collected at the community level using a structured questionnaire. The study was conducted in
three selected sub-districts among the six (6) sub-districts in the district using simple random and multistage
sampling techniques. Out of the selected sub-districts, ten communities were again selected by a simple lottery
method. The total sample size was then proportionally allocated among the selected communities.
Validity and reliability of the instrument
To identify the clarity and consistency of the questionnaire, pretesting was conducted using 10% of the sample
size in a similar population in the West Gonja District outside the selected study area, and necessary
modifications, such as clarity and consistency of the questions and evidence-based time allocation for each
respondent, were made accordingly.
Method of Data Analysis
Three levels of analysis (univariate, bivariate, and multivariate) were applied in the study. At the univariate level,
the percentage distribution of the study sample was displayed to show the distribution of respondents by the
various characteristics of the research participants. At the bivariate level, Pearson’s chi-square test was also used
to determine a statistically significant relationship between the independent variables and the dependent variable.
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A logistic regression was used to analyze the crude impact of each independent variable and the dependent
variable.
Ethical Consideration
Ethical clearance was obtained from the Committee for Human Research Publications and Ethics (CHRPE) of
Kwame Nkrumah University of Science and Technology, Kumasi, and the Ghana Health Service at the Saboba
District Health Directorate. The clearance letter from the Committee for Human Research Publications and
Ethics (CHRPE) was given to the District Health Directorate, which facilitated their approval for the research to
be conducted in the district. Participants were informed about the objective of the study. Written consent was
obtained from the participants. In order to keep the confidentiality of any information provided by this study, the
data collection procedure was anonymous, and participation was on a voluntary basis. Participants could
withdraw from the study at any time during data collection.
RESULTS AND DISCUSSION
Research and Analysis
Socio-demographic characteristics of the respondents
A total of 423 participants were recruited into the study, of whom two participants declined consent, leaving 421
participants whose responses are used in this analysis. Nearly one-third (28.3%) of the respondents were
adolescents (10-19 years, with four out of 10 (45.6%) being 20-29 years old, and more than one-quarter (26.1%)
were above thirty years old (30+). The majority (79.1%) of the respondents were Konkombas, followed by
Moshies (10.0%), and the least among the tribes were Ewes (1.4%). More than three-quarters (82.9%) of
respondents were married women, and less than 20 (17.1%) were not in marital homes and were single,
divorced/separated, or widowed. Among those who were married, 33.3% were living in polygamous homes,
while 66.8% were not. Religion is diverse in the Saboba district, with Christians being the majority who
constitute 67.7%, Muslims 17.6% and Traditionalists, as well as other religious bodies, were 14.7%. As shown
in Table 4.1 below.
Table 4.1: Respondents' Socio-demographic Characteristics
(N=421)
Variable
Frequency (n)
Percentage (%)
Age group
10—19
119
28.3
20—29
192
45.6
30+
110
26.1
Ethnic group
Konkombas
333
79.1
Anufo
18
4.3
Ewes
6
1.4
Dagombas
8
1.9
Moshie
42
10.0
Other tribe
14
3.3
Marital status
Single
18
4.3
Married
349
82.9
Co-habiting
46
10.9
Widowed
6
1.4
Divorced/Separated
2
0.5
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Only wife of the husband
No
140
33.3
Yes
281
66.8
Religion status
Christianity
285
67.7
Moslem
74
17.6
Traditionalist
62
14.7
Source: Author’s construct, 2017
Socio-economic Characteristics of the respondents
Table 4.2 presents findings on respondents’ socio-economic characteristics. More than half (57.7%) of the
respondents had no formal education, twenty-five percent (25.0%) had basic education (Primary and Junior High
School), eleven percent had secondary education, and 6.0% had tertiary education. Two-thirds (60.0%) of the
respondents were farmers. Similarly, proportions were traders (15.0%) and artisans, unemployed were 4.8%
and those involved in skilled labour represent 4.0%. Most (59.9%) respondents were rural dwellers, with 40.1%
living in the urban areas of the district.
