The MEASURE DHS project assists countries worldwide in the collection and use of data to monitor and 

evaluate population, health, nutrition, and HIV/AIDS programs. Funded by the United States Agency for 

International Development (USAID) under Contract No. GPO-C-00-03-00002-00, MEASURE DHS is 

implemented by Macro International Inc. in Calverton, Maryland. 

The main objectives of the MEASURE DHS project are: 

• To provide decisionmakers in survey countries with information useful for informed policy 

choices; 

• To expand the international population and health database; 

• To advance survey methodology; and 

• To develop in participating countries the skills and resources necessary to conduct high-quality 

demographic and health surveys. 

Additional information about the MEASURE DHS project is available on the Internet at 

http://www.measuredhs.com or by contacting Macro International Inc., MEASURE DHS, 11785 Beltsville 

Drive, Suite 300, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: 

reports@orcmacro.com. 
DHS Comparative Reports No. 15

Postpartum Care: Levels and Determinants 

in Developing Countries 

Alfredo L. Fort

Monica T. Kothari 

Noureddine Abderrahim 

Macro International Inc. 

Calverton, Maryland USA 

December 2006 

The authors’ views expressed in this publication do not necessarily reflect the views of the 

United states Agency for International Development or the United States Government.
This publication was made possible through support provided by the United States Agency for 

International Development under Contract No. GPO-C-00-03-00002-00. 

Recommended citation: 

Fort, Alfredo L., Monica T. Kothari, and Noureddine Abderrahim. 2006. Postpartum Care: Levels and 

Determinants in Developing Countries. Calverton, Maryland, USA: Macro International Inc. 
iii

Contents 

Tables and Figures ........................................................................................................................................v 

Preface.........................................................................................................................................................vii 

Acknowledgments........................................................................................................................................ix 

Executive Summary .....................................................................................................................................xi 

1 Background ......................................................................................................................................1 

2 Conceptual Framework and Study Design.......................................................................................4

3 Methods and Data Sources...............................................................................................................6 

 3.1 Postpartum Care ..................................................................................................................7 

 3.2 Correlates of Postpartum Care ............................................................................................8

 3.3 Statistical Methods ..............................................................................................................9 

4 Results ............................................................................................................................................10 

 4.1 Place of Delivery and Postpartum Care ............................................................................10 

 4.2 Timing of Postpartum Care (Noninstitutional Births).......................................................14 

 4.3 Place of Postpartum Care (All Births)...............................................................................18 

 4.4 Provider of Postpartum Care (Noninstitutional Births).....................................................20 

5 Differentials in Postpartum Care....................................................................................................22 

 5.1 Postpartum Care and Age at Time of Birth.......................................................................22 

 5.2 Postpartum Care and Birth Order......................................................................................22 

 5.3 Postpartum Care and Urban-rural Residence ....................................................................25 

 5.4 Postpartum Care and Level of Education..........................................................................26 

 5.5 Postpartum Care and Household Wealth Status................................................................27 

 5.6 Postpartum Care and Antenatal Care ................................................................................29 

 5.7 Postpartum Care and Media Exposure ..............................................................................31 

 5.8 Postpartum Care and Women’s Status ..............................................................................32 

6 Multivariate Analysis .....................................................................................................................34 

 6.1 Country Selection..............................................................................................................34 

 6.2 Variables for the Multivariate Model................................................................................34 

 6.3 Results of Multivariate Analysis .......................................................................................35 

7 Summary and Discussion ...............................................................................................................41 

 7.1 Extent and Timing of Postpartum Care.............................................................................41 

 7.2 Place and Providers of Postpartum Care for Noninstitutional Births................................41 

 7.3 Characteristics Associated with Receiving Postpartum Care............................................41 

 7.4 Limitations of Study..........................................................................................................42 

 7.5 Conclusions.......................................................................................................................43 

References ...................................................................................................................................................45 

Appendix A .................................................................................................................................................47

v

Tables and Figures 

Table 2.1 Key elements of postpartum care for the infant and mother, by length of time 

 following birth.............................................................................................................4 

Table 3.1 Characteristics of the DHS surveys included in this report.........................................6 

Table 4.1 Percent distribution of women whose most recent live birth occurred 

 in the five years preceding the survey by place where birth occurred 

 (institutional or noninstitutional) and, for noninstitutional births, receipt 

 of postpartum care and person who provided care....................................................11 

Table 4.2 Percent distribution of women whose most recent live noninstitutional birth 

 was in the five years preceding the survey, by timing of first postpartum 

 checkup......................................................................................................................13 

Table 4.3 Mean and median timing of postpartum care (in days) for noninstitutional 

 births in the five years preceding the survey and mean timing of postpartum 

 care for all births........................................................................................................16 

Table 4.4 Percent distribution of women who received postpartum care for the most 

 recent live birth in the five years preceding the survey, by place of first 

 postpartum checkup...................................................................................................19 

Table 4.5 Percent distribution of women who received postpartum care for the most 

 recent live noninstitutional birth in the five years preceding the survey, 

 by provider of postpartum care..................................................................................20 

Table 5.1 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by age at birth...............................23 

Table 5.2 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by birth order................................24 

Table 5.3 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by residence..................................25 

Table 5.4 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by education .................................27 

Table 5.5 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by household wealth status...........28 

Table 5.6 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by whether they received 

 antenatal care and by the number of antenatal care visits .........................................30 

Table 5.7 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by media exposure........................32 
vi

Table 5.8 Proportion of women who received postpartum care for the most recent 

 live birth in the five years preceding the survey, by sex of head of household, 

 employment status, and participation in health care decisionmaking....................... 33 

Table 6.1 Independent variables included in the multivariate analysis model.......................... 35 

Table 6.2 Effects (RRRs) of women’s background characteristics on postpartum care: 

 multinomial logistic regression for nine developing countries, noninstitutional 

 births (NIB) and institutional births .......................................................................... 36 

Table A.1 Proportion of women who received postpartum care for their most recent 

 noninstitutional birth (in the five years preceding the survey) by provider of 

 postpartum care and birth order ................................................................................ 47 

Table A.2 Proportion of women who received postpartum care for their most recent 

 noninstitutional birth (in the five years preceding the survey), by provider of 

 postpartum care and residence .................................................................................. 50 

Table A.3 Proportion of women who received postpartum care for their most recent 

 noninstitutional birth (in the five years preceding the survey), by provider 

 of postpartum care and women's educational status ................................................. 53 

Table A.4 Proportion of women who received postpartum care for their most recent 

 noninstitutional birth (in the five years preceding the survey), by provider of 

 postpartum care and wealth index quintile................................................................ 56 

Table A.5 Proportion of women who received postpartum care for their most recent 

 noninstitutional birth (in the five years preceding the survey), by provider of 

 postpartum care and antenatal care ........................................................................... 59 

Figure 1.1 Coverage of Maternal Health Services ....................................................................... 3 

Figure 2.1 Conceptual Framework for the Study on Determinants of Postpartum 

 Care (PPC) .................................................................................................................. 5 

Figure 4.1 Postpartum Care for Institutional Births and Noninstitutional 

 Births (NIB) .............................................................................................................. 13 

Figure 4.2 Correlation between Noninstitutional Births and Postpartum Care (Linear 

 Regression) ............................................................................................................... 14 

Figure 4.3 Mean and Median Timing of Postpartum Care (No. Days Following Birth 

 that PPC Occurred), Noninstitutional Births and All Births ..................................... 17 
vii

Preface 

One of the most significant contributions of the MEASURE DHS program is the creation of an 

internationally comparable body of data on the demographic and health characteristics of populations in 

developing countries. The DHS Comparative Reports series examines these data across countries in a 

comparative framework. The DHS Analytical Studies series focuses on specific topics. The principal objectives of both series are to provide information for policy formulation at the international level and to 

examine individual country results in an international context. Whereas Comparative Reports are 

primarily descriptive, Analytical Studies have a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending on the availability of data sets. Where possible, data from previous DHS surveys are used to evaluate trends over 

time. Each report provides detailed tables and graphs organized by region. Survey-related issues such as 

questionnaire comparability, survey procedures, data quality, and methodological approaches are addressed as needed. 

The topics covered in Comparative Reports are selected by MEASURE DHS staff in conjunction with the U.S. Agency for International Development. Some reports are updates of previously 

published reports. 

It is anticipated that the availability of comparable information for a large number of developing 

countries will enhance the understanding of important issues in the fields of international population and 

health by analysts and policymakers. 

Martin Vaessen 

Project Director 

ix

Acknowledgments 

The authors expanded and adapted a few tables (timing, place, and provider of postpartum care) 

and Figure 4.1 from an early work by Florence Nyangara and Beverly Johnston. The authors 

acknowledge the valuable comments received from Vinod Mishra, Deborah Armbruster, Vivien Tsu, 

Mary Ellen Stanton, Lily Kak, and Katherine Krasovec. 

xi

Executive Summary 

Maternal mortality continues to be high in many countries of the developing world. Focused 

antenatal care (ANC) and childbirth with a skilled attendant have been highlighted as effective 

interventions to reduce this burden. However, better understanding of conditions such as postpartum 

hemorrhage—the largest killer—and its occurrence in the early postpartum period have shown the 

importance of early and universal postpartum care (PPC). This study was undertaken to analyze the 

variables (occurrence, timing, and background characteristics) associated with receipt of postpartum 

care in 30 developing countries representing the major regions of the world. Data from Demographic 

and Health Surveys carried out between 1999 and 2004 were used in the study. Results show that about 

half of all births in these countries continue to occur outside health institutions, and in seven out of ten 

births mothers do not receive any postpartum care. Of the noninstitutional births for which mothers 

receive postpartum care, the average timing of the first postpartum checkup is three days after birth. If 

all births are counted—assuming institutional births receive postpartum care 12 hours after delivery—

the average timing of postpartum care is two days following delivery. The characteristics of women 

most often associated with receiving postpartum care are belonging to a household with higher wealth 

status and having received antenatal care. Education beyond the primary level, urban residence, and 

media exposure are strongly correlated with receiving postpartum care. However, some relationships are 

less clear, or are reversed, for postpartum care performed by traditional birth attendants or other 

nonskilled attendants. This paper highlights specific countries where, despite low numbers of 

institutional births, many women do receive postpartum care. It is suggested that countries should invest 

in ensuring that all births—whether at a health institution or at home—are attended by a skilled provider 

at the time of delivery or within a few hours, to help reduce maternal morbidity and mortality. 

1

1 Background 

Maternal mortality continues to be high in many parts of the world. Best estimates from the 

World Health Organization (WHO et al., 2004) put the figure at just over 500,000 maternal deaths every 

year; 99 percent of these deaths occur in the developing world. Recent research has identified the factors 

associated with maternal mortality, and narrowed down the main causes and the most critical period. For 

example, despite the fact that a higher percentage of women in high-risk pregnancy categories will have 

complications necessitating obstetric assistance during delivery, the large majority of life-threatening 

complications that occur during delivery are associated with women with normal pregnancies (PATH et 

al., 1998a; Rhode, 1995; Yuster, 1995). Although antenatal care (ANC) is important for pregnant women, 

it cannot predict whether an individual woman will have a critical complication at delivery (McCormick 

et al., 2002; Rhode, 1995). 

There is new information about the causes of maternal deaths and their timing. The most 

important causes of maternal deaths—accounting for 73 percent of cases—are hemorrhage (25 percent), 

postpartum sepsis (15 percent), unsafe abortion (13 percent), pregnancy-induced hypertension or 

eclampsia (12 percent), and obstructed labor (8 percent) (PATH et al., 1998b). A recent review of causes 

of maternal deaths by region shows differential rates, with hemorrhage (both pre- and postpartum) being 

the leading cause of death in Africa and Asia (more than 30 percent of all maternal deaths). In contrast, in 

Latin America and the Caribbean, hypertensive disorders in pregnancy were the leading cause of maternal 

death (26 percent). Abortion as a cause of death was highest in Latin America/Caribbean and lowest in 

Africa (Khan et al., 2006). This report focuses on the period around delivery, leaving out abortion and 

predelivery conditions. 

Twenty-five percent of maternal deaths and half of neonatal deaths occur during labor, delivery, 

and within the first 24 hours postpartum, increasing to 60 percent and two-thirds, respectively, by the end 

of the first week postpartum (Li et al., 1996; Lawn et al., 2001; Yinger and Ransom, 2003). The majority 

of deaths from postpartum hemorrhage, the number one killer, occur in the first four hours postpartum 

(Kwast, 1991; Kane et al., 1992). 

Evidence from historical epidemiology from the developed world has shown the importance of 

skilled attendants at delivery and the availability of emergency obstetric care in reducing maternal 

mortality. Toward the end of the nineteenth century, levels of maternal mortality were around 600 per 

100,000 live births in the industrialized world. Through training and wide deployment of midwifery 

personnel, these countries were able to reduce the level of mortality by one-fourth to one-half in a period 

of 30 years (Loudon, 2000; De Brouwere and Lerberght, 2001). This reduction was accomplished before 

the introduction of modern technology and improved obstetric technology and practices such as the use of 

antibiotics, blood transfusion, and caesarean section. This historical evidence highlights the importance of 

ensuring that every delivery is attended by a skilled attendant. A skilled attendant is defined here as a 

person with midwifery skills (i.e., a doctor, midwife, or nurse) who has been trained to proficiency in the 

skills necessary to provide competent care during pregnancy and childbirth. Skilled attendants must be 

able to manage normal labor and delivery, recognize the onset of complications, perform essential 

interventions, start treatment, and supervise the referral of mother and infant for interventions that are 

beyond their competence or cannot be implemented in the particular setting (McCormick et al., 2002; 

MacDonald and Starrs, 2002; WHO et al., 2004b). 

Although necessary, the presence of a skilled attendant at delivery is not sufficient to ensure safe 

delivery, and has been shown to have limitations in the effort to reduce maternal deaths below certain 

levels. To further reduce maternal mortality, it is necessary to add accessible obstetric technology and 

services (Maine and Rosenfield, 1999). Even if appropriate referrals are made, women in danger of dying 

from hemorrhage, sepsis, eclampsia, or obstructed labor should have access to life-saving procedures that
2

are usually only carried out at the hospital level and require a combination of specialized skills (e.g., for 

surgery) and appropriate technology (e.g., sterilized equipment, intravenous antibiotics). This growing 

realization of the need for skilled providers and an enabling environment is driving initiatives such as 

Safe Motherhood; MotherCare; the Maternal and Neonatal Health Program; Prevention of Postpartum 

Hemorrhage Initiative; Access to Clinical and Community Maternal, Neonatal, and Women’s Health 

Services (ACCESS) Program; and the Global Action for Skilled Attendants for Pregnant Women. These 

initiatives are aimed at: 

• Increasing the number of skilled birth attendants available in remote areas; 

• Upgrading the capacity of health facilities (through equipping and training) to provide 

different levels of emergency obstetric care; 

• Involving the community in assisting pregnant women with birth preparedness and early 

recognition of alarm signs, and prompt referral of complications around the time of delivery; 

and 

• Measuring the phenomenon with increased accuracy and better evaluating the results of 

interventions. 

The Demographic and Health Surveys (DHS) program has been measuring several components of 

maternal health in developing countries for more than 20 years. The DHS reports present information on 

the magnitude of maternal mortality and the occurrence, frequency of, and attendance at antenatal and 

delivery care for a number of characteristics of women of reproductive age (15-49 years). Data are 

gathered on several programmatic interventions during the antenatal visits, such as the measurement of 

height and weight, the collection of urine and blood samples, provision of iron/folate tablets, tetanus 

toxoid vaccination, malaria prophylaxis, and antiparasite medication. Data on childbirth include the 

person who assisted during delivery, the location of delivery, and (if applicable) the reason for not 

delivering in a health facility, and whether the woman delivered by caesarean section. Information is also 

collected on the occurrence of postpartum care (PPC) and the person who provides the care, as well as the 

place where the postpartum care was provided and whether vitamin A was given at that time. 

Previous research based on DHS surveys has shown a substantial increase worldwide in the use 

of antenatal care services. A recent review of data from 49 countries with two or more household surveys 

found an 11-point increase in use of antenatal care between 1990 and 2000, from an average of 53 to 64 

percent (WHO and UNICEF, 2003). However, the other components of maternal care have not followed 

such a promising path. There are wide gaps between antenatal and delivery care, and an even wider gap 

between delivery care and postpartum care. A 1997 review showed an important disparity between the 

proportion of women in the developing world receiving antenatal care (65 percent) and those whose last 

birth was attended by skilled personnel (53 percent). However, the gap between these two services and 

postpartum care was substantial, with postpartum care reaching only 30 percent. These figures are in 

contrast to the high and fairly consistent availability of services in developed countries and illustrate the 

challenge ahead for the reduction of maternal deaths in the developing world (see Figure 1.1) 

(WHO, 1997). 
3

Figure 1.1 Coverage of Maternal Health Services

A recent DHS report on trends in delivery care in six countries from 1988 to 2000 noted mixed 

gains (Bell et al., 2003). Increases in attendance at delivery by health professionals1

 ranged from zero (no 

gain) for Malawi in eight years (around 53 percent in both 1992 and 2000) to an increase of 39 percent for 

Bolivia in a similar period (58 percent in 1998). A multivariate analysis found important and separate 

influences of a health professional at a previous delivery, urban residence, and secondary education on the 

likelihood of the last delivery being attended by a health professional (Bell et al., 2003). The report also 

identified countries where attendance of a health professional at delivery was strongly correlated with 

institutional delivery (Bolivia, Ghana, and Malawi); other countries use a community approach to 

professional delivery (Indonesia); and some countries are in a transitional phase (Bangladesh and the 

Philippines). 

In contrast to antenatal and delivery care, less information is available on postpartum care in the 

developing world. It is important to examine the data on levels of postpartum care (both in an institution 

and at home) in different regions of the world. Additionally, it is crucial to examine the relationship 

between postpartum care and women’s background characteristics and other aspects of maternal health. 

This study attempts to fill this gap. 

 

1

 Health professionals were defined as doctors, nurses, or midwives, based on identification by the mothers interviewed. 

Source: WHO (1997)

97 99

90

65

53

30

Antenatal care Skilled attendance

at delivery

Postpartum care

0

20

40

60

80

100

Developed countries Developing countries
4

2 Conceptual Framework and Study Design 

As defined by the World Health Organization (1998), the postpartum period or puerperium is the 

period that begins immediately after delivery of the placenta and lasts up to 42 days (or six weeks). 

Postpartum care is provided for both mother and child, its main elements varying according to the time 

during the postpartum period when it is given (see Table 2.1). The terms “postpartum care” and “postnatal 

care” are sometimes used interchangeably; however, postnatal is more often used to refer to the care of 

the newborn. In this study, we use postpartum care throughout, referring primarily to care provided to the 

mother.

