Community perceptions of barriers to postpartum care accessibility for women and families in rural Pakistan

Background: Despite the importance of the postpartum period, during which the majority of maternal and newborns deaths occur, many women in Pakistan do not meet the WHO's recommended Postpartum Care (PPC) standard - at least two PPC visits within six weeks of delivery - due to institutional and cultural barriers. Methods: In the rural District Mandi Bahauddin (Punjab, Pakistan), this study explored community perceptions of barriers to accessing PPC in facilities and at home. Eight focus group discussions and fifteen in-depth interviews were conducted involving ‘beneficiaries' - new mothers, fathers and mothers-in-law - and ‘healthcare providers'. After data collection, transcription, and translation, the team conducted a detailed content analysis, summarized results, and made recommendations. Results: Several barriers to accessing PPC were identified, including financial unaffordability and physical inaccessibility. In particular, respondents cited transportation costs as a major barrier, and, despite the free services, expressed dissatisfaction with the quality of services at Government hospitals, including lack of sufficient medicines and functioning equipment. Lack of awareness and cultural factors such as decision-making influence of family members, also act as barriers to accessing PPC services. However, respondents were appreciative of healthcare providers, including nurses, Lady Health Visitors and especially community health workers. Conclusion: Access to PPC can be significantly improved by providing affordable services, including transport, and improving quality of services at Government hospitals. Additionally, increased community awareness about the importance of PPC services and involvement of husbands and mothers-in-law are critical to improve access to and quality of PPC in Pakistan.