Table 4.2: Respondents' Socio-economic Characteristics
Predisposing factors of the respondents to the utilization of Postnatal care
Table 4.3 depicts respondents' predisposing factors to the utilization of postnatal care services in Saboba District.
Five in 10 respondents delivered their first child as adolescents aged 10-19 years, and nearly half (49.9%)
delivered at aged 20-29 years. Most respondents' recent babies were between seven to eleven months old; only
a few babies were twelve months and above. Almost one-third of respondents’ babies were their first child,
22.3% of respondents were having their fifth baby, and nearly similar proportions were having their second,
third, and fourth babies. Nearly all respondents (96.7%) have ever attended antenatal care (ANC) before delivery,
with more than three-quarters (77.6%) of respondents having attended ANC more than four times before
delivery. Again, 18.5% reported having the obligation of obtaining permission from their husbands before
attending ANC, and 14.0% said they needed new clothes before they could go for postnatal care (PNC) services,
as well as 10.9% stating that a naming ceremony had to be performed on the child before they could attend PNC.
Respondents’ spouses' educational level
Figure 4.1 depicts the educational level of the spouses of the respondents. Half (50%) of their spouse had no
formal education, and both secondary and tertiary education had similar proportions.
Respondent's recent place of delivery for current child
Figure 4.2, nearly two-thirds (63.0%) of respondents delivered their current baby at the health facility (had skilled
delivery), 21% delivered with TBA, and 16.0% delivered at home without skilled personnel supervision.
Preferred place of delivery of respondents
In Figure 4.3 below, 8 in 10 of respondents (83.0%) reported preferring delivery at the health facility by skilled
personnel, and 12.0% still preferred home delivery, as well as 5% preferred to deliver with a TBA at the health
facility.
Respondents' enabling factors for postnatal service utilization
Table 4.4 below shows the enabling factors that enhance the utilization of the postnatal care service in the Saboba
district. Over a quarter (47.5%) had to cover a two-kilometre distance in accessing healthcare, while 37.2% had
to cover more than five kilometres. More than half (58.7%) walk on foot to the health facility, and 23.3% used
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a motorbike, and less than a tenth either used a bicycle or public transport systems for ANC and PNC. Nearly
two-thirds (61.3%) of their husbands were farmers, and a little over a tenth are engaged in formal work (15.2%),
artisanship 12.4%, trading 5.0% and unemployed 5.7%. The majority of the respondents belong to the poorer
households earning less than GHS500 monthly.
Table 4.4: Respondents' enabling factors for postnatal service utilization
Respondents need factors for successful utilization of PNC service
Table 4.5 below indicates the respondents need factors needed for successful utilization of postnatal care
services. With regards to things that will cause a mother to go for PNC, more than half (55.6%) of mothers said
if they are counselled on the importance of PNC, book appointment for PNC 11.9%, encounter health problem
after delivery 4.5%, and about a third (26.8%) said they will need to attend PNC if they encounter more than
two of these problems. The ability to recognize obstetric signs of complication by mothers also makes them go
for PNC, and was reported as 99.1% and 0.9% said it is not an issue. Also, about 92.2% of mothers said they
will go for PNC if, after delivery, they realize any health problems in the child. Postnatal service utilization was
reported to be low, with more than a tenth (19.5%) reporting attending PNC service for their last delivery, and
more than three-quarters (80.5%) did not attend PNC service for their last delivery.
Table 4.5: Respondents' need factors for PNC service utilization
Health Problems mothers experienced after delivery
Among health problems experienced by mothers before and during delivery include the following: 45% percent
of reported bodily weakness, prolapsed uterus was 19%, those who had severe vagina pain were 6%, fever 10%,
and among those with profuse vaginal bleeding were 10%. Also, among those who had inflammations of the
breast (mastitis) were 7%, and those who delivered and had no breast milk to breastfeed were 3%. These
problems were reported among mothers who triggered their need to go for postnatal care services, and without
which they would not have gone for the postnatal services, as shown in Figure 4.4 below.
