Examining barriers to providing good quality postnatal care:A mixed-methods study of global configurations of care and local clinical practice adaptations in Tanzania and Guinea.

Many women die during pregnancy and childbirth around the world
and this problem is most urgent in low-resource contexts such as
sub-Saharan Africa. Close monitoring of women and babies during
the first hours and days after childbirth (the postnatal period) can
save many lives. More than half of births in low-resource countries
now occur in health facilities, which should make it easier to provide
postnatal monitoring and treatment if necessary. However, many
women are not receiving even basic postnatal care, such as staying
long enough in the facility, or being checked before discharge. We do
not have a good understanding of why the basic protocols for
postnatal monitoring are not followed. In this project, I will review the
various configurations of postnatal care after a birth in health facilities
worldwide. Next, I will explore the barriers and enablers to providing
postnatal care monitoring to women before and after discharge from
health facilities in Tanzania (a large urban referral hospital) and
Guinea (small rural health centers). Quantitative data from patient
records and qualitative data from interviews with clinicians and
women will be used. I will summarise these findings to recommend
possible interventions to improve postnatal care in low-resource
settings. These results will better enable countries and health
facilities to implement new postnatal care recommendations
(expected in 2020) and thus make substantial advancements in
maternal survival and well-being.