Table 2.1 Key elements of postpartum care for the infant and mother, by length of time following birth

6-12 hours 3-6 days 6 weeks 6 months

Infant breathing 

warmth 

feeding 

cord care 

immunization 

feeding 

routine tests 

weight/feeding

immunization 

development 

weaning 

Mother blood loss 

pain 

blood pressure 

advice/warning signs

breast care 

temperature/

infection 

lochia 

mood 

recovery 

anemia 

contraception 

general health 

contraception 

continuing morbidity 

Source: WHO, 1998 

The focus of the study, the main dependent variable, is whether or not women received 

postpartum care. However, other related dependent variables are explored: when care occurred (0-1 day, 

1-2 days, 3-4 days, etc.), whether postpartum care was provided in an institution or at the community 

level, and whether postpartum care was provided by a professional or nonprofessional attendant. 

Independent variables are selected characteristics of women and their households (e.g., age, 

parity, level of education, wealth index, urban-rural residence, employment status). Other correlates of 

women’s status tested are whether the woman is head of household, whether she makes decisions about 

her own health care, and whether she is exposed to media. A health care covariate—whether the woman 

had any antenatal care during pregnancy—is also included. 

Bivariate analyses provide a first description of frequencies and relationships. This is followed by 

the application of multivariate analysis (multinomial logistic regression) to identify the characteristics 

strongly and independently associated with postpartum care (see framework in Figure 2.1). This further 

analysis is done using selected countries from all the regions. 
5

Figure 2.1 Conceptual Framework for the Study on Determinants 

of Postpartum Care (PPC) 

Place of care 

Provider of 

care 

Occurrence 

First ANC visit 

No. of ANC visits 

Provider of care 

ANC Delivery PPC 

MATERNAL 

MORTALITY 

Place of care 

Provider of care 

Timing of care 

Correlates 

Age, education, urban-rural residence, 

wealth, parity, sex of head of household, 

employment status, media exposure, 

health care decisionmaking 

INDEPENDENT VARIABLES 

DEPENDENT 

VARIABLES 
6

3 Methods and Data Sources 

The study uses data from 30 surveys conducted between 1999 and 2004 under the DHS program. 

All the surveys include women age 15-49, and the samples are nationally representative. Table 3.1 shows 

the number of women who were interviewed in each survey and the number whose most recent live birth 

was in the five years preceding the survey. These women constitute the base population of this 

comparative study. Countries are divided into five regions: 

• Sub-Saharan Africa, 

• North Africa/West Asia/Europe, 

• Central Asia, 

• South/Southeast Asia, and 

• Latin America/Caribbean. 

Table 3.1 Characteristics of the DHS surveys included in this report 

Region and country 

Survey 

date 

Number of 

respondents 

Number of 

women whose 

most recent live 

birth was in the five 

years preceding 

the survey 

Sub-Saharan Africa 

Benin 2001 6,219 3,514 

Burkina Faso 2003 12,477 7,427 

Cameroon 2004 15,241 5,289 

Eritrea 2002 8,754 4,152 

Ethiopia 2000 15,367 7,974 

Ghana 2003 5,691 2,630 

Kenya 2003 8,195 4,028 

Madagascar 2003 7,949 4,142 

Malawi 2000 13,220 8,028 

Mali 2001 12,849 8,231 

Mozambique 2003 23,870 7,138 

Namibia 2000 6,755 2,991 

Nigeria 2003 7,620 3,894 

Rwanda 2000 10,421 5,130 

Uganda 2000 7,246 4,452 

Zambia 2001 7,658 4,396 

Zimbabwe 1999 5,907 2,767 

North Africa/West Asia/Europe 

Armenia 2000 6,430 1,248 

Egypt 2000 15,573 7,931 

Jordan 2002 6,006 3,743 

Central Asia 

Turkmenistan 2000 7,919 2,460 

South/Southeast Asia 

Bangladesh 2004 11,440 5,387 

Cambodia 2000 15,351 5,678 

Indonesia 2002-2003 29,483 12,729 

Nepal 2001 8,726 4,739 

Latin America/Caribbean 

Colombia 2000 11,585 3,545 

Dominican Republic 2002 23,384 7,858 

Haiti 2000 10,159 4,237 

Nicaragua 2001 13,060 4,835 

Peru 2000 27,843 9,530 
7

The current study uses a woman-based analysis approach.2

 For all the postpartum care indicators 

used, the information is collected on the most recent live birth in the five years preceding the survey. For 

consistency purposes, countries with data only for three years preceding the survey were not included in 

the study. In the case of multiple births, the birth coded by the interviewer as the most recent one was 

used for collecting information on various postpartum care indicators. Although this approach seems to 

lead to some biased results compared with the birth-based approach, the bias is small for pregnancy and 

delivery-related indicators, as is our case (Grummer-Strawn and Stupp, 1996). 

In DHS surveys, information on the provider, timing, and location of postpartum care was 

collected only for noninstitutional births.3

 For this study, we assumed that all women with institutional 

births received postpartum care. Following this assumption in Table 4.2 and onwards, we consider 

women as having received postpartum care if they delivered in an institution or delivered outside an 

institution but reported receiving postpartum care. 

An obvious limitation of this assumption is the certainty that all institutional births did receive 

postpartum care and that the quality of this service was adequate. However, this latter limitation is 

common throughout all analyses, as quality of care is not covered with the postpartum care questions for 

noninstitutional births. In any case, it is reasonable to assume that most women who deliver in an 

institution will have had some type of postpartum checkup (measurement of temperature or blood 

pressure, or assessment of any evident hemorrhage) before discharge from the facility. 

The World Health Organization recommends that the first postpartum checkup should take place 

within six hours after delivery (WHO, 1998). However, as noted earlier, DHS surveys did not collect data 

specifically on the hours after birth that this service was provided;4

 thus, the minimum time that could be 

extracted was within the first 24 hours after delivery. Also, given that most DHS tables on the timing of 

postpartum care report the first category as within the first two days, both types of information are 

included in Table 4.2. Additionally, there were a few cases of postpartum care past the official period of 

six weeks, and these were also presented in the table. Therefore, the following breakdown was used in 

Table 4.2 for the timing of postpartum care: within 24 hours, within 2 days (which includes within 24 

hours), 3-6 days, 7-41 days, and 42 days or more. Because a few women in each survey had postpartum 

care but could not remember or did not know (DK) the time of first care, a Missing/DK column is 

included in the tables and subsequent analyses. 

3.1 Postpartum Care 

Information for this study comes from the Household Questionnaire and the pregnancy, postnatal5

care, and breastfeeding sections of the Women’s Questionnaire. For noninstitutional births, the 

postpartum care variables are derived from the following questions: 

Question: After (NAME) was born, did a health professional or a traditional birth attendant (TBA) 

check on your health? 

 

2

 Woman-based analysis—as opposed to birth-based analysis—uses one delivery per woman, i.e., the most recent 

birth in the past five years. The woman-based approach represents pregnancy and delivery indicators, whereas the 

birth-based approach represents mostly neonatal indicators. 

3

 Noninstitutional births are births that did not occur in a health facility. These include all home deliveries, plus other 

places, such as the home of a traditional birth attendant. 

4

 The DHS questionnaire only had a two-digit box for days after delivery when postpartum care was received. 

Interviewers were instructed to put zeros in these boxes if the first postpartum checkup was received within the 24 

hours after delivery. In the newly revised DHS questionnaire, a new two-digit box has been included for hours after 

delivery. 

5

 In DHS reports, this section is referred to as “postnatal”; in this study, the term “postpartum” is used instead. 
8

Question: How many days or weeks after the delivery did the first checkup take place? 

Question: Who checked on your health at that time? 

Question: Where did the first check take place? 

3.2 Correlates of Postpartum Care 

3.2.1 Household Characteristics 

Information on place of residence, sex of head of household, and socioeconomic status comes 

from the Household Questionnaire. 

Residence: This is the de facto6 place of residence (urban-rural), the place in the cluster or 

sample point where the respondent was interviewed. Urban areas are classified as large cities (capital 

cities and cities with over 1 million population), small cities (population 50,000-999,999), and towns 

(other urban areas). Rural areas are usually less than 2,000 inhabitants and are assumed to be in the 

countryside. 

Sex of head of household: This variable is classified as male or female. 

Wealth index: The DHS wealth index is a standardized composite variable made up of quintiles, 

determined through Principal Component Analysis (from Factor Analysis) and based on approximately a 

dozen assets and services present in a household (e.g., type of flooring, water supply, electricity, radio, 

television, refrigerator, type of vehicle). It was developed by Macro staff in collaboration with The World

Bank. Each quintile represents a relative measure of a household’s socioeconomic status (Rutstein and 

Johnson, 2004). 

3.2.2 Women’s Characteristics 

The information on women’s characteristics, such as age, education, employment status, media 

exposure, and participation in health care decisionmaking, comes from the Women’s Questionnaire. 

Age: This is the age of the woman at the birth of the last child under five, and is calculated by 

subtracting the century month code of the date of birth of the child from the century month code of the 

date of birth reported by the respondent.7

 This age is further classified into five-year age groups: less than 

20, 20-24, 25-29, 30-34, and 35-49 years. 

Education: This variable is reported as the highest level of education attended by the respondent 

and has the following categories: no education, primary, and secondary or higher. 

Employment: Employment status is derived from the information collected on whether the 

respondent is currently working, and does not identify the type of employment, whether self-employed or 

working in the agricultural or nonagricultural sector. 

Media exposure: This correlate covers information on whether the respondent has had any 

exposure to media sources like newspaper, radio, or television. Respondents who read the newspaper, 

listened to radio, or watched television—even if less than once a week—were categorized as having 

exposure to these media sources.8

 

 

6

 This was the place where the woman was interviewed, which might not be the woman’s usual place of residence. 7

 If a woman did not know her date of birth, the interviewer used her reported age in completed years. 

8

 Except in the case of Eritrea, where the “no” code included media seen/read/listened to less than once a week. 
9

3.2.3 Other Characteristics 

Antenatal care: Respondents were asked if they received antenatal care during the pregnancy for 

the last live birth in the five years preceding the survey. If antenatal care was received, a second question 

inquired about the number of antenatal care visits, categorized as none, 1-3, or 4 or more. 

Birth order of child: This variable looks at the birth order of the last live birth in the five years 

preceding the survey, categorized as 1, 2-4, or 5 or more. 

3.3 Statistical Methods 

The association between hypothesized determinants and postpartum care was examined using 

bivariate and multivariate analyses. A first series of tabulations explores the availability and 

characteristics of postpartum care, such as its occurrence with noninstitutional births, its timing, and place 

and provider of care. Next, cross-tabulations were produced for several characteristics of women. For 

total postpartum care, the fraction of institutional births was added to the fraction of noninstitutional 

births that received postpartum care. Characteristics highly associated with postpartum care were selected 

for multivariate analysis. 

The dependent variable is broken down into four categories: 

• Postpartum care through institutional births (postpartum care Prof-IB), 

• Postpartum care by professional attendants at noninstitutional births (postpartum care 

Prof-NIB), 

• Postpartum care by TBAs and other nonskilled attendants (e.g., relatives) at 

noninstitutional births (postpartum care Non-Prof-NIB), and 

• No postpartum care (no PPC). 

Multinomial logistic regression is used for multivariate analysis with a main-effects approach. 

Relative risk ratios (RRR) are used as measures of the likelihood of each type of postpartum care 

occurring (compared with no postpartum care), according to each category of selected variables. More 

information can be found in the appropriate section. 
10

4 Results 

4.1 Place of Delivery and Postpartum Care 

Table 4.1 shows the distribution of women by whether their most recent birth in the five years 

preceding the survey was delivered in an institutional or noninstitutional setting, and whether they 

received postpartum care. 

Countries in North Africa/West Asia/Europe and Central Asia generally have high levels of 

institutional births (over 90 percent), except in Egypt, where the level of institutional births is just over 50 

percent. This is followed by the Latin America/Caribbean region, which shows rates in excess of 70 

percent, except for Haiti (26 percent) and Peru (58 percent). 

Sub-Saharan Africa has intermediate and mixed levels of institutional births, starting with 

Ethiopia, where only 5 percent of births take place in a health institution. Countries with moderate levels 

include Cameroon (62 percent), Eritrea (29 percent), Madagascar (33 percent), Mozambique (50 percent), 

Nigeria (35 percent), Rwanda (26 percent), and Uganda (39 percent). Countries with substantially higher 

levels include Benin (78 percent), Namibia (77 percent), and Zimbabwe (74 percent). The four countries 

in South/Southeast Asia show low to moderate levels, between 10 and 11 percent for Bangladesh, 

Cambodia, and Nepal, and 41 percent for Indonesia. 

Table 4.1 shows the proportion of noninstitutional births for which women received postpartum 

care in the 42 days after the birth, and who provided the care. Again, there are wide differentials. The 

highest levels of postpartum care for noninstitutional births are in South/Southeast Asia: Cambodia (44 

percent) and Indonesia (49 percent). These are followed by a few countries with rates between 16 and 30 

percent: Bangladesh (17 percent), Ghana (25 percent), Haiti (19 percent), Madagascar (29 percent), 

Mozambique (21 percent), Nepal (19 percent), and Nigeria (19 percent). A third group of countries have 

rates between 10 and 15 percent: Burkina Faso (15 percent), Cameroon (13 percent), Kenya (11 percent), 

Mali (12 percent), Peru (14 percent), Zambia (13 percent), and Zimbabwe (12 percent). A last group of 

countries have rates under 10 percent, although for some countries in Latin America (Dominican 

Republic), Central Asia (Turkmenistan), North Africa/West Asia/Europe (Jordan), and even Sub-Saharan 

Africa (Benin and Namibia), these low rates are in the context of a high proportion of institutional births. 

The most critical information, however, is the percentage of women who did not receive any 

postpartum care.9

 The list is topped by Ethiopia, with 90 percent, followed by Bangladesh (73 percent), 

Nepal (72 percent), and Rwanda (71 percent). Other countries have substantial proportions of women who 

did not receive any postpartum care, including Burkina Faso (44 percent), Cambodia (46 percent), Eritrea 

(64 percent), Haiti (55 percent), Kenya (46 percent), Malawi (41 percent), Mali (49 percent), Nigeria (46 

percent), Uganda (57 percent), and Zambia (41 percent). On average, in the 30 countries examined, nearly 

40 percent of women with a live birth in the five years preceding the survey did not receive a postpartum 

care checkup. Figure 4.1 summarizes the information on postpartum care for institutional and 

noninstitutional births. 

 

9

 This figure is the complement to the percentage of women assumed to have received postpartum care for the most 

recent birth. Women receiving postpartum care is estimated as the sum of all institutional births (assumed to have 

received some type of postpartum care) plus the fraction of women with noninstitutional births who received 

postpartum care. 
11

Table 4.1 Percent distribution of women whose most recent live birth occurred in the five years preceding the survey by place 

where birth occurred (institutional or noninstitutional) and, for noninstitutional births, receipt of postpartum care and person who 

provided care, DHS surveys 1999-2004

 Noninstitutional births All births 

Received postpartum care Women 

Region and country 

Institutional 

births 

(1) 

From health 

professional

(2) 

From TBA/

other 

(3) 

Total 

(2+3) 

(4) 

Did not 

receive 

PPC 

(5) 

Received 

PPC 

(1 + 4)1

(6) 

Total 

(1+4+5) 

(7) 

Number 

(8) 

Sub-Saharan Africa 

Benin 2001 78.2 5.5 0.9 6.4 15.4 84.6 100.0 3,514 

Burkina Faso 2003 40.5 9.7 5.7 15.4 44.1 55.9 100.0 7,427 

Cameroon 2004 62.0 6.3 7.1 13.4 24.6 75.4 100.0 5,289 

Eritrea 2002 28.7 6.6 0.6 7.2 64.1 35.9 100.0 4,152 

Ethiopia 2000 5.4 3.5 1.6 5.1 89.5 10.5 100.0 7,974 

Ghana 2003 48.0 8.2 16.9 25.1 27.0 73.1 100.0 2,630 

Kenya 2003 43.2 6.3 5.0 11.3 45.5 54.6 100.0 4,028 

Madagascar 2003 32.9 11.3 18.0 29.3 37.7 62.3 100.0 4,142 

Malawi 2000 56.2 1.7 1.5 3.2 40.6 59.4 100.0 8,028 

Mali 2001 39.6 3.0 8.8 11.8 48.6 51.4 100.0 8,231 

Mozambique 2003 50.4 20.0 0.5 20.5 29.0 71.0 100.0 7,138 

Namibia 2000 77.2 6.7 1.1 7.8 15.0 85.0 100.0 2,991 

Nigeria 2003 34.5 7.9 11.2 19.1 46.3 53.6 100.0 3,894 

Rwanda 2000 25.7 0.8 2.4 3.2 71.1 28.9 100.0 5,130 

Uganda 2000 38.5 2.6 2.2 4.8 56.7 43.3 100.0 4,452 

Zambia 2001 46.2 6.9 5.6 12.5 41.3 58.7 100.0 4,396 

Zimbabwe 1999 74.2 11.0 0.5 11.5 14.3 85.7 100.0 2,767 

North Africa/West Asia/Europe 

Armenia 2000 92.5 4.9 0.2 5.1 2.4 97.6 100.0 1,248 

Egypt 2000 50.8 4.1 0.5 4.6 44.6 55.4 100.0 7,931 

Jordan 2002 97.3 0.9 0.0 0.9 1.8 98.2 100.0 3,743 

Central Asia 

Turkmenistan 2000 95.7 3.4 0.1 3.5 0.8 99.2 100.0 2,460 

South/Southeast Asia 

Bangladesh 2004 10.2 8.0 8.9 16.9 72.9 27.1 100.0 5,387 

Cambodia 2000 10.8 13.4 30.2 43.6 45.5 54.4 100.0 5,678 

Indonesia 2002-2003 41.0 29.6 19.7 49.3 9.7 90.3 100.0 12,729 

Nepal 2001 9.6 5.3 13.5 18.8 71.6 28.4 100.0 4,739 

Latin America/Caribbean 

Colombia 2000 87.6 2.1 0.0 2.1 10.3 89.7 100.0 3,545 

Dominican Republic 2002 98.5 0.8 0.1 0.9 0.6 99.4 100.0 7,858 

Haiti 2000 26.0 7.0 12.1 19.1 54.9 45.1 100.0 4,237 

Nicaragua 2001 71.2 8.7 0.0 8.7 20.1 79.9 100.0 4,835 

Peru 2000 58.0 13.5 0.4 13.9 28.1 71.9 100.0 9,530 

 

Total2

 48.7 ————— 12.4 ————— 38.9 61.1 

Note: Missing values for a few countries range from 0 to 1.3 (average 0.3) percent and have been excluded in this and 

subsequent tables. 

1

 Assumes all institutional births received postpartum care. 