Health problems the child experienced after delivery
From figure 4.5 below, 41% of children born had fever, and among those with skin infection were 19%, and
17% of them had an infected umbilical cord after delivery.
Also, about 15% had problems with breastfeeding, and 8% had difficulty breathing.
Relationship between socio-demographic and postnatal care utilization
Table 5.6 below shows that all socio-demographic variables were found not to have an association with postnatal
care utilization among mothers in Saboba district, with a p-value greater than 0.05.
Table 4.6: Socio-demographic characteristics and postnatal care utilization
Association between socio-economic characteristics and utilization of postnatal care
Among all variables in socio-economic characteristics, respondents’ educational and occupational levels were
found not to show an association with postnatal care utilization. However, respondents’ place of residence, where
those who delivered in urban areas were significantly more likely to go for postnatal service after delivery than
those who delivered in rural areas, with a p-value of 0.01.
Table 4.7: Socio-economic characteristics and utilization of postnatal care
Relationship between respondents' predisposing factors and utilization of postnatal care
Postnatal care utilization increases with age, where the older in age were more likely to attend postnatal care
than the younger, as shown in Table 4.8 below, but indicates no association (P=0.16). All other variables were
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showing no significant association except performing a naming ceremony for the child before attending postnatal
care. The children whose naming ceremony had been performed were significantly more likely to attend
postnatal care service than those whose naming ceremony had not been performed (P=0.01).
Table 4.8: Respondents' predisposing factors and utilization of postnatal care
Relationship between the respondent’s recent place of delivery and PNC utilization
From Figure 4.6, respondents' recent place of delivery shows a significant association with PNC utilization
(P=0.04), where more women were significantly likely to deliver with the traditional birth attendant (TBA) than
with the skilled personnel at the health facility, and were likely to have visited the health facility for postnatal
care service delivery.
Figure 4.6: Respondents' recent place of delivery and PNC utilization
Source: Author’s construct, 2017
Respondents' preferred place of delivery and PNC utilization
Figure 4.7 below shows respondents' preferred place of delivery and subsequent utilization of postnatal care
services. From the figure, more women would prefer to deliver at home (30.0%) and the health facility (18.4%),
and this was found to indicate no significant association (P=0.12) with the utilization of postnatal care service
in the Saboba district.
Figure 4.7: Respondent preferred place of delivery and PNC utilization
Association between respondents' enabling factors and PNC utilization
Table 4.9 below indicates the enabling factors of respondents to the utilization of postnatal services at Saboba.
Among all other factors, there was no significant association with postnatal service utilization, indicating p-
values greater than 0.05 significant levels. The only variable that was found to show a significant association
with postnatal service utilization was respondent household monthly income earned (P=0.03) and the utilization
PNC service. Respondents who earned a high income in monthly income were significantly more likely to have
used postnatal care services than those who earned less or were poor in household wealth status.
Table 4.9: Respondents' enabling factors and PNC utilization
Association between respondents' need factors and utilization of PNC services
Table 4.10 below shows respondents' need for the utilization of postnatal care services. Among all other
variables, such as respondents’ ability to recognize obstetric complications (P=0.32), child having health
problem after delivery (P=0.12), ever been advised on PNC on date of second visit (0.45), and whether
respondents think PNC services are beneficial (P=0.39), were found to have no significant association with PNC
service utilization. Notwithstanding, variable such as things that caused respondents the need to go for PNC
service was found to show a significant association with postnatal care utilization (P<0.01), in which respondents
who were booked for an appointment or encountered any health problem after delivery were significantly more
likely to visit the health facility again for postnatal service than their counterparts.
Table 4.10 Respondents' need factors and utilization of PNC services
Health problems after delivery and postnatal care utilization
Figure 4.8: Respondents who, after delivery, had health problems such as vaginal bleeding, fever, vaginal pains,
mastitis, bodily weakness, and others were likely to go to the health facility for postnatal care, but did not show
any significant relationship (P=0.24).
