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Effect of Postpartum Care Cards on Postpartum Care Attendance among Mothers in Nigeria

Abstract

Postpartum care is an essential component of maternal and newborn healthcare because the period following childbirth is associated with important physical, emotional, and social changes that may require continued healthcare monitoring. Timely postpartum care can facilitate early identification and management of maternal and newborn complications, provide breastfeeding and family planning support, assess maternal recovery, and promote appropriate newborn care. However, many mothers in Nigeria do not attend recommended postpartum care visits because of inadequate awareness, forgetfulness, transportation difficulties, financial constraints, competing household responsibilities, limited follow-up systems, and poor communication between healthcare facilities and mothers. Postpartum care cards provide mothers with a tangible record of scheduled appointments, important postpartum health information, warning signs, and follow-up instructions and may therefore improve attendance at recommended postpartum services. Against this background, this study investigates the effect of postpartum care cards on postpartum care attendance among mothers in Nigeria. The study will be anchored on the Health Belief Model, Andersen's Behavioral Model of Health Services Use, and the Social Ecological Model. The Health Belief Model explains how mothers' perceptions of postpartum health risks, perceived severity of complications, perceived benefits of postpartum care, perceived barriers, and cues to action may influence attendance. Andersen's Behavioral Model explains how predisposing characteristics, enabling resources, and perceived healthcare needs influence utilization of postpartum healthcare services. The Social Ecological Model emphasizes the interaction between individual, family, community, healthcare-system, and broader environmental factors affecting postpartum healthcare utilization. Collectively, these theoretical perspectives provide a suitable framework for explaining how postpartum care cards may influence postpartum care attendance among mothers in Nigeria. The study will adopt a quantitative quasi-experimental or analytical cross-sectional research design. The study population will comprise postpartum mothers attending selected hospitals, primary healthcare centres, maternity facilities, postnatal clinics, and community maternal health programmes across Nigeria. A multistage sampling technique will be used to select states, local government areas, communities, healthcare facilities, and eligible mothers. Postpartum care cards will be assessed based on indicators such as provision of a standardized care card, clarity of appointment dates, documentation of maternal and newborn information, postpartum warning signs, medication and follow-up instructions, breastfeeding information, family planning information, referral information, and ease of use. Postpartum care attendance will be assessed using indicators such as attendance at scheduled postpartum visits, timeliness of attendance, completion of recommended postpartum visits, attendance for maternal and newborn assessments, compliance with follow-up appointments, and completion of referrals where applicable. Data will be collected using structured questionnaires, postpartum care cards, clinic attendance registers, maternal and newborn records, appointment records, and follow-up registers. Descriptive statistics will be used to summarize participants' characteristics, use of postpartum care cards, and attendance patterns. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of postpartum care cards on postpartum care attendance. Where a quasi-experimental design is adopted, postpartum attendance rates before and after introduction of the care cards may be compared to determine changes associated with the intervention. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that postpartum care cards have a significant positive effect on postpartum care attendance among mothers in Nigeria. Mothers who receive clear and user-friendly postpartum care cards are expected to demonstrate higher attendance at scheduled postpartum visits than mothers without such reminders and information. The cards may help mothers remember appointment dates, recognize postpartum warning signs, understand the importance of follow-up care, and retain important maternal and newborn health information. Providing clear information about available services may also encourage mothers to seek timely professional care when complications arise. However, transportation difficulties, financial constraints, maternal workload, cultural beliefs, limited family support, long distances to healthcare facilities, and inadequate availability of postpartum services may continue to affect attendance despite the provision of care cards. The study therefore expects simple, accessible, culturally appropriate, and well-designed postpartum care cards, when integrated with effective follow-up services, to contribute significantly to improved postpartum care attendance among mothers in Nigeria. The study is expected to contribute to the literature on postpartum care cards, postpartum care attendance, postnatal healthcare utilization, maternal health, newborn health, appointment reminders, postpartum follow-up, maternal health education, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, state ministries of health, hospitals, primary healthcare centres, maternity facilities, nurses, midwives, community health workers, maternal and child health organizations, development partners, and policymakers regarding strategies for improving postpartum follow-up. The study will also provide evidence-based recommendations for incorporating standardized postpartum care cards into maternity and postnatal services, improving appointment documentation, strengthening postpartum education, integrating reminder systems, improving referral and follow-up mechanisms, and reducing barriers to postpartum care attendance among mothers across Nigeria.

Keywords: Postpartum care cards, postpartum care attendance, postnatal care, postpartum mothers, maternal healthcare utilization, appointment reminders, maternal health, newborn health, postpartum follow-up, postnatal services, Nigeria, public health.