2

 Weighted averages 
12

Figure 4.1 Postpartum Care for Institutional Births (IB) and Noninstitutional 

Births (NIB) 

Another way of presenting these data is to look at the percentage of women receiving postpartum 

care only among women with noninstitutional births (see “Any checkup” column in Table 4.2). The 

countries can be grouped into three categories. The first category is those with very low levels of 

postpartum care (0 to 10 percent). These are Egypt (9 percent), Eritrea (10 percent), Ethiopia (5 percent), 

Malawi (7 percent), Rwanda (4 percent), and Uganda (8 percent). A second category is countries with 

postpartum care between 11 and 40 percent; there are 15 countries in this category ranging from 

Colombia (17 percent) to Cameroon (35 percent). The third category is countries with postpartum care 

above 40 percent. These include Armenia (68 percent), Cambodia (49 percent), Dominican Republic (59 

percent), Ghana (48 percent), Indonesia (84 percent), Madagascar (44 percent), Mozambique (41 

percent), Turkmenistan (81 percent), and Zimbabwe (45 percent). This last group of countries 

demonstrates the importance of outreach programs and increased access to health professionals for 

women who do not deliver at facilities. Indonesia is a leader in community outreach efforts for women 

during the perinatal period, despite having a large rural population and one that is dispersed on the many 

islands that make up the country. On average, in the 30 countries reviewed, only 28 percent of women 

with noninstitutional births receive postpartum care. 

Ethiopia 2000

Bangladesh 2004

Nepal 2001

Rwanda 2001

Eritrea 2002

Uganda 2000

Haiti 2000

Mali 2001

Nigeria 2003

Kenya 2003

Cambodia 2000

Egypt 2000

Burkina Faso 2003

Zambia 2001

Malawi 2000

Madagascar 2003

Mozambique 2003

Peru 2000

Ghana 2003

Cameroon 2004

Nicaragua 2001

Benin 2001

Namibia 2000

Zimbabwe 1999

Colombia 2000

Indonesia 2002-2003

Armenia 2000

Jordan 2002

Turkmenistan 2000

Dominican Rep 2002

0%

20%

40%

60%

80%

100%

Percent

Institutional Births NIB with PPC NIB without PPC
13

A correlation analysis between noninstitutional births and receipt of postpartum care points out an 

interesting phenomenon (see Figure 4.2). The overall correlation is tenuous, but in the right direction: 

noninstitutional births are loosely associated with receiving less postpartum care. Positive outliers are 

Cambodia, Indonesia, and Turkmenistan. Turkmenistan presents an ideal situation with few 

noninstitutional births and a high percentage of those births receiving postpartum care. Indonesia and 

Cambodia have large proportions of noninstitutional births, but a relatively large proportion of these 

births receive postpartum care. On the negative side, are countries such as Colombia which has relatively 

few noninstitutional births, but less than one-fifth of such births receive postpartum care. The worst 

situation is in countries such as Malawi and Rwanda, where a large proportion of births are 

noninstitutional (44 and 74 percent, respectively), and only a few of the women (7 and 4 percent, 

respectively) received postpartum care. 

Table 4.2 Percent distribution of women whose most recent live noninstitutional birth was in the five years preceding the survey, by 

timing of first postpartum checkup, DHS surveys 1999-2004

 Timing of first postpartum checkup after delivery 

 

Women 

Region and country 

Within 

24 hours1

Within 

2 days 

3-6 days 

after 

delivery

7-41 

days after 

delivery 

42 days 

or more 

after 

delivery 

Missing/

don’t 

klnow 

timing 

Any 

checkup 

No 

checkup Total Number

Sub-Saharan Africa 

Benin 2001 5.4 12.5 5.4 9.2 1.2 1.3 29.5 70.5 100.0 766 

Burkina Faso 2003 5.5 12.1 3.4 8.6 1.2 0.7 25.9 74.1 100.0 4,421 

Cameroon 2004 11.5 29.1 1.4 3.9 0.4 0.3 35.2 64.8 100.0 2,010 

Eritrea 2002 1.0 1.9 1.3 4.7 2.0 0.2 10.1 89.9 100.0 2,961 

Ethiopia 2000 1.5 2.6 1.0 1.2 0.4 0.2 5.3 94.7 100.0 7,542 

Ghana 2003 5.1 25.4 9.3 12.2 0.9 0.5 48.2 51.8 100.0 1,368 

Kenya 2003 4.7 10.1 2.4 6.7 0.5 0.1 19.9 80.1 100.0 2,287 

Madagascar 2003 5.9 32.3 6.2 4.4 0.7 0.1 43.8 56.2 100.0 2,777 

Malawi 2000 2.0 4.0 1.0 2.1 0.2 0.1 7.3 92.7 100.0 3,520 

Mali 2001 0.0 12.3 1.1 2.9 0.2 3.2 19.6 80.4 100.0 4,972 

Mozambique 2003 3.1 12.2 8.5 18.3 1.1 1.3 41.4 58.6 100.0 3,539 

Namibia 2000 u u u u u u 34.2 65.8 100.0 683 

Nigeria 2003 12.7 23.4 2.5 2.5 0.3 0.6 29.2 70.8 100.0 2,549 

Rwanda 2000 3.2 4.0 0.0 0.1 0.0 0.2 4.4 95.6 100.0 3,812 

Uganda 2000 3.0 5.9 0.9 0.9 0.0 0.0 7.7 92.3 100.0 2,738 

Zambia 2001 7.3 12.0 2.4 8.4 0.4 0.1 23.3 76.7 100.0 2,364 

Zimbabwe 1999 6.9 14.8 4.0 15.5 10.3 0.1 44.6 55.4 100.0 713 

North Africa/West Asia/Europe 

Armenia 2000 15.9 51.7 4.4 7.2 0.0 4.9 68.2 31.8 100.0 94 

Egypt 2000 0.2 2.5 1.3 5.1 0.3 0.1 9.4 90.6 100.0 3,900 

Jordan 2002 1.2 7.5 0.0 23.7 3.6 0.0 34.7 65.3 100.0 102 

Central Asia 

Turkmenistan 2000 28.2 67.0 6.2 6.5 0.0 1.4 81.1 18.9 100.0 105 

South/Southeast Asia 

Bangladesh 2004 8.2 11.5 1.5 4.7 1.1 0.1 18.8 81.2 100.0 4,838 

Cambodia 2000 7.2 35.0 11.4 2.4 0.1 0.1 48.9 51.1 100.0 5,064 

Indonesia 2002-2003 35.7 61.9 12.8 8.0 0.8 0.1 83.5 16.5 100.0 7,514 

Nepal 2001 15.5 17.2 0.8 2.7 0.1 0.0 20.8 79.2 100.0 4,285 

Latin America/Caribbean 

Colombia 2000 0.0 0.8 1.1 12.8 2.4 0.0 17.1 82.9 100.0 441 

Dominican Republic 2002 4.2 15.7 17.8 17.3 5.9 2.4 59.3 40.7 100.0 115 

Haiti 2000 3.1 14.8 5.5 4.6 0.3 0.6 25.8 74.2 100.0 3,134 

Nicaragua 2001 0.0 3.6 4.0 20.8 1.6 0.1 30.2 69.8 100.0 1,390 

Peru 2000 0.5 4.6 3.6 23.1 1.4 0.5 33.2 66.8 100.0 4,007 

Note: Missing values are excluded. 

1

 Not included in the total. 

u = Unknown 
14

Figure 4.2 Correlation between Noninstitutional Births and 

Postpartum Care (Linear Regression) 

Linear Regression

0.00 25.00 50.00 75.00

NIB

20.00

40.00

60.00

80.00

P

P

C

N

BI

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

PPCNIB = 48.55 + -0.36 * NIB

R-Square = 0.21

Correlation between Non-Institutional Births and Post-partum Care

Percentages

4.2 Timing of Postpartum Care (Noninstitutional Births) 

When the postpartum care first occurred (timing of postpartum care) is the next important piece 

of information being considered. This information is available only for women who received postpartum 

care for their most recent noninstitutional birth in the past five years.10 Table 4.2 shows the distribution of 

these women by timing of first postpartum checkup. Although the DHS questionnaire did not ask for the 

number of hours after delivery that the postpartum care occurred, receipt of any postpartum care in the 24 

hours after the birth was marked either 0 or 1 in the appropriate days box. This information was used to 

derive the first column of Table 4.2, which has particular importance for estimating early postpartum 

care.11

Table 4.2 indicates that in only a few countries is significant postpartum care provided to 

noninstitutional births in the 24 hours following delivery. In the 29 countries for which timing data are 

available, on average, only 8 percent of women delivering at home have a postpartum care checkup 

within 24 hours of delivery. Indonesia is the only country where up to 36 percent of these births received 

postpartum care within 24 hours, and 62 percent of births in the two days after delivery. Given the wide 

dispersal of the Indonesian population, the effort is remarkable. 

 

10 The revised version of the DHS questionnaire (from June 2005) now asks about postpartum care for both 

institutional and noninstitutional births. It also includes an extra set of boxes to specify the number of hours 

following the birth that the postpartum care occurred. 11 The accuracy of this recall data is discussed later as a limitation of the study. 

Turkmenistan (4.3, 81.4) 

Indonesia (59.0, 83.6) 

Cambodia (89.2, 48.9) 

Colombia (12.4, 16.9) 

Malawi (43.8, 7.3) 

Rwanda (74.3, 4.3) 
15

The next country scoring high on this service is Turkmenistan, where 28 percent of the few 

women who did not deliver at a facility received their first postpartum care within 24 hours, and about 

two-thirds received it within two days after delivery. Armenia (16 percent), Nepal (16 percent), and 

Nigeria (13 percent) rank substantially lower in providing early postpartum care. For the remaining 24 

countries, hardly any postpartum care was received in the 24 hours after delivery, or none at all was 

received, as in the case of Colombia, Mali, and Nicaragua. 

In 17 of the 29 countries, among women who received postpartum care, the majority received 

services within two days of delivery. Thereafter, the proportion drops substantially. It is of concern that in 

eight countries the highest level of receipt of postpartum care occurs between 7 and 41 days after delivery 

(particularly in the Latin America/Caribbean region and in Egypt and Jordan). A more complete picture 

can be seen when the means and medians of the timing of postpartum care are calculated (Table 4.3 and 

Figure 4.2). The first two columns of Table 4.3 present the situation for noninstitutional births; the 

median for receipt of postpartum care after delivery is three days. However, some countries have above 

average figures, such as Eritrea and Zimbabwe (15 days), Jordan (14 days), and several Latin American 

countries (8 to 10 days). 

Table 4.2 confirms a worrying situation anticipated from Table 4.1: a large majority of 

noninstitutional births simply do not receive any postpartum care. For all countries, the weighted average 

is 72 percent. In the 17 sub-Saharan countries, more than half of women who delivered outside a facility 

did not receive postpartum care. In other regions, the situation is similar, except for Armenia, the 

Dominican Republic, Indonesia, and Turkmenistan, which have relatively lower percentages (32, 41, 17, 

and 19 percent, respectively) of women who do not receive postpartum care when delivering outside an 

institution.12 Major changes are needed in the planning and implementation of postpartum care for women 

who do not seek delivery services at health facilities. 

 

12 These percentages need to be viewed with caution because they are based on relatively small numbers of cases 

(around 100). 
16

Table 4.3 Mean and median timing of postpartum care (in days) for noninstitutional births in the five years 

preceding the survey and mean timing of postpartum care for all births, DHS surveys 1999-2004

 Noninstitutional births All births 

Region and country 

Mean 

time of 

postpartum 

care 

Median 

time of 

postpartum 

care 

Number of 

women with 

noninstitutional births 

Mean 

time of 

postpartum 

care1

Total 

number 

of 

women 

Sub-Saharan Africa 

Benin 2001 8.9 3.9 766 1.1 3,514 

Burkina Faso 2003 9.6 3.4 4,421 3.0 7,427 

Cameroon 2004 3.0 1.4 2,010 0.9 5,289 

Eritrea 2002 23.8 14.8 2,961 5.1 4,152 

Ethiopia 2000 11.3 3.3 7,542 5.6 7,974 

Ghana 2003 5.9 2.8 1,368 2.3 2,630 

Kenya 2003 6.6 2.9 2,287 1.7 4,028 

Madagascar 2003 3.3 1.8 2,777 1.8 4,142 

Malawi 2000 6.5 2.6 3,520 0.8 8,028 

Mali 2001 3.7 1.9 4,972 1.1 8,231 

Mozambique 2003 9.1 7.0 3,539 2.9 7,138 

Namibia 2000 u u 683.0 u 2,991 

Nigeria 2003 2.8 1.2 2,549 1.3 3,894 

Rwanda 2000 1.1 u 3,812 0.6 5,130 

Uganda 2000 2.6 1.4 2,738 0.7 4,452 

Zambia 2001 8.5 6.9 2,364 1.9 4,396 

Zimbabwe 1999 21.7 14.7 713.0 2.5 2,767 

 

North Africa/West Asia/Europe 

Armenia 2000 2.4 1.8 94.0 0.6 1,248 

Egypt 2000 8.4 2.9 3,900 1.5 7,931 

Jordan 2002 18.9 14.1 102.0 0.7 3,743 

 

Central Asia 

Turkmenistan 2000 1.8 1.4 105.0 0.5 2,460 

South/South East Asia 

Bangladesh 2004 9.7 1.4 4,838 6.2 5,387 

Cambodia 2000 2.1 1.7 5,064 1.8 5,678 

Indonesia 2002-2003 2.6 1.1 7,514 1.7 12,729 

Nepal 2001 3.4 u 4,285 2.4 4,739 

 

Latin America/Caribbean 

Colombia 2000 16.2 9.1 441 1.0 3,545 

Dominican Republic 2002 14.6 10.2 115 0.6 7,858 

Haiti 2000 5.1 2.4 3,134 2.4 4,237 

Nicaragua 2001 12.0 8.2 1,390 2.0 4,835 

Peru 2000 14.4 8.7 4,007 3.5 9,530 

 

Total2

 7.3 3.2 2.1 

u = Unknown (information not available) 

1

 Assumes all institutional births received first postpartum care at an average 0.5 days after delivery. 2

 Weighted average 
Figure 4.3 Mean and Median Timing of Postpartum Care (No. Days Following Birth that PPC Occurred), 

Noninstitutional Births and All Births 

17

Rwanda 2001

Tu kr men si at n 2000 C ma bod ai 2000 A mr en ai 2000 nI dones ai 2002 2- 003 Uganda 2000 N gi er ai 2003 Madagascar 2003 Nepal 2001 Mali 2001 Haiti 2000 Ghana 2003 Ma al wi 2000 Kenya 2003 Egypt 2000 Z ma b ai 2001 Ben ni 2001 Moz ma b qi ue 2003 Bu kr ni a Faso 2003 C ma e or on 2004 Bang al desh 2004 E ht oi p ai 2000 N ci a ar gua 2001 Pe ur 2000 D mo ni ci an Rep 2002 Co ol mb ai 2000 Jo dr an 2002 Z mi babwe 1999 Erit er a 2002 Ave ar ge

50

25201510

d

e

r

r

u

c

c

o

C

P

P

t

a

h

t

h

t

r

i

b

g

n

i

w

o

l

l

of

s

y

a

d

.

o

N

Mean time of PPC (NIB) Median time of PPC (NIB) Mean time of PPC (all births)

2.9 2.8 2.4

3.9

1.9

3.4

6.9

2.6

1.7

7.0

1.8 1.1

10.2

1.4

1.8

1.2

2.9

1.4 1.4

1.4

3.3

8.2

8.7

9.1

14.7

14.1

14.8

3.2

Note: Figures shown are for median timing of postpartum care among noninstitutional births.
18

The mean number of days following delivery that postpartum care occurred is larger than the 

median (more than double) because some countries have extremely high figures: Eritrea (24 days), Jordan 

(19 days), and Zimbabwe (22 days), and several Latin American countries (12 to 16 days). In addition to 

cultural and other barriers to accessing these services, some longer times [until receipt of postpartum care] 

may be related to topographic/geographic characteristics of the terrain that make it difficult for women to 

reach the available postpartum care centers, or for health personnel and workers to reach women in their 

households. If we take as given that noninstitutional births are at higher risk of undesirable outcomes 

from maternal complications, the occurrence and timing of postpartum care in these countries highlights 

the need for increased outreach efforts by the health care system. 

The timing of postpartum care for all births (institutional and noninstitutional) is examined in 

Table 4.3. It is assumed that all institutional births receive postpartum care an average of 12 hours (or 0.5 

days) after delivery. If we combine this estimate with the actual timing of noninstitutional births, we 

obtain the fourth column in Table 4.3, the mean time of postpartum care for all births.13 In the 29 

countries for which data are available, the occurrence of first postpartum care for all births is an average 

of two days after delivery. This timing is considered too late because of the dangers of postpartum 

hemorrhage and hypertensive disorders, and would address only medium-term conditions such as 

postpartum sepsis. In some countries, the average timing of postpartum care occurs even later—

Bangladesh (6 days), Burkina Faso (3 days), Eritrea (5 days), Ethiopia (6 days), Mozambique (3 days), 

Peru (4 days), and Zimbabwe (3 days)—because of a combination of lack of universal institutional 

delivery and late postpartum care for noninstitutional births. 

4.3 Place of Postpartum Care (All Births) 

The DHS questionnaire asked women who did not deliver at a health facility where they received 

their postpartum care. With this information and the information on place of delivery it is possible to 

determine the place where all postpartum care was provided—again assuming that all institutional births 

received postpartum care shortly after the birth (see Table 4.4). In all four countries in South/Southeast 

Asia, a substantial proportion of postpartum care takes place at home (or in a related location, e.g., the 

home of a TBA), from a high of nearly 80 percent in Cambodia to just under half of all births in 

Bangladesh. This picture coincides with the community orientation of service delivery in these countries. 

This group of countries is followed by a group in which 20 to 44 percent of births receive 

postpartum care at home or in a related location. These countries are mostly in Sub-Saharan Africa: 

Ethiopia (29 percent), Ghana (26 percent), Madagascar (44 percent), Mali (21 percent), and Nigeria (30 

percent). In the Latin America/Caribbean region, the only country in this group is Haiti, where 31 percent 

of postpartum care takes place at home. The situation of these two groups of countries probably reflects 

the development of varying types of community outreach postpartum care services by varying types of 

providers. 