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Health problems of the child after delivery and utilization of the postnatal care service
Figure 4.9; most respondents were significantly more likely to go for postnatal care service (P<0.01) after
delivery if they realized that the child had developed a particular problem, such as inability of the child to
breastfeed, difficulty in breathing, and others.
Univariate analysis of significantly associated factors and utilization of PNC service
Table 4.11 below presents the univariate analysis of significantly associated factors and the utilization of
postnatal care services among mothers at Saboba. Postnatal care service was significantly less likely in the urban
area showing 48% less chance of utilization (COR=0.52 (95% CI 0.31-0.88), P=0.02) even though, the urban
folds are usually conceived to be pregnant with a lot of health facility than the rural area where women need to
cover long distance in accessing healthcare like of PNC; this might be due to the CHPS concepts in Ghana which
is making healthcare service such as PNC to be closer to the rural communities and therefore have created some
similarity between the urban and rural folds in term of Postnatal care service.
Table 4.11: Univariate analysis of significantly associated factors and utilization of postnatal care service
Final multivariate logistic regression model of significantly associated factors and the utilization of
postnatal care service
Table 4.12 below presents the final multivariate logistic regression model of significantly associated variables
that influenced postnatal care service utilization among mothers at Saboba district. Key among variables include
respondents place of resident in which mothers who dwell in urban areas show significant relationship and were
25% chance less likely to have visit the postnatal care clinic for service utilization (AOR=0.75 (95%CI 0.38-
1.45, P=0.02) even though there might be abundance of health facility as compared to those who live in rural
communities where they probably might have to cover distance before reaching the service site which could
prevent the rural women from patronising PNC.
Table 4.12: Final multivariate logistic regression analysis of significantly associated factors and Utilization
of postnatal care service
DISCUSSION
Predisposing factors affecting PNC service uptake
Antenatal care utilization does not translate into postnatal service utilization and this was widely reported in
literature and in study by the Ghana Demographic and Health Survey, (2014) reporting 95% ANC and 68% PNC
utilization, and Belemsaga et al, (2015) study in Cameroun equally reporting86% ANC and 37% PNC utilization
which are indicating higher ANC and lower PNC utilization by mothers after delivery.
Enabling factors of postnatal service utilization
Among the enabling factors, the key variable that influenced women's postnatal care utilization was household
monthly income, where respondents whose household monthly income earned less than GHS500.00 were one-
fold more likely not to utilize postnatal care service compared to the households that earned more than GHS1000.
This was because the poor households were not able to afford transport and the payment of other costs at the
health facility, which could have prevented them from attending the postnatal care services after they had
delivered.
Need factors influencing the uptake of postnatal services
Respondents need factors are factors that stimulate the respondents in the utilization of postnatal care services
in the district. These factors were reported by several studies, and in our current study findings show that; factors
such as respondents’ ability to recognize obstetric complications, child health problems after delivery, ever been
advice on the date of next postnatal care visit and respondents thinking on the benefits of postnatal care were
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found not to have significant association with postnatal care service which can be attributed to the current health
education that goes on at the health facility.
SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS
Summaries of Findings
Strengths and Limitations of the Study
The study was an analytical cross-sectional study and therefore measured the factors that have influenced the
utilization of postnatal services in Saboba District within a specific time period, and thus does not represent any
longitudinal study that may be conducted in the district. The study limitations include: The study targeted women
who were visited at their homes, so there might be selection bias since the visits were conducted during the day.
Conclusion
Nursing mothers’ postnatal service utilization in the district was found to (19.5%, and more than 90% utilization
of antenatal care service. From the study, factors that predisposed mothers to the utilization of postnatal care
services were: mother’s age at first delivery, place of residence, whether living in urban or rural areas, place of
recent delivery, either TBA or health facility, and cultural practices like performing a child naming ceremony
were strong predictors in determining women's utilization of postnatal care services.
