Barriers to Utilization of Postnatal Care Services within the First 48 Hours of Birth in North West Syria: A Barrier Analysis Study

Abstract

Objectives: The objective of this study is to identify barriers to the utilization of postnatal care services among mothers and neonates in a conflict-affected area. Methods: This study involves a cross-sectional survey utilizing the Barrier Analysis (BA) approach, which is based on the Health Belief Model and the Theory of Reasoned Action. It explores up to 12 recognized determinants of behavior adoption. The survey was conducted in six communities located in Idlib and western rural Aleppo, representing both urban and rural areas for host and displaced populations in northwest Syria (Selwa, Abin Samaan, Sahara, Tal Elkaramej, Boz Ghaz, Koknaya). Data collection took place from 7th to 11th November 2021. Initially, screening questions were used to verify participants' eligibility for the survey. The interviewed mothers were then classified into two main groups: the first group consisted of mothers of newborns who attended postnatal care within the first 48 hours after birth (DOERS), while the second group comprised mothers of newborns who did not attend postnatal care within the first 48 hours after birth (NON-DOERS). From both groups, a random sample of 90 mothers of newborns aged 0-6 months was selected (45 DOERS and 45 NON-DOERS) out of a total of 418 respondents. Their answers were analyzed based on the 12 determinants included in the questionnaire. All collected data, including coded qualitative data and closed-ended questions, along with their frequencies, were entered into the Standard Barrier Analysis Tabulation Sheet Excel (SBATS). The odds ratio and P-value were calculated, considering results to be "significant" if the P-value was less than 0.05. Results: All demonstrated significant results are being compared between doers (mothers who attend postnatal care within the first 48 hours after birth) and non-doers (mothers who did not attend postnatal care within the first 48 hours after birth) according to the determinants and based on their recurrence, not their percentage. A total of 90 mothers with newborns aged 0-6 months (45 DOERS and 45 NON-DOERS) were interviewed, the findings revealed that 68% of the interviewed mothers had a normal delivery at health facilities, while 20% had a cesarean delivery, and 12% had a normal delivery at home. The barriers to PNC services included the long distance of the health facilities and the absence of transportation, social norms and traditions that prevent women from leaving home after childbirth, overcrowding at health facilities, fear of COVID-19 infection when visiting health facilities, absence of accompanying people, and the perception among mothers that they were unlikely to experience immediate post-birth problems. On the other hand, the enablers for accessing postnatal care services included community-based health support through community health workers, awareness of the available services, the mother's level of education, and a perceived understanding of the risks associated with medical complications that may arise after birth. Additionally, the availability of transportation and economic resources played a facilitating role in accessing postnatal care services. Conclusion: This study examines the low uptake of postnatal care (PNC) services for mothers and neonates in a conflict-affected area. Findings highlight barriers including limited maternal knowledge, inadequate health service coverage, transportation challenges, and social norms.