 

13 It is not possible to estimate a median time of postpartum care for institutional births; thus, the only measure of 

central tendency here is the mean. 
19

Table 4.4 Percent distribution of women who received postpartum care for the most 

recent live birth in the five years preceding the survey, by place of first postpartum 

checkup, DHS surveys 1999-2004 

Place of first postpartum care 

Region and country 

Health 

facility 

Home or 

other 

place Total 

Number 

of 

women 

Sub-Saharan Africa 

Benin 2001 98.7 1.3 100.0 2,973 

Burkina Faso 2003 88.9 11.1 100.0 4,135 

Cameroon 2004 88.4 11.6 100.0 3,970 

Eritrea 2002 95.6 4.4 100.0 1,488 

Ethiopia 2000 71.4 28.6 100.0 836 

Ghana 2003 74.5 25.5 100.0 1,917 

Kenya 2003 89.5 10.5 100.0 2,192 

Madagascar 2003 55.8 44.2 100.0 2,579 

Malawi 2000 97.5 2.5 100.0 4,765 

Mali 2001 79.4 20.6 100.0 4,232 

Mozambique 2003 99.8 0.2 100.0 5,041 

Namibia 2000 98.4 1.6 100.0 2,527 

Nigeria 2003 70.5 29.5 100.0 2,078 

Rwanda 2000 90.9 9.1 100.0 1,482 

Uganda 2000 92.3 7.7 100.0 1,925 

Zambia 2001 90.6 9.4 100.0 2,578 

Zimbabwe 1999 98.7 1.3 100.0 2,366 

North Africa/West Asia/Europe 

Armenia 2000 95.4 4.6 100.0 1,218 

Egypt 2000 96.5 3.5 100.0 4,397 

Jordan 2002 100.0 0.0 100.0 3,677 

Central Asia 

Turkmenistan 2000 96.9 3.1 100.0 2,438 

South/Southeast Asia 

Bangladesh 2004 56.6 43.4 100.0 1,455 

Cambodia 2000 20.9 79.1 100.0 3,090 

Indonesia 2002-2003 49.4 50.6 100.0 11,483 

Nepal 2001 40.8 59.2 100.0 1,342 

Latin America/Caribbean 

Colombia 2000 100.0 0.0 100.0 3,178 

Dominican Republic 2002 99.8 0.2 100.0 7,722 

Haiti 2000 68.7 31.3 100.0 1,913 

Nicaragua 2001 99.9 0.1 100.0 3,862 

Peru 2000 97.0 3.0 100.0 6,833 

In the remaining countries, a large majority of postpartum care is provided at health facilities. 

These findings indicate that, except for the countries highlighted above, the majority of countries have 

developed institution-based systems of postpartum care, whereby women give birth at a health facility or 

attend it after delivery, either on their own or by referral. 

If analysis is restricted to noninstitutional births (table not shown) the pattern is similar to the one 

presented above, except that contrasts are greater, as with Ghana, Mali, and Nigeria, where receipt of 

postpartum care at home is 75, 90, and 84 percent, respectively. The major exceptions are Rwanda and 

Uganda, where the few noninstitutional births that received postpartum care did so mostly at home or in a 

related place (70 and 83 percent, respectively). As expected, an average of 68 percent of noninstitutional 

births received postpartum care at home. 
20

4.4 Provider of Postpartum Care (Noninstitutional Births) 

It is assumed that postpartum care for institutional births is provided by health professionals, 

whether doctors, nurses, or midwives. However, it is of interest to look at who the providers of 

postpartum care are among noninstitutional births (Table 4.5). In six of the 30 countries, a majority of 

postpartum care among noninstitutional births is provided by a TBA (trained or untrained): Cambodia (69 

percent), Ghana (64 percent), Mali (58 percent), Nepal (69 percent), Nigeria (55 percent), and Rwanda 

(72 percent). In another eight countries, from about one-third to one-half of noninstitutional births are 

attended by a TBA: Cameroon (51 percent), Ethiopia (31 percent), Haiti (39 percent), Indonesia (40 

percent), Kenya (42 percent), Malawi (46 percent), Uganda (45 percent), and Zambia (39 percent). 

Table 4.5 Percent distribution of women who received postpartum care for the most recent live 

noninstitutional birth in the five years preceding the survey, by provider of postpartum care, DHS 

surveys 1999-2004 

Provider of postpartum care 

Region and country 

Health 

professional 

Any 

TBA Other1 Total 

Number 

of women 

Sub-Saharan Africa 

Benin 2001 86.1 11.3 2.7 100.0 226 

Burkina Faso 2003 63.0 36.0 1.0 100.0 1,144 

Cameroon 2004 47.2 51.1 1.7 100.0 707 

Eritrea 2002 91.2 8.2 0.6 100.0 298 

Ethiopia 2000 69.3 30.7 0.0 100.0 403 

Ghana 2003 32.7 63.5 3.8 100.0 659 

Kenya 2003 55.8 42.1 2.1 100.0 455 

Madagascar 2003 38.6 11.8 49.6 100.0 1,215 

Malawi 2000 53.7 46.0 0.3 100.0 257 

Mali 2001 25.5 57.5 17.0 100.0 975 

Mozambique 2003 97.7 0.4 1.9 100.0 1,466 

Namibia 2000 86.1 7.8 6.1 100.0 233 

Nigeria 2003 41.6 54.6 3.8 100.0 744 

Rwanda 2000 25.5 71.8 2.7 100.0 166 

Uganda 2000 54.5 45.0 0.6 100.0 212 

Zambia 2001 55.2 38.6 6.2 100.0 550 

Zimbabwe 1999 95.5 3.6 0.9 100.0 318 

North Africa/West Asia/Europe 

Armenia 2000 95.2 3.1 1.7 100.0 64 

Egypt 2000 90.2 9.8 0.0 100.0 365 

Jordan 2002 (100.0)a

 (0.0)a (0.0)a 100.0 35 

Central Asia 

Turkmenistan 2000 96.7 0.8 2.5 100.0 85 

South/Southeast Asia 

Bangladesh 2004 47.4 1.3 51.3 100.0 909 

Cambodia 2000 30.7 68.9 0.4 100.0 2,477 

Indonesia 2002-2003 60.0 39.9 0.1 100.0 6,274 

Nepal 2001 28.1 69.4 2.6 100.0 890 

Latin America/Caribbean 

Colombia 2000 100.0 0.0 0.0 100.0 76 

Dominican Republic 2002 91.8 8.2 0.0 100.0 68 

Haiti 2000 36.5 39.1 24.4 100.0 810 

Nicaragua 2001 99.7 0.0 0.3 100.0 420 

Peru 2000 96.9 0.6 2.5 100.0 1,329 

 

Total2

 57.4 35.5 7.1 

Note: Totals may not add to 100 because of rounding. 

1 Relative, friend, or other person (e.g., health student) 

2

 Weighted average 

a

 Figures should be interpreted with caution because they are based on small numbers (<50). 
21

It is interesting to note that in Bangladesh and Madagascar postpartum care for about half of 

noninstitutional births is received from other types of providers. These other providers include auxiliary 

health personnel, community volunteers, students of a health discipline, traditional healers, and even 

relatives or friends. There are four countries with sizable proportions in this category: Haiti (24 percent), 

Mali (17 percent), Namibia (6 percent), and Zambia (6 percent). Overall, there are 20 countries in which 

the majority of noninstitutional births are attended by health professionals, usually a physician, nurse, or 

midwife. 

Despite large differentials across countries and regions, on average, 57 percent of providers of 

postpartum care for noninstitutional births are health professionals. Though not guaranteeing a safe birth, 

this level of coverage by health professionals is encouraging, considering the high risk of adverse 

outcomes for women delivering at home in many countries. 

A combined analysis of the two variables—place of postpartum care and provider of postpartum 

care—indicates that, as expected, the large majority of providers of postpartum care in health facilities are 

health professionals (data not shown). Interestingly, in two countries in Asia—Bangladesh and 

Cambodia—more than one-fourth of providers of postpartum care in health facilities are not health 

professionals. These providers appear to be lower-level health workers (e.g., homeopaths, trained TBAs, 

auxiliary nurse-midwives) that are allowed to operate at some facilities. Conversely, most providers of 

postpartum care to women with noninstitutional births are not health professionals; however, there are 

some exceptions. In Armenia and Turkmenistan, 61 and 79 percent, respectively of postpartum care is 

provided at home by health professionals. It is also high in Indonesia (47 percent), followed by Cambodia 

(15 percent) and Madagascar (15 percent), and the Dominican Republic (13 percent). These are examples 

of the positive results of outreach health programs and the greater accessibility of health professionals to 

women who give birth at home. 

Another way to examine the likelihood of receiving postpartum care is to relate it to the type of 

provider attending the woman’s last delivery. Because we have hypothesized that all women delivering 

with a health professional would receive postpartum care, we focus on those delivering with other types 

of providers (TBAs, friends, and relatives). A quick review of the data (not shown) indicates that in half 

of the countries examined, women delivering with nonprofessional providers had very low levels of 

postpartum care, from zero or 1 percent (e.g., Armenia, Colombia, Egypt, Eritrea, Jordan, Nicaragua, and 

Peru) to 5 or 6 percent (e.g., Benin and Namibia); ten countries had low to moderate levels. Only in 

Cambodia (40 percent), Ghana (38 percent), and Indonesia (67 percent) is delivering with a 

nonprofessional provider related to significant levels of postpartum care. 
22

5 Differentials in Postpartum Care 

In this section, differentials in postpartum care by women’s characteristics are presented for three 

subpopulations: institutional births, noninstitutional births, and all births (i.e., the sum of institutional and 

noninstitutional births). 

5.1 Postpartum Care and Age at Time of Birth 

Table 5.1 shows the proportion of women who received postpartum care for the most recent birth 

in the past five years by age at birth. As expected, in most countries the proportion receiving postpartum 

care tends to decline as age at birth increases. Among women with institutional births, this effect is seen 

in 19 countries, while there is little change in 11 other countries. The pattern is unclear for women with 

noninstitutional births. When all births are combined, postpartum care is the lowest among mothers age 

35-49 in all countries except Cambodia, Egypt, Madagascar, and Nigeria, where mothers under age 20 are 

less likely to receive postpartum care. Conversely, younger women tend to have higher levels of 

postpartum care, probably reflecting increased education and wealth, as well as recent improvements in 

program outreach. 

5.2 Postpartum Care and Birth Order 

Table 5.2 shows the proportion of women who received postpartum care for the most recent birth 

in the past five years by birth order. The effect of birth order is unambiguous for institutional births and 

all births. In every country examined, the percentage receiving postpartum care is higher for first order 

births than for higher order births. As noted above, this may indicate recent improvements in policy and 

program effectiveness, as well as better education and economic conditions among the younger cohorts. It 

may also reflect an increased perception by the population of the need for care for first births, compared 

with subsequent births. Interestingly, among noninstitutional births, the opposite relationship is seen. That 

is, the occurrence of postpartum care is higher as birth order increases, especially for the 5+ category, 

although the effect is not as strong as in the preceding case. This may indicate that women who give birth 

at home have differential access to services or behave differently from their counterparts who have 

institutional births. These women, who are younger and/or delivering for the first time, may be less 

informed of, have less access to, or not feel as much need for postpartum care as older women and 

women at higher parity. Appendix Table A.1 provides more information on birth order differentials, by 

type of provider (i.e., health professional versus any TBA/other). 
23

Table 5.1 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by age at birth, DHS 

surveys 1999-2004

Institutional births Noninstitutional births All births 

Region and country <20 20-24 25-29 30-34 35-49 Total <20 20-24 25-29 30-34 35-49 Total <20 20-24 25-29 30-34 35-49 Total 

Sub-Saharan Africa 

Benin 2001 76.7 80.9 77.0 80.0 75.1 78.2 6.5 5.6 7.2 6.6 6.3 6.4 83.2 86.5 84.2 86.6 81.4 84.6 

Burkina Faso 2003 44.4 42.9 42.3 36.4 36.1 40.5 14.2 13.9 14.8 17.0 17.5 15.4 58.6 56.8 57.1 53.4 53.6 55.9 

Cameroon 2004 61.9 62.2 62.3 64.2 59.0 62.0 13.4 14.4 11.8 14.1 12.8 13.4 75.3 76.6 74.1 78.3 71.8 75.4 

Eritrea 2002 31.3 31.4 30.9 27.4 23.2 28.7 7.1 7.5 6.2 7.7 7.6 7.2 38.4 38.9 37.1 35.1 30.8 35.9 

Ethiopia 2000 7.2 6.6 5.6 4.5 3.4 5.4 5.2 4.2 4.7 6.7 5.0 5.1 12.4 10.8 10.3 11.2 8.4 10.5 

Ghana 2003 48.8 48.3 51.3 47.8 43.6 47.9 27.0 27.2 22.8 25.4 24.1 25.1 75.8 75.5 74.1 73.2 67.7 73.0 

Kenya 2003 51.3 46.2 42.5 42.8 30.2 43.2 10.8 10.1 11.3 10.8 14.9 11.3 62.1 56.3 53.8 53.6 45.1 54.5 

Madagascar 2003 28.7 37.2 33.7 31.1 31.5 33.0 30.1 26.3 32.8 29.1 28.5 29.3 58.8 63.5 66.5 60.2 60.0 62.3 

Malawi 2000 59.6 57.3 56.6 53.9 51.0 56.2 2.7 3.2 2.4 4.6 3.8 3.2 62.3 60.5 59.0 58.5 54.8 59.4 

Mali 2001 44.4 40.5 38.7 36.9 37.7 39.6 10.5 11.5 13.0 11.4 12.5 11.8 54.9 52.0 51.7 48.3 50.2 51.4 

Mozambique 2003 57.1 52.1 48.6 46.6 45.0 50.5 18.8 20.6 19.9 22.4 21.9 20.5 75.9 72.7 68.5 69.0 66.9 71.0 

Namibia 2000 81.2 79.3 79.7 79.0 66.2 77.2 6.8 7.3 6.9 9.1 9.2 7.8 88.0 86.6 86.6 88.1 75.4 85.0 

Nigeria 2003 24.3 34.1 42.0 36.3 33.8 34.6 22.3 20.9 17.2 17.4 17.7 19.1 46.6 55.0 59.2 53.7 51.5 53.7 

Rwanda 2000 37.8 33.3 27.5 20.4 17.5 25.7 4.1 3.9 3.6 3.3 2.1 3.2 41.9 37.2 31.1 23.7 19.6 28.9 

Uganda 2000 49.7 42.1 35.4 34.3 28.2 38.5 3.8 5.2 3.8 5.9 5.5 4.8 53.5 47.3 39.2 40.2 33.7 43.3 

Zambia 2001 49.1 47.9 50.9 41.4 36.7 46.2 14.1 12.9 9.7 12.7 13.7 12.5 63.2 60.8 60.6 54.1 50.4 58.7 

Zimbabwe 1999 79.7 77.3 75.1 69.1 62.1 74.2 8.5 11.4 12.6 14.4 11.5 11.5 88.2 88.7 87.7 83.5 73.6 85.7 

North Africa/West 

 Asia/Europe 

Armenia 2000 86.6 94.0 95.7 88.7 89.0 92.5 8.8 4.4 2.7 8.9 5.1 5.1 95.4 98.4 98.4 97.6 94.1 97.6 

Egypt 2000 48.3 51.7 50.5 52.1 49.5 50.7 4.5 5.0 4.8 4.0 4.3 4.6 52.8 56.7 55.3 56.1 53.8 55.3 

Jordan 2002 98.2 97.7 96.3 97.3 98.3 97.3 0 0.7 1.6 0.9 0.4 0.9 98.2 98.4 97.9 98.2 98.7 98.2 

Central Asia 

Turkmenistan 2000 96.5 97.1 96.5 93.2 92.4 95.7 2.5 2.2 2.7 5.5 7.2 3.5 99.0 99.3 99.2 98.7 99.6 99.2 

South/Southwest Asia 

Bangladesh 2004 10.0 10.8 12.0 8.4 5.8 10.2 17.7 16.0 16.4 17.0 18.4 16.9 27.7 26.8 28.4 25.4 24.2 27.1 

Cambodia 2000 13.1 14.1 11.7 10.2 6.8 10.9 39.2 43.3 43.4 43.3 46.1 43.6 52.3 57.4 55.1 53.5 52.9 54.5 

Indonesia 2002-2003 30.1 40.3 45.8 46.1 34.8 41.0 60.4 50.4 46.1 43.2 52.3 49.3 90.5 90.7 91.9 89.3 87.1 90.3 

Nepal 2001 12.8 12.1 9.5 5.4 3.4 9.6 20.0 20.3 18.6 18.1 14.1 18.8 32.8 32.4 28.1 23.5 17.5 28.4 

Latin America/ 

 Caribbean 

Colombia 2000 86.9 87.5 90.1 86.5 85.4 87.5 2.1 2.0 1.9 3.1 1.5 2.1 89.0 89.5 92.0 89.6 86.9 89.6 

Dominican Republic 

2002 99.3 98.2 98.7 98.8 96.9 98.4 0.4 1.2 0.8 0.6 1.4 0.9 99.7 99.4 99.5 99.4 98.3 99.3 

Haiti 2000 34.8 25.9 24.7 27.4 20.4 25.9 21.7 19.5 18.3 18.0 18.9 19.1 56.5 45.4 43.0 45.4 39.3 45.0 

Nicaragua 2001 73.3 73.7 71.0 72.0 59.7 71.0 7.6 8.0 10.1 8.5 10.4 8.7 80.9 81.7 81.1 80.5 70.1 79.7 

Peru 2000 55.5 59.2 59.9 61.8 50.8 58.0 15.0 14.0 13.8 12.6 14.8 13.9 70.5 73.2 73.7 74.4 65.6 71.9 
24