Recommendations
Government
1. The government should revamp the current policies on maternal and child health services to address the
potential barriers that prevent nursing mothers from accessing postnatal services and other reproductive
health services, by building more hospitals and clinics in rural communities to prevent residential status
barriers in the Saboba district.
DECLARATION
I hereby do declare that this submission is my own work towards the award of Master of Public Health Degree
in Population and Reproductive Health and that, it contains no material previously published by another person,
nor material which has been accepted for the award of any other degree of the University, except where due
acknowledgement has been made in the text.
ACKNOWLEDGEMENT
Special thanks to GOD ALMIGHTY for seeing me through the completion of this study. I want to express my
profound and sincere gratitude to my academic supervisor, who doubles as Head of Department for Population,
Family and Reproductive Health at the School of Public Health, KNUST, DR. SAM NEWTON, for his
enthusiasm, diligence, and for painstakingly going through my work and making valuable comments,
suggestions, and corrections timeously. I equally want to thank Dr. CRISANTUS KUBIO, my field supervisor
and the District Director of Health Services, Saboba District, for his personal assistance spanning from getting
clearance at the project site to the conclusion of this research. May God bless you abundantly, sir.
I also acknowledge, with profound appreciation, the immeasurable assistance offered me by the staff of Ghana
Health Service and the people of Saboba District, whose auspices the material for this study was obtained and
administered. I also wish to thank my family, colleagues, staff of the School of Public Health, KNUST, and the
university community as a whole for their varying support towards the success of this research work.
REFERENCES
1. Abor P. A., Abekah-nkrumah, G. and Sakyi, K. (2011) ‘The socio-economic determinants of maternal
health care utilization in The socio-economic determinants of maternal health care utilization in
Ghana’, (May 2014). doi: 10.1108/03068291111139258.
2. Andersen, R.M., 1995. Andersen and Newman Framework of Health Services Utilization. Journal of
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025
Page 1494
www.rsisinternational.org
Health and Social Behavior, 36, pp.1-10.
3. Amoakoh, H.B. (2011). Evaluating the effect of a clinical decision-making support system on
maternal and neonatal mortality and morbidity in Ghana: A cluster randomized controlled trial.
4. Belemsaga, D. Y., Kouanda, S., Goujon, A., Kiendrebeogo, J. A., Duysburgh, E., Degomme, O., and
Temmerman, M. (2015) ‘A review of factors associated with the utilization of healthcare services and
strategies for improving postpartum care in Africa’, 28(2), pp. 83–105.
5. Dhakal, S., Chapman, G. N., Simkhada, P. P., Van, E. R., Stephens, J. and Raja, A. E. (2007) ‘BMC
Pregnancy and Childbirth Utilisation of postnatal care among rural women in Nepal’, 9, pp. 1–9. doi:
10.1186/1471-2393-7-19.
6. Eric, O.A.and Steve, K.G.(2013). 2010 Population and Housing Census Report. Millennium
Development Goals in Ghana, Ghana Statistical Service. UNDP.
7. Ghana Demographic and Health Survey (2014), Ghana Statistical Service, Accra. The DHS program,
ICF International, Rockville, Maryland, USA. P1-13
8. Hales, S., Lesher-Trevino, A., Ford, N., Maher, D. and Tran, N. (2016) ‘Reporting guidelines for
implementation and operational research’, (November 2015), pp. 58–64.
9. Haque, S. E. (2011) ‘Factors affecting the utilisation of postpartum care among young mothers in’,
19, pp. 138–147. doi: 10.1111/j.1365-2524.2010.00953.x.
10. Jat, T. R., Ng, N. and Sebastian, M. S. (2011) ‘Factors affecting the use of maternal health services in
Madhya Pradesh state of India : a multilevel analysis’, pp. 1–11.