Table 5.2 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, 

by birth order, DHS surveys 1999-2004

 Institutional births Noninstitutional births All births 

Region and country 1 2-4 5+ Total 1 2-4 5+ Total 1 2-4 5+ Total 

Sub-Saharan Africa

Benin 2001 86.5 79.5 72.1 78.2 3.7 6.3 8.1 6.4 90.2 85.8 80.2 84.6 

Burkina Faso 2003 53.2 41.1 33.9 40.5 13.2 14.1 17.9 15.4 66.4 55.2 51.8 55.9 

Cameroon 2004 75.4 63.4 50.7 62.0 9.3 13.6 15.9 13.4 84.7 77.0 66.6 75.4 

Eritrea 2002 44.4 31.5 16.9 28.7 6.3 7.1 7.7 7.2 50.7 38.6 24.6 35.9 

Ethiopia 2000 12.4 5.2 2.8 5.4 4.8 4.7 5.5 5.1 17.2 9.9 8.3 10.5 

Ghana 2003 60.2 49.8 36.7 47.9 20.7 25.5 27.5 25.1 80.9 75.3 64.2 73.0 

Kenya 2003 65.5 44.1 24.3 43.2 7.9 10.6 15.1 11.3 73.4 54.7 39.4 54.5 

Madagascar 2003 43.0 32.5 26.4 33.0 26.8 29.6 30.8 29.3 69.8 62.1 57.2 62.3 

Malawi 2000 63.8 55.6 52.0 56.2 2.5 2.9 4.1 3.2 66.3 58.5 56.1 59.4 

Mali 2001 49.3 42.0 34.0 39.6 9.9 11.4 12.9 11.8 59.2 53.4 46.9 51.4 

Mozambique 2003 62.9 50.6 42.6 50.5 16.2 21 22.5 20.5 79.1 71.6 65.1 71.0 

Namibia 2000 86.5 77.9 62.3 77.2 6.1 7.7 10.6 7.8 92.6 85.6 72.9 85.0 

Nigeria 2003 43.9 36.9 27.3 34.6 17.1 19.3 19.9 19.1 61.0 56.2 47.2 53.7 

Rwanda 2000 46.2 24.9 17.4 25.7 3.7 3.7 2.5 3.2 49.9 28.6 19.9 28.9 

Uganda 2000 60.1 37.4 31.0 38.5 3.8 4.7 5.2 4.8 63.9 42.1 36.2 43.3 

Zambia 2001 58.6 46.3 38.1 46.2 11.5 12.5 13.1 12.5 70.1 58.8 51.2 58.7 

Zimbabwe 1999 85.2 73.8 58.0 74.2 6.6 13.2 15.1 11.5 91.8 87.0 73.1 85.7 

North Africa/West Asia/Europe 

Armenia 2000 96.5 91.5 72.3 92.5 2.9 5.5 19.8 5.1 99.4 97.0 92.1 97.6 

Egypt 2000 68.9 51.2 33.2 50.7 3.7 4.6 5.5 4.6 72.6 55.8 38.7 55.3 

Jordan 2002 98.7 97.0 97.2 97.3 0.1 1.2 0.9 0.9 98.8 98.2 98.1 98.2 

Central Asia 

Turkmenistan 2000 98.5 95.8 90.4 95.7 1.3 3.2 8.8 3.5 99.8 99.0 99.2 99.2 

South/Southwest Asia 

Bangladesh 2004 17.8 8.5 3.4 10.2 19.7 16.1 14.9 16.9 37.5 24.6 18.3 27.1 

Cambodia 2000 20.0 12.0 4.4 10.9 40.3 43.4 45.7 43.6 60.3 55.4 50.1 54.5 

Indonesia 2002-2003 47.9 41.0 21.6 41.0 45.8 49.8 56.7 49.3 93.7 90.8 78.3 90.3 

Nepal 2001 20.3 8.6 3.1 9.6 18.5 18.8 18.9 18.8 38.8 27.4 22.0 28.4 

Latin America/Caribbean 

Colombia 2000 94.6 86.9 65.4 87.5 1.2 2.1 5.5 2.1 95.8 89.0 70.9 89.6 

Dominican Republic 2002 99.3 98.9 94.4 98.4 0.6 0.7 2.6 0.9 99.9 99.6 97.0 99.3 

Haiti 2000 43.5 28.7 11.6 25.9 17.9 19.4 19.5 19.1 61.4 48.1 31.1 45.0 

Nicaragua 2001 83.5 73.0 51.0 71.0 5.4 8.9 12.7 8.7 88.9 81.9 63.7 79.7 

Peru 2000 74.0 61.0 28.2 58.0 9.5 14.1 19.7 13.9 83.5 75.1 47.9 71.9 
25

5.3 Postpartum Care and Urban-rural Residence 

Table 5.3 shows the proportion of women who received postpartum care for the most recent birth 

in the past five years by whether the woman lived in an urban or rural area. As expected, in all countries 

where women delivered at a health facility, postpartum care was higher if the woman lived in an urban 

area. However, when the analysis looked at noninstitutional births, the opposite effect was seen, i.e., 

postpartum care is higher among women living in rural areas (except in Ethiopia and Madagascar). This 

seems to indicate that women in rural areas who have noninstitutional births are more likely to receive 

postpartum care. However, it could also reflect greater programmatic effort in providing postpartum care 

to women in rural areas; or it could be a combination of the two. Conversely, the results may reflect that 

some women in urban areas are delivering at home and are not receiving postpartum care. If the 

differentials on residence are examined further, by type of provider (i.e., health professional versus any 

TBA/other), the pattern remains largely the same, although somewhat weakened (see Appendix Table 

A.2). Sixteen countries show the same orientation as before; eight countries show a reverse association 

(i.e., more postpartum care among women when the provider is a health professional); and six countries 

had such small numbers as to preclude comparison. 

Table 5.3 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by 

residence, DHS surveys 1999-2004 

Institutional births Noninstitutional births All births 

Region and country Urban Rural Total Urban Rural Total Urban Rural Total 

Sub-Saharan Africa 

Benin 2001 86.1 74.3 78.2 4.9 7.2 6.4 91.0 81.5 84.6 

Burkina Faso 2003 88.9 32.5 40.5 5.2 17.1 15.4 94.1 49.6 55.9 

Cameroon 2004 83.2 43.9 62.0 7.5 18.4 13.4 90.7 62.3 75.4 

Eritrea 2002 65.1 9.4 28.7 4.5 8.6 7.2 69.6 18.0 35.9 

Ethiopia 2000 33.3 1.9 5.4 9.9 4.4 5.1 43.2 6.3 10.5 

Ghana 2003 79.3 30.5 47.9 13.2 31.7 25.1 92.5 62.2 73.0 

Kenya 2003 73.3 35.4 43.2 5.8 12.7 11.3 79.1 48.1 54.5 

Madagascar 2003 44.7 30.1 33.0 30.6 29.0 29.3 75.3 59.1 62.3 

Malawi 2000 82.9 52.0 56.2 0.9 3.6 3.2 83.8 55.6 59.4 

Mali 2001 81.1 26.2 39.6 8.3 13.0 11.8 89.4 39.2 51.4 

Mozambique 2003 82.5 35.8 50.5 10.1 25.3 20.5 92.6 61.1 71.0 

Namibia 2000 93.2 67.7 77.2 3.5 10.4 7.8 96.7 78.1 85.0 

Nigeria 2003 56.6 25.4 34.6 17.3 19.9 19.1 73.9 45.3 53.7 

Rwanda 2000 64.9 19.0 25.7 2.9 3.3 3.2 67.8 22.3 28.9 

Uganda 2000 80.7 32.4 38.5 3.4 5.0 4.8 84.1 37.4 43.3 

Zambia 2001 79.2 29.2 46.1 10.0 13.8 12.5 89.2 43.0 58.6 

Zimbabwe 1999 90.1 65.8 74.2 5.3 14.8 11.5 95.4 80.6 85.7 

 

North Africa/West Asia/Europe 

Armenia 2000 98.8 85.2 92.5 0.8 10.1 5.1 99.6 95.3 97.6 

Egypt 2000 72.0 36.5 50.8 2.5 6.0 4.6 74.5 42.5 55.4 

Jordan 2002 97.6 96.3 97.3 1.0 0.7 0.9 98.6 97.0 98.2 

Central Asia 

Turkmenistan 2000 98.3 93.9 95.7 1.6 4.8 3.5 99.9 98.7 99.2 

South/Southeast Asia 

Bangladesh 2004 24.2 6.5 10.2 15.4 17.3 16.9 39.6 23.8 27.1 

Cambodia 2000 36.8 6.7 10.9 35.1 45.0 43.6 71.9 51.7 54.5 

Indonesia 2002-2003 60.8 23.6 41.0 33.3 63.3 49.3 94.1 86.9 90.3 

Nepal 2001 46.2 6.9 9.6 10.4 19.4 18.8 56.6 26.3 28.4 

 

Latin America/Caribbean 

Colombia 2000 94.5 70.6 87.6 1.2 4.5 2.1 95.7 75.1 89.7 

Dominican Republic 2002 99.2 97.1 98.5 0.6 1.4 0.9 99.8 98.5 99.4 

Haiti 2000 52.7 11.5 26.0 16.2 20.7 19.1 68.9 32.2 45.1 

Nicaragua 2001 89.7 49.7 71.2 4.9 13.1 8.7 94.6 62.8 79.9 

Peru 2000 82.4 23.8 58.0 8.2 22.0 13.9 90.6 45.8 71.9 
26

When all births are considered (see Table 5.3), the figures for postpartum care by urban-rural 

residence are similar to those for institutional births. Countries where the differentials are not large 

include Benin, Cameroon, Ghana, Madagascar, Namibia, and Zimbabwe in Sub-Saharan Africa; 

Armenia, Jordan, and Turkmenistan in North Africa/West Asia/Europe/Central Asia; Indonesia in 

South/Southeast Asia; and all the Latin America/Caribbean countries except Haiti and Peru. 

Differences in postpartum care by urban-rural residence are moderate in Cambodia (72 and 52 

percent, respectively), Malawi (84 and 56 percent), and Nigeria (74 and 45 percent). There are more 

contrasting differentials in Egypt, Haiti, Kenya, Mali, Nepal, Peru, Uganda, and Zambia, where twice as 

many women are receiving postpartum care in urban areas as in rural areas. However, gaps are even more 

striking in Eritrea, Ethiopia, and Rwanda, where women in urban areas are three to seven times more 

likely to receive postpartum care than women in rural areas.

5.4 Postpartum Care and Level of Education 

Table 5.4 shows the proportion of women who receive postpartum care for the most recent birth 

in the past five years by level of education. As expected, among institutional births, higher education is 

associated with greater likelihood of receiving postpartum care, and illiteracy (in a number of countries) is 

associated with less likelihood of receiving postpartum care (Table 5.4). In some countries—Bangladesh, 

Cambodia, Ethiopia, and Peru—the effect is seen mostly at the secondary or higher level. 

For women with noninstitutional births, the relationship appears to be the opposite. Generally, 

women with no education exhibit higher levels of postpartum care than women with any level of 

education, especially secondary or higher education (except in Madagascar, Jordan, and Bangladesh). 

However, when postpartum care is broken down by the provider (Appendix Table A.3), the picture is less 

clear. The previous relationship still holds for 11 countries, but in another eight countries it is reversed, 

that is, postpartum care is higher among women with more education when the provider is a health 

professional. Conversely, the least educated tend to have more postpartum care provided by a TBA or a 

relative or friend. This further breakdown reduces denominators so that relationships cannot be 

ascertained in five countries. 

Analyses combining all births show a similar pattern to that of institutional births. Similar levels 

of postpartum care at different educational levels can be found in Benin, the Dominican Republic, Jordan, 

and Turkmenistan, while moderate differences are found between no education and secondary or higher 

levels of education in Cambodia, Colombia, Ghana, Indonesia, Namibia, and Zimbabwe. The small 

differentials in these countries appear to indicate either the wide accessibility of health services or the 

presence of effective outreach programs for less educated women. 

Much larger differences are found in the remaining 20 countries. Ranges from around two to 

three times as much difference between no education and secondary or higher are found in Bangladesh, 

Burkina Faso, Cameroon, Egypt, Haiti, Kenya, Malawi, Mali, Nepal, Nicaragua, Nigeria, Peru, Uganda, 

and Zambia. However, the most striking contrasts are seen in Eritrea and Rwanda, where women with the 

highest level of education are about five times as likely to receive postpartum care as those with no 

education; and in Ethiopia, where women with secondary or higher education are eight times as likely to 

have received postpartum care as those with no education (54 and 7 percent, respectively). 

These findings shows how government efforts to increase women’s level of education can lead to 

increased likelihood that women will receive postpartum care after a birth. 
27

Table 5.4 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by education, DHS 

surveys 1999-2004 

Institutional births Noninstitutional births All births 

Region and country 

No 

education Primary 

Secondary

or higher Total 

No 

education Primary

Secondary

or higher Total 

No 

education Primary 

Secondary 

or higher Total 

Sub-Saharan Africa 

Benin 2001 73.3 87.8 98.7 78.2 7.4 5.0 1.0 6.4 80.7 92.8 99.7 84.6 

Burkina Faso 2003 34.8 70.9 95.0 40.5 16.4 11.0 4.0 15.4 51.2 81.9 99.0 55.9 

Cameroon 2004 22.4 68.4 89.8 62.0 24.6 12.3 4.5 13.4 47.0 80.7 94.3 75.4 

Eritrea 2002 11.8 41.0 86.4 28.7 8.1 7.0 2.8 7.2 19.9 48.0 89.2 35.9 

Ethiopia 2000 2.2 9.8 44.3 5.4 4.4 7.6 9.2 5.1 6.6 17.4 53.5 10.5 

Ghana 2003 29.0 43.8 69.2 47.9 28.8 30.0 18.5 25.1 57.8 73.8 87.7 73.0 

Kenya 2003 15.0 39.1 71.7 43.2 11.4 12.4 8.4 11.3 26.4 51.5 80.1 54.5 

Madagascar 2003 17.3 31.8 52.9 33.0 26.1 30.5 30.3 29.3 43.4 62.3 83.2 62.3 

Malawi 2000 45.1 57.9 87.0 56.2 2.5 3.8 0.7 3.2 47.6 61.7 87.7 59.4 

Mali 2001 34.0 58.6 91.2 39.6 12.4 10.9 4.8 11.8 46.4 69.5 96.0 51.4 

Mozambique 2003 32.4 61.8 95.6 50.5 24.8 18.4 4.2 20.5 57.2 80.2 99.8 71.0 

Namibia 2000 47.6 69.7 89.3 77.2 11.9 10.3 5.1 7.8 59.5 80.0 94.4 85.0 

Nigeria 2003 11.2 43.6 72.3 34.6 22.6 19.3 12.1 19.1 33.8 62.9 84.4 53.7 

Rwanda 2000 13.2 25.7 69.2 25.7 2.6 3.9 1.7 3.2 15.8 29.6 70.9 28.9 

Uganda 2000 19.3 38.2 76.1 38.5 5.1 4.8 3.9 4.8 24.4 43.0 80.0 43.3 

Zambia 2001 18.4 39.4 79.4 46.1 11.6 14.6 7.7 12.5 30.0 54.0 87.1 58.6 

Zimbabwe 1999 45.9 64.8 86.2 74.2 23.4 14.3 7.5 11.5 69.3 79.1 93.7 85.7 

North Africa/West Asia/ 

 Europe 

Armenia 2000 0.0 0.0 92.5 92.5 0.0 0.0 5.1 5.1 0.0 0.0 97.6 97.6 

Egypt 2000 32.0 46.5 68.4 50.8 5.0 5.0 4.1 4.6 37.0 51.5 72.5 55.4 

Jordan 2002 90.4 95.2 97.8 97.3 0.5 0.8 1.0 0.9 90.9 96.0 98.8 98.2 

Central Asia 

Turkmenistan 2000 83.5 94.7 95.8 95.7 9.6 5.3 3.4 3.5 93.1 100 99.2 99.2 

South/Southeast Asia 

Bangladesh 2004 2.7 6.9 21.7 10.2 12.6 17.5 21.2 16.9 15.3 24.4 42.9 27.1 

Cambodia 2000 3.3 9.0 34.2 10.9 44.6 44.6 38.0 43.6 47.9 53.6 72.2 54.5 

Indonesia 2002-2003 10.6 25.0 60.4 41.0 67.7 61.4 35.0 49.3 78.3 86.4 95.4 90.3 

Nepal 2001 4.3 12.1 36.0 9.6 20.8 13.5 13.5 18.8 25.1 25.6 49.5 28.4 

Latin America/ 

 Caribbean 

Colombia 2000 61.8 75.8 96.6 87.6 8.4 3.7 0.8 2.1 70.2 79.5 97.4 89.7 

Dominican Republic 2002 91.5 98.3 99.2 98.5 3.6 0.9 0.7 0.9 95.1 99.2 99.9 99.4 

Haiti 2000 11.5 23.8 62.6 26.0 19.5 19.4 17.7 19.1 31.0 43.2 80.3 45.1 

Nicaragua 2001 39.0 66.3 93.4 71.2 14.0 10.8 3.5 8.7 53.0 77.1 96.9 79.9 

Peru 2000 14.5 30.6 81.6 58.0 18.7 21.6 8.3 13.9 33.2 52.2 89.9 71.9 

5.5 Postpartum Care and Household Wealth Status 

Table 5.5 presents the distribution of women who received postpartum care according to 

household wealth status. As expected, for women delivering at health facilities, the proportion receiving 

postpartum care is positively associated with household wealth. The differentials are especially marked 

for women in the highest wealth quintile in Bangladesh, Cambodia, Ethiopia, Haiti, Indonesia, Malawi, 

Mali, Rwanda, and Uganda, where levels of postpartum care are much higher than for women in the 

lower wealth quintiles. 
28

Table 5.5 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by household wealth status (wealth 

quintiles), DHS surveys 1999-2004 

Institutional births Noninstitutional births All births 

 Region and country Lowest Second Middle Fourth Highest Total Lowest Second Middle Fourth Highest Total Lowest Second Middle Fourth Highest Total

Sub-Saharan 

 Africa 

Benin 2001 57.1 67.6 82.3 91.8 98.2 78.2 12.8 8.1 5.8 2.8 0.9 6.4 69.9 75.7 88.1 94.6 99.1 84.6

Burkina Faso 2003 19.1 26.8 33.9 46.2 86.2 40.5 15.5 15.5 18.9 17.6 7.1 15.4 34.6 42.3 52.8 63.8 93.3 55.9

Cameroon 2004 28.8 44.1 69.7 86.2 92.5 62.0 21.5 20.2 11.4 6.6 4.1 13.4 50.3 64.3 81.1 92.8 96.6 75.4

Eritrea 2002 5.6 6.4 12.6 43.7 84.9 28.7 8.9 8.2 8.5 7.7 1.7 7.2 14.5 14.6 21.1 51.4 86.6 35.9

Ethiopia 2000 0.7 1.1 1.3 2.6 24.7 5.4 3.6 3.8 3.3 6.3 9.1 5.1 4.3 4.9 4.6 8.9 33.8 10.5

Ghana 2003 18.3 31.6 44.0 73.2 90.8 47.9 30.6 34.5 31.6 15.7 6.8 25.1 48.9 66.1 75.6 88.9 97.6 73.0

Kenya 2003 16.2 31.6 38.1 54.6 77.0 43.2 15.8 11.9 11.9 10.1 6.6 11.3 32.0 43.5 50.0 64.7 83.6 54.5

Madagascar 2003 19.0 23.5 32.9 42.4 54.5 33.0 31.1 30.4 29.7 25.2 29.2 29.3 50.1 53.9 62.6 67.6 83.7 62.3

Malawi 2000 46.8 49.7 52.0 52.5 81.9 56.2 3.4 3.8 4.1 3.0 1.5 3.2 50.2 53.5 56.1 55.5 83.4 59.4

Mali 2001 21.8 24.4 26.3 45.1 86.5 39.6 13.9 12.4 12.4 13.3 6.4 11.8 35.7 36.8 38.7 58.4 92.9 51.4

Mozambique 2003 25.3 34.3 44.6 70.5 90.6 50.5 24.3 26.7 22.7 18.9 7.8 20.5 49.6 61.0 67.3 89.4 98.4 71.0

Namibia 2000 56.2 65.4 78.8 86.0 96.5 77.2 10.9 10.2 8.7 6.9 2.7 7.8 67.1 75.6 87.5 92.9 99.2 85.0

Nigeria 2003 13.3 18.3 27.2 44.3 80.1 34.6 19.4 19.7 22.8 20.9 11.5 19.1 32.7 38.0 50.0 65.2 91.6 53.7

Rwanda 2000 15.7 15.9 17.0 22.0 58.4 25.7 3.9 3.2 2.6 3.8 2.5 3.2 19.6 19.1 19.6 25.8 60.9 28.9

Uganda 2000 18.6 25.1 32.2 44.4 79.5 38.5 5.4 4.4 4.1 5.9 4.0 4.8 24.0 29.5 36.3 50.3 83.5 43.3

Zambia 2001 20.1 22.9 36.0 69.4 91.7 46.2 12.6 15.9 15.1 12.0 5.0 12.5 32.7 38.8 51.1 81.4 96.7 58.7

Zimbabwe 1999 58.5 63.6 70.0 82.9 94.0 74.2 19.1 16.2 11.5 7.9 3.6 11.5 77.6 79.8 81.5 90.8 97.6 85.7

North Africa/West 

 Asia/Europe 

Armenia 2000 81.6 87.0 98.0 98.5 99.8 92.5 12.2 8.8 1.4 1.5 0.2 5.1 93.8 95.8 99.4 100.0 100.0 97.6

Egypt 2000 23.5 33.5 47.6 62.5 85.0 50.7 6.1 5.7 5.5 3.7 2.1 4.6 29.6 39.2 53.1 66.2 87.1 55.3

Jordan 2002 94.6 97.3 97.4 99.2 99.3 97.3 1.5 1.1 1.1 0.4 0.0 0.9 96.1 98.4 98.5 99.6 99.3 98.2

Central Asia 

Turkmenistan 2000 94.2 95.5 95.1 95.0 99.1 95.7 4.0 4.3 3.7 4.2 0.9 3.5 98.2 99.8 98.8 99.2 100.0 99.2

South/Southeast 

 Asia 

Bangladesh 2004 1.9 3.5 5.6 12.3 32.7 10.2 12.7 16.2 15.6 21.3 20.3 16.9 14.6 19.7 21.2 33.6 53.0 27.1

Cambodia 2000 2.1 3.3 5.1 9.1 48.6 10.9 42.4 45.8 44.1 49.1 34.6 43.6 44.5 49.1 49.2 58.2 83.2 54.5

Indonesia 2002-2003 11.6 25.5 38.6 54.2 81.4 41.0 68.6 63.2 52.3 40.9 16.8 49.3 80.2 88.7 90.9 95.1 98.2 90.3

Nepal 2001 1.9 3.2 5.4 9.7 36.9 9.6 12.0 19.3 29.6 19.0 14.9 18.8 13.9 22.5 35.0 28.7 51.8 28.4

Latin America/ 

 Caribbean 

Colombia 2000 64.6 85.8 95.0 97.4 98.4 87.5 5.6 3.1 0.9 0.2 0.1 2.1 70.2 88.9 95.9 97.6 98.5 89.6

Dominican 

 Republic 2002 u u u u u 98.4 u u u u u 0.9 u u u u u 99.3

Haiti 2000 3.9 10.5 13.1 38.0 68.4 25.9 19.7 19.7 23.3 21.3 10.1 19.1 23.6 30.2 36.4 59.3 78.5 45.0

Nicaragua 2001 32.8 64.0 83.4 91.1 96.3 71.0 14.4 12.0 7.2 5.3 2.1 8.7 47.2 76.0 90.6 96.4 98.4 79.7

Peru 2000 16.0 41.0 73.7 89.5 96.3 58.0 20.4 20.8 13.4 6.0 2.0 13.9 36.4 61.8 87.1 95.5 98.3 71.9

u = Unknown (information not available) 

The situation is reversed for noninstitutional births. The proportion of women receiving 

postpartum care is lowest among women in the highest wealth quintile (except in Bangladesh, 

Madagascar, and Nepal). Percentages receiving postpartum care are similar for the remaining wealth 

quintiles in several countries. It is unclear why women in more affluent households are less likely to 

obtain postpartum care than their counterparts in the lower wealth quintiles. While not obtaining 

postpartum care may be a matter of choice on the part of some women, it may also be that outreach 

programs are targeting women with fewer resources. 

The situation for all births is similar to that of institutional births. The prevalence of postpartum 

care rises gradually from lowest to highest wealth quintile, except in Armenia, Jordan, and Turkmenistan, 

where postpartum care coverage is almost universal. Some differentials are moderate, as in Benin, 

Colombia, Indonesia, Namibia, and Zimbabwe. Large differentials are seen in 16 countries, where women 
29

in the highest quintile are two to three times more likely to receive postpartum care than women in the 

lowest wealth quintile. In Bangladesh, Nepal, and Uganda the differences are fourfold. 

Eritrea and Ethiopia present an interesting situation. While the differentials in postpartum care 

between women in the lowest and highest wealth quintiles are the largest overall—a six- to eightfold 

difference (from 15 to 87 percent in Eritrea and from 4 to 34 percent in Ethiopia)—there are only small 

differentials between the lowest and middle quintiles. 

In Ethiopia, the lowest, second, and middle wealth quintiles show an almost unchanging level of 

postpartum care (4.3, 4.9, 4.6, respectively), improving to only 9 percent for women in the fourth quintile, 

and reaching just one-third of women in the highest wealth quintile. Such low levels of postpartum care, 

even among women in the most affluent households, indicate limited availability of postpartum care 

services. 

Appendix Table A.4 shows the differentials in postpartum care by wealth quintile and type of 

provider.

5.6 Postpartum Care and Antenatal Care 

It is reasonable to assume that exposure to the formal health care system will influence whether a 

woman receives postpartum care after giving birth. For example, Mishra and Retherford (2006) found that 

receipt of antenatal care has a large effect on institutional delivery in India. Table 5.6 examines the 

association between receipt of antenatal care and receipt of postpartum care. As expected, women who 

received antenatal care for the last birth in the past five years and whose last birth was at a health facility, 

were much more likely to have received postpartum care than other women. This relationship is very 

strong, especially in Bangladesh, Burkina Faso, Cambodia, Ethiopia, Madagascar, Nepal, and Nigeria, 

where receipt of antenatal care is associated with some level of postpartum care, while lack of exposure to 

antenatal care is associated with negligible levels of postpartum care. 

Among women who delivered at home, the relationship is less clear. There are eight countries 

where receipt of antenatal care is associated with receipt of postpartum care. However, the relationship is 

reversed in five countries, and in 14 countries there does not seem to be any association at all, or there are 

insufficient numbers to determine the relationship. When the differentials are examined by type of 

provider of postpartum care (Appendix Table A.5), in five of the eight countries that showed a positive 

relationship between antenatal care and postpartum care, the association is reversed when the providers 

are TBA/others. Similarly, in the five countries that showed a negative relationship, the association is 

reversed in three—i.e., antenatal care is positively related to receiving postpartum care—if the provider is 

a health professional. In the other countries, there are insufficient numbers or the relationship is unclear. 

The situation for all births is the same as for institutional births. There is a strong association 

between antenatal care and postpartum care. The exceptions are Armenia, the Dominican Republic, 

Jordan, and Turkmenistan, where differentials are small. A small influence was also observed for 

Cambodia and Indonesia, where receipt of antenatal care increases the likelihood of receiving postpartum 

care by only 38 and 44 percent, respectively. In 18 other countries, receiving antenatal care increases the 

likelihood of receiving postpartum care two to three times. The association is particularly strong in 

Burkina Faso, Eritrea, Ethiopia, Malawi, Mozambique, and Uganda, where women are four to five times 

more likely to receive postpartum care if they have previously received antenatal care. 
30

Table 5.6 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by whether they received antenatal care 

and by the number of antenatal care visits, DHS surveys 1999-2004 

Institutional births Noninstitutional births All births 

 

 

Number of antenatal 

care visits 

Number of antenatal 

care visits 

Number of antenatal 

care visits 

 Antenatal 

care 

Antenatal

care 

Antenatal 

care 

Region and country No Yes 0 1-3 4+ 

Don’t 

know/ 

missing Total No Yes 0 1-3 4+ 

Don’t 

know/ 

missing Total No Yes 0 1-3 4+ 

Don’t 

know/ 

missing Total

Sub-Saharan 

 Africa

Benin 2001 25.7 85.5 10.9 75.7 89.8 72.0 78.2 12.4 5.6 12.6 9.2 4.3 5.2 6.4 38.1 91.1 23.5 84.9 94.1 77.2 84.6 

Burkina Faso 2003 3.8 53.6 3.7 50.2 63.8 52.5 40.5 11.1 17.0 10.9 17.1 16.6 19.0 15.4 14.9 70.6 14.6 67.3 80.4 71.5 55.9 

Cameroon 2004 10.9 72.0 10.2 55.1 78.5 53.4 62.0 25.5 11.0 25.7 16.8 8.7 17.1 13.4 36.4 83.0 35.9 71.9 87.2 70.5 75.4 

Eritrea 2002 7.2 37.4 7.1 14.9 53.9 18.5 28.7 5.6 7.8 5.6 9.0 6.6 23.8 7.2 12.8 45.2 12.7 23.9 60.5 42.3 35.9 

Ethiopia 2000 1.4 16.2 1.4 6.9 30.1 21.8 5.4 3.5 9.3 3.4 8.1 10.9 19.5 5.1 4.9 25.5 4.8 15.0 41.0 41.3 10.5 

Ghana 2003 10.0 50.6 10.4 20.7 59.2 54.5 47.9 18.0 25.6 17.9 36.3 22.3 26.7 25.1 28.0 76.2 28.3 57.0 81.5 81.2 73 

Kenya 2003 11.1 46.8 10.3 35.5 54.3 48.0 43.2 9.6 11.5 8.3 13.0 10.2 19.4 11.3 20.7 58.3 18.6 48.5 64.5 67.4 54.5 

Madagascar 2003 3.0 38.9 2.8 30.1 47.9 38.0 33.0 24.0 30.4 23.8 28.5 32.2 33.1 29.3 27.0 69.3 26.6 58.6 80.1 71.1 62.3 

Malawi 2000 13.5 58.3 12.4 53.7 61.5 52.0 56.2 3.2 3.2 3.1 3.5 3.0 2.4 3.2 16.7 61.5 15.5 57.2 64.5 54.4 59.4 

Mali 2001 9.3 62.2 9.0 47.2 72.1 68.4 39.6 13.3 10.7 13.4 13.9 8.7 8.8 11.8 22.6 72.9 22.4 61.1 80.8 77.2 51.4 

Mozambique 2003 6.5 58.2 5.1 45.3 65.4 67.4 50.5 11.3 22.2 11.4 24.5 20.8 18.7 20.5 17.8 80.4 16.5 69.8 86.2 86.1 71.0 

Namibia 2000 28.4 81.0 26.7 68.4 83.1 81.8 77.2 10.3 7.6 8.0 10.1 7.2 8.6 7.8 38.7 88.6 34.7 78.5 90.3 90.4 85.0 

Nigeria 2003 4.0 52.8 3.7 27.8 58.1 71.2 34.6 19.5 18.9 19.4 21.0 19.4 9.7 19.1 23.5 71.7 23.1 48.8 77.5 80.9 53.7 

Rwanda 2000 8.5 27.1 7.4 24.5 47.4 27.9 25.7 2.1 3.3 2.2 3.3 3.9 0.0 3.2 10.6 30.4 9.6 27.8 51.3 27.9 28.9 

Uganda 2000 8.4 40.6 7.8 28.7 54.0 55.2 38.5 2.2 4.9 2.3 4.8 5.2 1.9 4.8 10.6 45.5 10.1 33.5 59.2 57.1 43.3 

Zambia 2001 9.5 48.3 7.4 30.6 52.9 56.1 46.2 10.3 12.6 11.5 11.6 13.1 5.0 12.5 19.8 60.9 18.9 42.2 66.0 61.1 58.7 

Zimbabwe 1999 31.8 77.0 34.5 67.5 77.5 83.1 74.2 7.4 11.8 5.5 13.5 12.0 8.9 11.5 39.2 88.8 40.0 81.0 89.5 92.0 85.7 

North Africa/West 

 Asia/Europe 

Armenia 2000 66.0 94.6 65.1 86.8 97.7 92.8 92.5 18.2 4.1 18.7 10.2 1.7 4.8 5.1 84.2 98.7 83.8 97.0 99.4 97.6 97.6 

Egypt 2000 29.0 68.0 29.0 43.2 75.3 76.9 50.7 5.2 4.2 5.2 5.2 3.8 4.5 4.6 34.2 72.2 34.2 48.4 79.1 81.4 55.3 

Jordan 2002 86.3 97.5 86.8 91.2 97.9 100.0 97.3 1.1 0.9 0.6 1.7 0.9 0.0 0.9 87.4 98.4 87.4 92.9 98.8 100.0 98.2 

Central Asia 

Turkmenistan 2000 79.8 96.0 77.9 86.5 96.3 96.8 95.7 7.8 3.4 8.5 11.7 3.0 3.2 3.5 87.6 99.4 86.4 98.2 99.3 100.0 99.2 

South/Southeast 

 Asia 

Bangladesh 2004 2.2 18.6 2.2 9.5 34.5 24.7 10.2 13.6 20.4 12.1 19.7 23.4 0.0 16.9 15.8 39.0 14.3 29.2 57.9 24.7 27.1 

Cambodia 2000 3.3 20.2 3.3 15.6 40.3 3.3 10.9 43.3 44.1 43.3 45.2 42.8 22.1 43.6 46.6 64.3 46.6 60.8 83.1 25.4 54.5 

Indonesia 

 2002-2003 10.1 42.6 8.4 14.9 47.3 36.0 41.0 53.6 49.1 52.6 66.7 46.0 57.6 49.3 63.7 91.7 61.0 81.6 93.3 93.6 90.3 

Nepal 2001 1.8 17.8 1.8 8.5 40.1 26.4 9.6 13.8 24.0 13.7 26.9 16.7 45.4 18.8 15.6 41.8 15.5 35.4 56.8 71.8 28.4 

Latin America/ 

 Caribbean 

Colombia 2000 48.4 91.5 48.0 71.8 94.1 89.0 87.5 3.6 2.0 3.6 3.1 1.8 5.5 2.1 52.0 93.5 51.6 74.9 95.9 94.5 89.6 

Dominican 

 Republic 2002 88.1 98.7 80.3 93.1 98.9 97.4 98.4 3.3 0.8 3.5 2.5 0.8 1.5 0.9 91.4 99.5 83.8 95.6 99.7 98.9 99.3 

Haiti 2000 9.6 29.9 9.4 15.0 41.6 41.4 25.9 13.9 20.4 13.6 22.1 19.0 21.8 19.1 23.5 50.3 23.0 37.1 60.6 63.2 45.0 

Nicaragua 2001 28.9 78.0 28.9 57.6 81.8 77.6 71.0 11.4 8.2 11.4 12.4 7.5 7.7 8.7 40.3 86.2 40.3 70.0 89.3 85.3 79.7 

Peru 2000 17.4 66.2 17.6 37.1 72.0 41.7 58.0 13.4 14.1 11.9 19.8 13.0 16.0 13.9 30.8 80.3 29.5 56.9 85.0 57.7 71.9 

Table 5.6 also shows the likelihood of a women receiving postpartum care by the number of 

antenatal care (ANC) visits (none, 1-3, and 4+). The pattern is similar to that described above for the 

relationship between receipt of antenatal care and receipt of postpartum care, except that the association 

between the two extremes (no visits versus 4+ visits) is even stronger. Still, the biggest differential is 

between women who have had no ANC visits and those who have had one to three visits, which 

highlights the importance of having even one ANC visit. For institutional births, four or more visits are 

associated with the highest level of postpartum care. For noninstitutional births, the pattern is less clear. 

Analysis of postpartum care by number of antenatal care visits (1-3 versus 4+) identifies an unusual 

pattern. In almost half (13) of the countries, women with four or more antenatal care visits are less likely 

to receive postpartum care than women with one to three visits. This relationship persists, even when the 

data are distributed by type of provider (Appendix Table A.5), except in Haiti, Indonesia, and Nepal, 

where having more ANC visits is related to increased postpartum care if that care was provided by a 

health professional. Interpreting these findings is difficult because they suggest that increased ANC visits 
31

(in some situations) are not necessarily related to increased postpartum care or that more ANC visits 

among women who deliver at home may be associated with less postpartum care. 

It should be noted that the “don’t know/missing” category in Table 5.6 often produces levels of 

postpartum care between the 1-3 and 4+ categories, or similar to the 4+ category. 

5.7 Postpartum Care and Media Exposure 

The DHS questionnaire asked women who had a live birth in the five years preceding the survey 

whether they read newspapers, listen to the radio, and watch television.14 Answers to these questions 

provide an estimate of women’s exposure to mass media. Table 5.7 shows the percentage of women who 

received postpartum care by whether they were exposed to each of the three types of mass media. For 

institutional births, women exposed to mass media were much more likely to have received postpartum 

care than those who were not exposed to mass media. In a few countries with high levels of postpartum 

care, such as the Dominican Republic, Jordan, and Turkmenistan, no relationship was found between 

receipt of postpartum care and exposure to mass media. 

For noninstitutional births, the relationship was the reverse. Women who delivered at home and 

had no exposure to mass media generally had higher levels of postpartum care than those who were 

exposed to mass media. Results for all births were similar to those for institutional births. In countries 

such as Armenia, Benin, the Dominican Republic, Indonesia, Jordan, Turkmenistan, and Zimbabwe, 

exposure to mass media does not appear to be associated with increased postpartum care. 

In all other countries, the differentials in levels of postpartum care by exposure to newspapers, 

radio, and television vary, but are always higher for exposed women. For newspapers, the difference 

between exposed women and nonexposed women ranges from about 30 percent (e.g., Cambodia, Malawi, 

and Nicaragua) to two or three times the level for nonexposed women (e.g., Mali, Rwanda, Peru). The 

contrast is greatest in Ethiopia, where postpartum care is nearly six times higher for women who read the 

newspaper than for those who do not. Radio has slightly less influence on levels of postpartum care, but is 

still higher for women who listen to the radio than those who do not. Differentials for radio are highest in 

Ethiopia (3.5 times), Rwanda (2.0 times), and Uganda (1.9 times). 