11. Khanal, V., Adhikari, M., Karkee, R. and Gavidia, T. (2014) ‘Factors associated with the utilisation
of postnatal care services among the mothers of Nepal : analysis of Nepal
12. Oluwaseyi, S.D., 2014. Determinants of postnatal care non-utilization among women in
Nigeria (Doctoral dissertation).
13. Opoku, E. A. (2009) ‘Utilization of Maternal Care services in Ghana by Region after the
Implementation of the Free Maternal Care Policy’.
14. Paudel, M., Khanal, V., Acharya, B. and Adhikari, M. (2013) ‘Women's Health Care Determinants of
Postnatal Service utilization in a Western District of Nepal : Community Based Cross Sectional
Study’, 2(3). doi: 10.4172/2167-0420.1000126.
15. Regassa, N. (2011) ‘Antenatal and postnatal care service utilization in southern Ethiopia : a
population-based study’, 11(3).
16. Senait B. Sr.Y. A. and Berhanu W. G. (2016) 'Prevalence of Postnatal Care Utilization and Associated
Factors among Women Who Gave Birth and Attending Immunization Clinic in Selected Government
Health Centers in Addis Ababa, Ethiopia'
17. Sines, B. E., Syed, U., Wall, S., and Worley, H. (2007) ‘Postnatal Care : A Critical Opportunity to’.
18. Singh, P. K., Rai, R. K., Alagarajan, M. and Singh, L. (2012) ‘Determinants of Maternity Care
Services Utilization among Married Adolescents in Rural India’, 7(2). doi:
10.1371/journal.pone.0031666.
19. Somefun, O. D. and Ibisomi, L. (2016) ‘Determinants of postnatal care non-utilization among women
in Nigeria Determinants of postnatal care non ‑ utilization among women in Nigeria’, BMC Research
Notes. BioMed Central, (December). Doi: 10.1186/s13104-015-1823-3.
20. Sr, S. B., Asefa, Y. and Giru, B. W. (2016) ‘Prevalence of Postnatal Care Utilization and Associated
Factors among Women Who Gave Birth and Attending Immunization Clinic in Selected Government
Health Centers in Addis Ababa ’, 26(6), pp. 94–108.
21. Takai IU, Dlakwa HD, Bukar M, Audu M, K. A. (2015) ‘Factors responsible for under-utilization of
postnatal care services in Maiduguri, north-eastern Nigeria Takai IU, Dlakwa HD, Bukar M, Audu
BM, Kwayabura AS - Sahel Med J. Kanu state: department of obstetric and gynecology, Kanu state
hospital, Nigeria, pp. 109–115.
22. Tao, F., Huang, K., Lecturer, M. A., Health, C., Long, X., Attending, M. A., Health, C., Tolhurst, R.,
Science, S., Health, I. and Raven, J. (2011) ‘Low postnatal care rates in two rural counties in Anhui
Province, China : Perceptions of key stakeholders’, Midwifery. Elsevier, 27(5), pp. 707–715. doi:
10.1016/j.midw.2009.10.001.
23. Ten Hoope-Bender, P., de Bernis, L., Campbell, J., Downe, S., Fauveau, V., Fogstad, H., Homer, C.S.,
Kennedy, H.P., Matthews, Z., McFadden, A., and Renfrew, M.J., 2014. Improvement of maternal and
newborn health through midwifery. The Lancet, 384(9949), pp.1226-1235.
INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)
ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue XI November 2025
Page 1495
www.rsisinternational.org
24. Tsegay, Y., Gebrehiwot, T., Goicolea, I., Edin, K., Lemma, H. and Sebastian, M. S. (2013)
‘Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia : a cross-sectional
study’, pp. 1–10.
25. World Health Organization (WHO), 2014. WHO recommendations on postnatal care of the mother
and newborn. Geneva: WHO; 2013.
26. Workineh, Y. G. and Hailu, D. A. (2014) ‘Factors affecting utilization of postnatal care service in
Jabitena district, Amhara region, Ethiopia’, 2(3), pp. 169–176. doi: 10.11648/j.sjph.20140203.15.