 

14 The actual questions are: “Do you read a newspaper or magazine[/listen to the radio][/watch television] almost 

every day, once a week, less than once a week, or not at all?” The first three answers were recoded as yes and the 

fourth as no. 
32

Table 5.7 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by media exposure, DHS surveys 

1999-2004 

 Institutional births Noninstitutional births All births 

 

Newspaper Radio Television Newspaper Radio Television Newspaper Radio Television 

Region and country Yes No Yes No Yes No Total Yes No Yes No Yes No Total Yes No Yes No Yes No Total 

Sub-Saharan Africa 

Benin 2001 96.1 76.9 81.8 61.9 92.5 73.8 78.2 1.1 6.8 5.2 11.8 2.9 7.5 6.4 97.2 83.7 87.0 73.7 95.4 81.3 84.6 

Burkina Faso 2003 92.6 37.7 46.9 26.2 69.9 33.0 40.5 5.1 16.0 15.3 15.7 14.0 15.8 15.4 97.7 53.7 62.2 41.9 83.9 48.8 55.9 

Cameroon 2004 87.6 55.1 72.9 46.7 84.0 47.5 62.0 5.9 15.4 9.7 18.5 7.1 17.5 13.4 93.5 70.5 82.6 65.2 91.1 65.0 75.4 

Eritrea 2002 69.2 42.8 38.0 10.7 80.9 15.7 28.7 4.4 7.3 7.1 7.4 2.8 8.3 7.2 73.6 50.1 45.1 18.1 83.7 24.0 35.9 

Ethiopia 2000 33.0 3.6 15.1 2.2 38.1 3.3 5.4 12.3 4.6 7.5 4.2 9.1 4.8 5.1 45.3 8.2 22.6 6.4 47.2 8.1 10.5 

Ghana 2003 81.8 44.3 51.8 27.4 65.6 31.3 47.9 12.4 26.5 24.7 26.8 19.3 30.5 25.1 94.2 70.8 76.5 54.2 84.9 61.8 73.0 

Kenya 2003 61.5 33.4 47.8 22.8 68.2 32.8 43.2 10.5 11.7 11.0 12.6 8.1 12.6 11.3 72.0 45.1 58.8 35.4 76.3 45.4 54.5 

Madagascar 2003 50.0 27.5 40.9 20.8 55.2 27.6 33.0 29.9 29.2 29.6 29.0 27.1 29.9 29.3 79.9 56.7 70.5 49.8 82.3 57.5 62.3 

Malawi 2000 69.9 51.4 59.3 46.8 72.4 54.6 56.2 3.6 3.0 3.4 2.6 3.4 3.2 3.2 73.5 54.4 62.7 49.4 75.8 57.8 59.4 

Mali 2001 87.5 37.0 45.2 23.1 66.3 25.5 39.6 5.3 12.2 11.7 12.3 9.5 13.1 11.8 92.8 49.2 56.9 35.4 75.8 38.6 51.4 

Mozambique 2003 89.1 45.9 52.6 40.5 81.1 40.1 50.5 6.8 22.2 20.2 22.2 12.1 23.4 20.5 95.9 68.1 72.8 62.7 93.2 63.5 71.0 

Namibia 2000 89.0 65.3 80.7 62.3 93.2 68.2 77.2 6.1 9.4 7.6 9.0 3.0 10.5 7.8 95.1 74.7 88.3 71.3 96.2 78.7 85.0 

Nigeria 2003 73.6 27.4 39.4 21.8 59.6 20.4 34.6 13.7 20.0 19.1 19.4 16.6 20.5 19.1 87.3 47.4 58.5 41.2 76.2 40.9 53.7 

Rwanda 2000 47.0 21.1 33.0 15.9 64.7 21.8 25.7 2.7 3.4 3.5 2.8 2.4 3.3 3.2 49.7 24.5 36.5 18.7 67.1 25.1 28.9 

Uganda 2000 74.5 33.1 50.1 24.6 78.4 34.9 38.5 4.2 4.8 5.3 4.2 3.6 4.9 4.8 78.7 37.9 55.4 28.8 82.0 39.8 43.3 

Zambia 2001 78.7 39.4 59.4 30.8 81.5 34.5 46.2 8.1 13.4 11.0 14.3 8.2 13.9 12.5 86.8 52.8 70.4 45.1 89.7 48.4 58.7 

Zimbabwe 1999 87.7 65.6 79.3 67.5 87.8 68.4 74.2 6.0 15.0 10.2 13.1 5.7 14.0 11.5 93.7 80.6 89.5 80.6 93.5 82.4 85.7 

North Africa/West 

 Asia/Europe 

Armenia 2000 95.1 86.6 97.0 88.7 93.4 76.3 92.5 3.9 8.0 2.3 7.5 4.5 16.4 5.1 99.0 94.6 99.3 96.2 97.9 92.7 97.6 

Egypt 2000 69.2 39.1 53.8 37.0 52.0 31.7 50.7 4.3 4.8 4.3 6.1 4.5 5.7 4.6 73.5 43.9 58.1 43.1 56.5 37.4 55.3 

Jordan 2002 97.9 95.8 97.6 96.9 97.1 98.4 97.3 0.9 1.1 1.0 0.8 1.0 0.5 0.9 98.8 96.9 98.6 97.7 98.1 98.9 98.2 

Central Asia 

Turkmenistan 2000 97.1 94.4 96.5 95.3 96.1 90.0 95.7 2.7 4.2 2.6 3.9 3.2 7.6 3.5 99.8 98.6 99.1 99.2 99.3 97.6 99.2 

South/Southeast Asia 

Bangladesh 2004 29.6 6.5 11.9 8.9 15.4 4.3 10.2 21.5 16.0 19.5 14.7 18.1 15.3 16.9 51.1 22.5 31.4 23.6 33.5 19.6 27.1 

Cambodia 2000 27.6 6.0 13.8 5.6 14.4 4.2 10.9 40.3 44.7 44.4 42.3 42.4 45.9 43.6 67.9 50.7 58.2 47.9 56.8 50.1 54.5 

Indonesia 2002-2003 54.4 28.2 43.9 33.0 43.6 15.6 41.0 40.0 58.1 47.7 53.6 48.1 60.7 49.3 94.4 86.3 91.6 86.6 91.7 76.3 90.3 

Nepal 2001 u u u u u u 9.6 u u u u u u 18.8 u u u u u u 28.4 

Latin America/ 

 Caribbean 

Colombia 2000 u u u u u u 87.5 u u u u u u 2.1 u u u u u u 89.6 

Dominican Republic 2002 99.1 97.8 98.8 96.9 99.1 93.8 98.4 0.8 1.0 0.7 1.8 0.6 2.8 0.9 99.9 98.8 99.5 98.7 99.7 96.6 99.3 

Haiti 2000 44.5 17.9 31.1 10.8 49.2 13.2 25.9 21.4 18.1 19.0 19.5 16.6 20.5 19.1 65.9 36.0 50.1 30.3 65.8 33.7 45.0 

Nicaragua 2001 85.7 58.6 73.9 57.3 88.2 44.0 71.0 5.6 11.4 8.0 12.1 5.3 14.1 8.7 91.3 70.0 81.9 69.4 93.5 58.1 79.7 

Peru 2000 71.2 21.4 59.4 37.0 68.0 16.3 58.0 11.3 21.2 13.8 15.7 12.1 21.6 13.9 82.5 42.6 73.2 52.7 80.1 37.9 71.9 

u = Unknown (information not available) 

5.8 Postpartum Care and Women’s Status 

Table 5.8 shows the proportion of women who received postpartum care by three indicators of 

women’s status: sex of head of household, current employment status, and whether the woman 

participates in decisionmaking regarding her own health care. Overall, the results were mixed and none of 

the three indicators of women’s status showed a clear pattern of relationship with the proportion of 

women receiving postpartum care. 

Analyses so far have focused on the bivariate relationship between the likelihood of receiving 

postpartum care and various background characteristics. The next section presents a multivariate analysis 

of postpartum care with these same characteristics, to identify the most important and consistent 

characteristics. 
Table 5.8 Proportion of women who received postpartum care for the most recent live birth in the five years preceding the survey, by sex of head of household, employment status, and participation in health care 

decisionmaking, DHS surveys 1999-2004

Institutional births Noninstitutional births All births 

Health care 

decisionmaking 

Health care 

decisionmaking 

Health care 

decisionmaking 

Employment 

status 

Employment 

status 

Employment 

status Sex of 

head of 

houshold 

Sex of 

head of 

household 

Sex of 

head of 

household 

 Female Male 

Working 

Not 

working Woman herself

Jointly

wity 

spouse

or 

other 

person

Other 

person Total Female Male

Working 

Not

working Woman herself 

Jointly 

wity 

spouse

or 

other 

person 

Other 

person Total Female Male

Working 

Not

working Woman herself

Jointly

wity 

spouse

or 

other 

person

Other

person Total 

Sub-Saharan  Africa

Benin 2001 88.7 76.6 77.6 83.6 83.0 81.2 76.2 78.2 4.1 6.8 6.6 5.0 5.9 4.4 7.0 6.4 92.8 83.4 84.2 88.6 88.9 85.6 83.2 84.6 

Burkina Faso 2003 54.2 39.7 37.8 67.8 55.9 40.0 38.7 40.5 17.1 15.3 16.2 6.8 12.9 16.5 15.6 15.4 71.3 55.0 54.0 74.6 68.8 56.5 54.3 55.9 

Cameroon 2004 76.3 58.7 59.3 67.3 74.0 61.3 58.6 62.0 10.6 14.0 14.0 12.1 10.7 12.5 14.3 13.4 86.9 72.7 73.3 79.4 84.7 73.8 72.9 75.4 

Eritrea 2002 31.4 26.6 48.7 25.1 30.5 19.4 21.9 28.7 7.2 7.2 7.1 7.2 6.9 9.1 7.9 7.2 38.6 33.8 55.8 32.3 37.4 28.5 29.8 35.9 Ethiopia 2000 9.0 4.8 5.3 5.6 u u u 5.4 6.6 4.8 4.5 5.8 u u u 5.1 15.6 9.6 9.8 11.4 u u u 10.5 

Ghana 2003 60.5 43.0 46.8 55.3 48.5 53.3 44.9 47.9 23.7 25.6 25.3 23.6 25.4 24.9 24.9 25.1 84.2 68.6 72.1 78.9 73.9 78.2 69.8 73.0 

Kenya 2003 43.5 43.1 44.7 41.1 49.2 42.1 38.3 43.2 10.4 11.7 13.2 8.1 10.5 10.1 12.4 11.3 53.9 54.8 57.9 49.2 59.7 52.2 50.7 54.5 Madagascar 2003 30.6 33.4 31.5 40.9 32.7 35.3 27.1 33.0 32.9 28.7 29.5 28.6 33.0 28.3 25.4 29.3 63.5 62.1 61.0 69.5 65.7 63.6 52.5 62.3 

Malawi 2000 55.4 56.4 54.5 58.4 56.8 61.0 55.5 56.2 3.5 3.1 3.6 2.7 2.8 3.6 3.3 3.2 58.9 59.5 58.1 61.1 59.6 64.6 58.8 59.4 

Mali 2001 46.8 39.0 40.4 38.3 45.0 42.4 38.8 39.6 11.9 11.8 11.5 12.4 10.6 6.5 12.3 11.8 58.7 50.8 51.9 50.7 55.6 48.9 51.1 51.4 

Mozambique 2003 54.8 49.2 45.1 67.6 50.9 47.7 51.2 50.5 20.6 20.5 21.3 18.0 21.4 19.2 20.2 20.5 75.4 69.7 66.4 85.6 72.3 66.9 71.4 71.0 

Namibia 2000 81.4 73.6 85.2 72.9 u u u 77.2 7.7 7.9 5.4 9.1 u u u 7.8 89.1 81.5 90.6 82.0 u u u 85.0 Nigeria 2003 51.5 32.8 39.2 26.6 55.5 60.0 28.0 34.6 16.9 19.3 18.6 20 14.4 13.3 20.6 19.1 68.4 52.1 57.8 46.6 69.9 73.3 48.6 53.7 

Rwanda 2000 23.3 26.5 23.0 43.9 25.9 23.7 26.7 25.7 3.4 3.2 3.2 3.5 3.1 2.6 3.6 3.2 26.7 29.7 26.2 47.4 29.0 26.3 30.3 28.9 Uganda 2000 41.6 37.6 36.0 47.0 42.1 35.8 35.2 38.5 5.2 4.7 5.0 4.1 4.9 3.5 5.1 4.8 46.8 42.3 41.0 51.1 47.0 39.3 40.3 43.3 Zambia 2001 46.2 46.2 41.3 53.3 52.2 36.9 44.2 46.2 11.1 12.8 14.5 9.6 10.7 22.9 11.7 12.5 57.3 59.0 55.8 62.9 62.9 59.8 55.9 58.7 

Zimbabwe 1999 73.4 74.7 74.1 74.4 76.3 77.1 70.7 74.2 11.2 11.6 11.7 11.2 12.0 8.2 11.7 11.5 84.6 86.3 85.8 85.6 88.3 85.3 82.4 85.7 

North Africa/ West Asia/Europe 

Armenia 2000 93.0 92.3 87.9 93.7 93.2 93.1 90.7 92.5 3.6 5.6 8.3 4.3 5.2 5.5 4.7 5.1 96.6 97.9 96.2 98.0 98.4 98.6 95.4 97.6 

Egypt 2000 52.5 50.8 64.5 48.5 55.7 57.8 43.1 50.8 4.5 4.6 4.2 4.7 4.2 4.3 5.0 4.6 57.0 55.4 68.7 53.2 59.9 62.1 48.1 55.4 

Jordan 2002 97.6 97.2 98.6 97.2 97.5 97.0 97.0 97.3 0.3 1.0 0.3 1.0 1.0 0.9 0.6 0.9 97.9 98.2 98.9 98.2 98.5 97.9 97.6 98.2 

Central Asia

Turkmenistan 2000 96.5 95.5 96.6 95.0 95.0 95.5 97.6 95.7 2.6 3.7 2.8 4.0 4.2 3.7 1.6 3.5 99.1 99.2 99.4 99.0 99.2 99.2 99.2 99.2 

South/Southeast  Asia

Bangladesh 2004 10.2 10.2 7.4 10.8 10.5 12.1 9.2 10.2 16.7 16.9 14.6 17.4 16.4 18.5 16.2 16.9 26.9 27.1 22.0 28.2 26.9 30.6 25.4 27.1 

Cambodia 2000 15.3 10.0 10.0 13.0 u u u 10.9 40.6 44.2 44.8 40.7 u u u 43.6 55.9 54.2 54.8 53.7 u u u 54.5 

Indonesia 2002-2003 48.9 40.4 37.4 43.3 42.2 43.2 31.7 41.0 43.4 49.7 51.1 48.1 48.7 46.5 58.0 49.3 92.3 90.1 88.5 91.4 90.9 89.7 89.7 90.3 

Nepal 2001 10.0 9.6 7.2 20.8 12.0 11.7 8.9 9.6 12.2 19.7 15.3 35.0 12.4 19.1 19.8 18.8 22.2 29.3 22.5 55.8 24.4 30.8 28.7 28.4 

Latin America/  Caribbean

Colombia 2000 88.5 87.4 89.3 86.2 89.2 85.6 81.1 87.6 1.4 2.3 2.2 2.1 1.7 3.0 3.5 2.1 89.9 89.7 91.5 88.3 90.9 88.6 84.6 89.7 Dominican Republic  2002 98.3 98.6 99.1 98.3 u u u 98.5 1.3 0.7 0.6 1.0 u u u 0.9 99.6 99.3 99.7 99.3 u u u 99.4 

Haiti 2000 31.7 22.1 23.4 29.0 24.9 27.2 26.2 26.0 18.4 19.6 21.9 16 22.2 18.6 18.1 19.1 50.1 41.7 45.3 45.0 47.1 45.8 44.3 45.1 

Nicaragua 2001 80.5 67.6 79.5 66.9 76.7 68.4 60.2 71.2 7.5 9.1 7.3 9.4 7.0 9.8 11.8 8.7 88.0 76.7 86.8 76.3 83.7 78.2 72.0 79.9

Peru 2000 70.4 56.1 54.6 62.0 68.9 45.6 36.8 58.0 11.4 14.3 15.7 11.8 11.6 18.2 16.7 13.9 81.8 70.4 70.3 73.8 80.5 63.8 53.5 71.9 

u = Unknown (information not available) 

 33
34

6 Multivariate Analysis 

The preceding bivariate analyses identified several factors associated with women’s receipt of 

postpartum care. The next step is to select a representative group of countries for the multivariate analysis 

and define the variables that will be included in the multivariate model. 

6.1 Country Selection 

Throughout the bivariate analyses in previous sections, a few countries either had consistently 

low levels of postpartum care or showed important contrasts when women’s characteristics were 

considered. For the multivariate analysis, nine countries were selected as follows: 15

Sub-Saharan Africa: Burkina Faso, Ethiopia, and Rwanda 

North Africa/West Asia/Europe/Central Asia: Egypt 

South/Southeast Asia: Cambodia, Indonesia, and Nepal 

Latin America/Caribbean: Haiti and Peru 

6.2 Variables for the Multivariate Model 

6.2.1 Dependent Variable 

The dependent variable was receiving (or not receiving) postpartum care by place of birth and 

provider of care, and had values for the following four categories: delivery in a health facility (woman is 

assumed to have received postpartum care), postpartum care by health professional among noninstitutional births, postpartum care by TBA/other among noninstitutional births, and no postpartum care 

(the reference category). These items correspond to columns 1, 2, 3, and 5, respectively, in Table 4.1. 

6.2.2 Independent Variables 

Nine independent variables were selected, based on their association with postpartum care in the 

bivariate analyses. They represent different correlates of women’s characteristics (as indicated in the 

conceptual framework in Figure 1.1) and are described in Table 6.1. 

Because the two variables around antenatal care (whether ANC was received and the number of 

ANC visits) are similar (both include “not receiving antenatal care”), it was decided to include only the 

second variable in the model. Likewise, the variables around delivery (i.e., place where delivery occurred 

and provider at delivery) are not included because they are already part of the dependent variable. They 

would be highly significant in the final model, but would not necessarily add explanation to it. 

 

15 Although not following a particular procedure, countries selected were largely considered representative of their 

regions and had sufficient numbers in all categories of the dependent variable to allow for analysis. They had 

different levels of institutional births. They also had sufficient numbers and proportions of births not receiving 

postpartum care to allow for analysis. Haiti is considered a unique country in Latin America and represents the 

Caribbean, while Peru was selected to represent the Spanish-speaking countries of Central and South America, 

where large contrasts were found in the bivariate analyses. Finally, given their programmatic efforts in maternal 

health and community outreach, the South/Southeast Asian region was overrepresented with three countries. See 

Appendix Table A.6 for more details on the countries selected. 
35

Table 6.1 Independent variables included in the multivariate analysis model

Dimension Variable Values 

1 Residence Urban, rural 

2 Woman’s employment Not working, working 

3 Birth order (representing parity) 1, 2-4, 5+ 

4 Woman’s education None, primary, secondary+ 

Sociodemographic factors

5 Wealth (quintiles) Lowest, second, middle, fourth, highest 

Exposure to health care 6 Number of antenatal care visits 0 (no antenatal care), 1-3, 4+, 

 don’t know/missing 

Media contact 7 Newspapers Yes, no 

 8 Television Yes, no 

Status—health care 

 decisionmaking 

9 Woman’s health care 

 decisionmaking 

Self, jointly, others 

6.3 Results of Multivariate Analysis 

Table 6.2 presents the results of the multinomial logistic regression applied to the nine selected 

countries. It shows the effects of the nine independent variables that were most consistently associated 

with postpartum care in the bivariate analysis, on the various modalities of postpartum care described 

above. For each of the countries, effects are calculated for the “full” model, the one in which all nine 

explanatory variables have been added to the equation. 

Effects are estimated through relative risk ratios (RRRs). Relative risks are predicted probabilities 

based on the fitted multinomial model, and can be represented as P1/P4, P2/P4, and P3/P4, where: 

P1 is the probability of postpartum care by TBA/others among noninstitutional births, 

P2 is the probability of postpartum care by a health professional among noninstitutional births, 

P3 is the probability of postpartum care through institutional births, and 

P4 is the probability of receiving no postpartum care. 

P4 has been arbitrarily designated as the reference category in this analysis. In Table 6.2, P1/P4 is 

column 1, P2/P4 is column 2, and P3/P4 is column 3. The RRRs in each column are, in turn, estimated for 

each of the categories of the nine explanatory variables, choosing one value as the reference category. For 

example, in Table 6.2 for Burkina Faso, the RRR 2.88 in column 3 for the residence variable is the ratio 

of P3/P4 —t he probability of having postpartum care in an institutional birth over not receiving 

postpartum care — for urban residence compared with the P3/P4 probability for rural residence (RRR of 

1.00). Because the dependent variable has more than two categories, relative risks are not complementary, 

that is, they do not add up to one as in the case of a binary dependent variable, where P + (1 – P) = 1. 

Results need to be interpreted with caution because RRRs can be affected by dissimilar increases or 

reductions in individual p-values. However, in our examples, RRRs for each explanatory variable provide 

an idea of the likelihood of receiving postpartum care services by background characteristics of women. 
36

Table 6.2 Effects (relative risk ratios) of women’s background characteristics on postpartum care: multinomial 

logistic regression for nine developing countries, noninstitutional births (NIB) and institutional births, DHS surveys 

2000-2004 

Burkina Faso 2003 Ethiopia 2000 Rwanda 2000 

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

births 

Postpartum 

care by 

TBA/

others 

for NIB

Postpartum 

care by 

health 

professional 

for NIB

Institutional 

births

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

Background births 

characteristic (1) (2) (3) (1) (2) (3) (1) (2) (3) 

Residence 

Urban (1) 0.22** 2.06*** 2.88*** 0.60 1.34 4.05*** 0.81 (2.66*) 2.74***

Rural (2) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Woman’s employment 

Yes (0) 1.83 1.38 1.01 1.34 0.96 0.94 1.05 (0.58) 0.98 

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Birth order 

5+ (1) 1.10 0.99 0.68*** 1.38 0.97 0.49*** 0.42** (0.59) 0.31***

2-4 (2) 0.70* 0.84 0.62*** 1.02 0.76 0.49*** 0.64 (1.00) 0.33***

1 (3) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Woman’s education 

Secondary+ (0) 1.22 1.70 3.81** 1.32 1.14 3.34*** 1.54 (1.12) 4.50***

Primary (1) 1.29 1.14 2.07*** 1.04 0.81 1.80*** 1.45 (1.00) 1.49***

None (2) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Wealth (quintiles) 

Highest (1) 2.26** 1.72* 6.28*** 0.97 2.42*** 5.98*** 0.85 (1.56) 2.48***

Fourth (2) 1.65** 1.58** 2.68*** 1.37 1.48 2.13* 0.98 (0.92) 1.20 

Middle (3) 1.31 1.64*** 1.88*** 0.78 0.96 1.72 0.85 (0.55) 0.97 

Second (4) 1.15 1.15 1.51*** 1.11 0.70 1.20 0.75 (1.13) 0.99 

Lowest (5) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Antenatal care visits 

4+ (1) 2.80*** 11.59*** 50.61*** 1.32 4.62*** 7.32*** 3.04* (7.34*) 9.16***

1-3 visits (2) 1.89*** 7.24*** 30.16*** 1.24 3.15*** 2.77*** 1.96 (2.17) 4.03***

0 (3) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Read newspaper 

Yes (0) 4.55** 2.36 3.40** 0.83 1.88* 1.00 0.97 (1.16) 1.24* 

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Watch television 

Yes (0) 3.72*** 1.37* 1.91*** 1.80 1.12 2.07*** 1.09 (1.35) 1.69***

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 

Health care decisionmaking 

Self (1) 0.71 1.52** 1.16 na na na 0.98 (0.98) 0.88 

Jointly (2) 0.85 1.57** 1.43** na na na 0.83 (0.40) 0.79* 

Others (3) 1.00 1.00 1.00 na na na 1.00 (1.00) 1.00 

 

Number of cases 415 415 738 158 317 799 108 49 1,465 

Continued...
37

Table 6.2—Continued 

Cambodia 2000 Indonesia 2002-2003 Nepal 2001 

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

births 

Postpartum 

care by 

TBA/

others 

for NIB

Postpartum 

care by 

health 

professional 

for NIB

Institutional 

births 

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

Background births 

characteristic (1) (2) (3) (1) (2) (3) (1) (2) (3) 

Residence 

Urban (1) 1.00 1.46** 2.72*** 0.82* 1.00 2.43*** 0.21*** 0.98 2.72***

Rural (2) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Woman’s employment 

Yes (0) 1.11 0.94 1.03 0.99 1.02 1.03 0.25*** 0.40*** 0.62***

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Birth order 

5+ (1) 1.11 0.95 0.47*** 0.88 0.74** 0.53*** 1.18 1.00 0.46**

2-4 (2) 1.06 1.00 0.58*** 0.99 0.94 0.75*** 1.07 0.99 0.51**

1 (3) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Woman’s education 

Secondary+ (0) 0.76 2.15*** 2.48*** 0.68** 2.26*** 3.10*** 0.25*** 1.56** 2.09***

Primary (1) 1.00 1.38** 1.35* 0.95 1.34* 1.44* 0.45*** 1.05 1.28 

None (2) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Wealth (quintiles) 

Highest (1) 0.88 5.66*** 4.80*** 0.75 1.53* 15.74*** 1.01 2.86*** 4.02***

Fourth (2) 1.13 3.01*** 3.80*** 0.84 1.68*** 6.95*** 1.36 2.10** 1.95**

Middle (3) 1.02 1.50** 2.22** 1.10 1.52*** 4.10*** 2.24*** 1.92* 1.53 

Second (4) 1.17 1.34 2.02** 1.08 1.54*** 2.60*** 1.43* 1.64 1.39 

Lowest (5) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Antenatal care visits 

4+ (1) 1.23 4.14*** 7.03*** 2.80*** 10.75*** 13.88*** 1.09 6.01*** 11.96***

1-3 visits (2) 1.10 2.28*** 2.89*** 2.20*** 4.61*** 2.89*** 2.18*** 3.85*** 3.43***

0 (3) 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 

Read newspaper 

Yes (0) 0.98 1.15 1.55** 0.98 1.32*** 1.19*** na na na 

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 na na na 

Watch television 

Yes (0) 0.83 1.20 1.42** 1.13 1.46*** 1.14*** na na na 

No (1) 1.00 1.00 1.00 1.00 1.00 1.00 na na na 

Health care decisionmaking 

Self (1) na na na 0.81* 0.85 0.97 0.57** 1.13 1.26 

Jointly (2) na na na 0.64*** 0.77* 1.00 0.88 1.60* 1.47* 

Others (3) na na na 1.00 1.00 1.00 1.00 1.00 1.00 

 

Number of cases 1,749 715 541 2,273 4,366 5,075 465 236 420 

Continued...
38

Table 6.2—Continued

Egypt 2000 Haiti 2000 Peru 2000 

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

births 

Postpartum 

care by 

TBA/

others 

for NIB

Postpartum 

care by 

health 

professional 

for NIB

Institutional 

births

Postpartum 

care by 

TBA/ 

others 

for NIB 

Postpartum 

care by 

health 

professional 

for NIB 

Institutional 

Background births 

characteristic (1) (2) (3) (1) (2) (3) (1) (2) (3) 

Residence 

Urban (1) (0.45) 0.77 1.69*** 1.01* 1.48* 1.72*** (0.36) 1.14 2.91***

Rural (2) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Woman’s employment 

Yes (0) (0.31) 1.19 1.29** 1.25* 1.06 1.07 (1.26) 1.19** 0.90 

No (1) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Birth order 

5+ (1) (0.29*) 1.00 0.46*** 1.03 0.73 0.49*** (0.29*) 0.85 0.44***

2-4 (2) (0.44) 0.83 0.49*** 1.01 1.08 0.56*** (0.82) 1.01 0.58***

1 (3) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Woman’s education 

Secondary+ (0) (3.34*) 1.09 1.28** 0.96 2.10** 2.70*** (0.36) 1.06 1.78***

Primary (1) (1.52) 1.13 1.24* 0.99 1.20 1.22 (0.45) 1.07 0.84 

None (2) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Wealth (quintiles) 

Highest (1) (0.95) 1.01 4.39*** 1.57 1.38 8.08*** - 2.28* 14.27***

Fourth (2) (0.40) 1.11 2.19*** 1.25 1.81* 4.63*** (4.80) 1.77** 5.33***

Middle (3) (0.43) 1.03 1.87*** 1.11 1.93** 2.26** (1.11) 1.80*** 3.10***

Second (4) (0.60) 1.04 1.30** 1.18 1.58* 1.65* (0.55) 1.36*** 1.64***

Lowest (5) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Antenatal care visits 

4+ (1) (0.68) 2.27*** 4.14*** 1.14 5.67*** 3.79*** (3.72**) 4.34*** 7.09***

1-3 visits (2) (0.73) 1.30 1.69*** 1.30* 3.58*** 1.66* (1.58) 2.67*** 2.61***

0 (3) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Read newspaper 

Yes (0) (0.69) 1.45* 1.13 1.36* 1.17 1.28* (0.76) 1.16* 1.65***

No (1) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Watch television 

Yes (0) (1.94) 0.98 0.91 0.65** 1.25 1.73*** (0.76) 1.03 1.37***

No (1) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

Health care decisionmaking 

Self (1) (1.01) 1.14 1.16* 1.27* 0.79 0.92 (1.18) 1.56*** 1.71***

Jointly (2) (0.56) 1.11 1.16* 1.15 1.30 1.19 (1.43) 1.38*** 1.45***

Others (3) (1.00) 1.00 1.00 1.00 1.00 1.00 (1.00) 1.00 1.00 

 

Number of cases 31 325 4,103 588 293 739 39 1,579 5,496 

Note: Figures in parentheses are based on small numbers. A hyphen indicates there were no cases. 

* p<0.05; ** p<0.01; *** p<0.001 

NIB = Noninstitutional birth 
39

6.3.1 Sociodemographic Characteristics 

 Residence 

As expected, living in urban areas is associated with increased likelihood of receiving postpartum 

care. This is particularly true for women delivering at an institution, and RRRs are typically high for all 

the countries. The likelihood of receiving postpartum care from a health professional when delivering at 

home is less clear; this association is seen in only four of the nine countries. In Ethiopia, where delivery 

by a health professional is uncommon, urban residence is not associated with higher levels of receipt of 

postpartum care from a health professional among women delivering at home. A similar situation is seen 

in Indonesia and Nepal, although the interpretation here is that the broad coverage of delivery care by 

professionals in rural areas may account for this lack of distinction. Finally, in Egypt and Peru, which 

have large proportions of noninstitutional births that do not receive postpartum care, the phenomenon 

appears to reflect a lack of pattern in postpartum care. 

Receiving postpartum care from a TBA/others goes in the opposite direction. In seven of the nine 

countries (except Cambodia and Haiti), living in rural areas is associated with receiving postpartum care 

from a TBA/others if delivering at home. In countries with large proportions of women delivering at 

home who receive no professional postpartum care, the findings point to a lack of formal health coverage 

for these women.

Woman’s Employment 

Women’s employment is generally not associated with receipt of postpartum care in these 

countries. Only in Peru is being employed related to an increased likelihood of receiving postpartum care 

from a health professional if the woman delivered at home. In Egypt, an employed woman is more likely 

to have delivered at an institution than not have received postpartum care. Curiously, in Nepal, women’s 

employment is negatively associated with the probability of receiving any type of postpartum care. One 

interpretation of this is that women who work mostly in the agricultural sector represent a poorer segment 

of the population and therefore are less likely to receive postpartum care. 

Birth Order 

In all countries, birth order (starting at the second or higher birth order) is negatively associated 

(strongly and consistently) with women delivering at a health facility. In Egypt, Peru, and Rwanda, 

having five or more births is associated with receiving less postpartum care from a TBA/others, compared 

with having fewer births. Women having their first birth (parity 1) may be more concerned and less 

confident about the pregnancy outcome, and thus more likely to seek professional assistance at delivery 

than their more experienced multiparous counterparts. 

Woman’s Education 

Education is strongly and positively associated with postpartum care, particularly for women with 

secondary or higher levels of education. However, most of this effect is seen only for institutional births. 

In Burkina Faso, Ethiopia, Peru and Rwanda, education is not associated with any postpartum care among 

women delivering at home. In Indonesia and Nepal, having secondary or more education is negatively

associated with receiving postpartum care by a TBA/others. 
40

Household Wealth Status 

Household wealth status is strongly and positively associated with postpartum care in all nine 

countries. However, the effect is more definite for institutional births than for noninstitutional births. In 

Rwanda, only the highest wealth quintile is associated with increased likelihood of postpartum care for 

institutional births, and no pattern is seen for noninstitutional births. In Ethiopia, only at the highest 

wealth quintile is a positive association found with professional postpartum care for noninstitutional 

births. There is no effect of wealth on postpartum care by TBA/others in Cambodia, Egypt, Haiti, 

Indonesia, and Peru. Only in Burkina Faso are the two highest wealth quintiles associated with increased 

postpartum care by TBA/others among noninstitutional births. 

6.3.2 Health and Media Exposure 

Number of Antenatal Care Visits 

In every country, the probability of having an institutional birth and/or receiving postpartum care 

increases significantly and consistently with receipt of any antenatal care, and with increased number of 

antenatal care visits. When four or more visits are compared with no visits, the ratio is 51 in Burkina Faso 

and 14 in Indonesia for having an institutional birth versus no postpartum care. Only in Ethiopia is the 

number of antenatal care visits for noninstitutional births not associated with a significant increase in 

postpartum care by TBA/others. (In Egypt, although numbers are small, the trend shows a negative 

association). 

Reading Newspapers and Watching Television 

Reading newspapers and watching television have small, positive associations with receiving 

some form of postpartum care, although there are no definite patterns. For example, reading newspapers 

has no bearing on any form of postpartum care in Ethiopia (probably reflecting the scarcity of this media 

format), while in Indonesia it is positively associated with receiving postpartum care from professionals, 

both for institutional and noninstitutional deliveries. 

Watching television is positively associated with all forms of postpartum care in Burkina Faso, 

but only with institutional deliveries in most other countries. In Egypt, watching television is not 

associated with any increase in postpartum care over receiving no postpartum care. This may be related to 

universal television access or to nonuse of television for health promotion. 

6.3.3 Woman’s Status—Health Care Decisionmaking Capacity 

The final variable used in the multivariate models is women’s participation in decisionmaking 

regarding matters of their own health. In the seven countries where data were available, the results are 

mixed. On the one hand, in countries such as Burkina Faso and Peru, women making decisions on their 

own or jointly with others is positively associated with increased postpartum care by professionals, either 

for institutional or noninstitutional deliveries. This occurs to a lesser extent in Egypt and Nepal. However, 

the effect is not seen in Haiti, Indonesia, and Rwanda. In fact, in Indonesia and Nepal, for noninstitutional 

births, women making decisions for themselves is associated with increased likelihood of not receiving 

postpartum care compared with receiving it from a TBA/others. 
41

7 Summary and Discussion 

7.1 Extent and Timing of Postpartum Care 

The present study has identified attributes of postpartum care in a number of developing 

countries, based on data from DHS surveys 1999 to 2004. The general scarcity of postpartum care in 

these countries is a matter of major public health concern. In the 30 countries covered, four in ten women 

with a live birth in the five years preceding the survey did not receive postpartum care. 

If timing of care is examined, on average, the first postpartum care for all births (in the 29 

countries for which there is information) is received two days after delivery. When the analysis is 

restricted to noninstitutional births, the situation is even less favorable. Only 13 percent of these women 

received postpartum care in the 24 hours after delivery, and the average was three days postpartum. These 

women are clearly in a life-threatening situation should they suffer complications such as postpartum 

hemorrhage, the number one maternal killer. This is because the window of opportunity between the 

onset of hemorrhage and death is extremely short (two hours) (Starrs, 1998). 

7.2 Place and Providers of Postpartum Care for Noninstitutional Births 

The majority of women in Cambodia, Indonesia, and Nepal receive their first postpartum care at 

home, an indication of effective community outreach and/or the accessibility of postpartum care services 

in South/Southeast Asia. Additionally, in Cambodia and Nepal, seven in ten providers of postpartum care 

for noninstitutional births are TBAs. Interestingly, this is not the case with Indonesia, where the majority 

of postpartum care, even at the community level, is provided by trained health personnel. In a few African 

countries and in Haiti, around one-fourth to one-third of postpartum care is provided at home, often by 

TBAs. In Haiti, nearly 40 percent of postpartum care for home deliveries is provided by TBAs, and an 

additional one-fourth is provided by other people, mostly unskilled workers, relatives, or friends. These 

countries need to increase the delivery of professional postpartum care for noninstitutional births, either 

through facility or community-based approaches. 

7.3 Characteristics Associated with Receiving Postpartum Care 

For this analysis, postpartum care was divided into three categories. Women who delivered at a 

health facility were assumed to have received postpartum care from a health professional. Women who 

delivered at home (noninstitutional birth) were subdivided into groups depending on whether they 

received postpartum care from a health professional or from a TBA/other person. The three categories 

were used to analyze the correlation of selected background characteristics of women with receipt of 

postpartum care (according to the conceptual framework). 

Most characteristics were correlated with having received postpartum care, particularly area of 

residence (urban-rural), birth order, level of education, household wealth quintile, number of antenatal 

care visits, reading newspapers, watching television, and participation in health care decisionmaking. Age 

at birth, sex of head of household, and listening to the radio did not produce consistent or definite 

patterns, and they were excluded from further analysis. 

To show which of the explanatory variables were most influential on whether postpartum care 

was received and what type of care was received, a multivariate analysis was carried out on nine countries 

from different regions. The following are the results of this analysis: 

First, a few explanatory variables emerged as being most powerful in their association with 

postpartum care. Women who lived in households in the higher wealth quintiles and who received 

antenatal care for their last pregnancy were consistently more likely to have received postpartum care, 
42

particularly from a health professional. Education (especially beyond the primary level), first births, urban 

residence, and exposure to mass media (newspaper and television) were also significantly associated with 

having an institutional delivery and/or receiving postpartum care. Two further variables—whether the 

woman was employed and whether she participates in her own health care decisions—were weakly or 

inconsistently related to postpartum care, after interacting with the other variables. 

Second, differentiation of the type of postpartum care produced an interesting phenomenon. 

Women who received postpartum care from a TBA/others often had different characteristics from women 

who received postpartum care from a health professional. For instance, if they lived in rural areas, they 

were more likely to receive postpartum care from a TBA/others. However, increased education and 

wealth did not affect whether women received postpartum care from a TBA/others in Cambodia and 

Haiti; and in Indonesia and Nepal, increased education was associated with receiving less postpartum care 

from a TBA/others. 

A few countries included in the further analysis should be mentioned. In Egypt, media exposure 

hardly had any influence with respect to postpartum care. This lack of differentials may be because of 

wide exposure to media in Egypt or because mass media is not used to promote access to services. 

In Nepal, women’s employment—which is mostly in the agricultural sector—may be an indicator 

of poverty rather than relative affluence, which could account for the negative association with 

postpartum care. It is also interesting to note that in Indonesia and Nepal, living in rural areas is not 

necessarily detrimental to receiving professional postpartum care for noninstitutional births, and may 

reflect an active outreach program of health services in these countries. 

7.4 Limitations of Study 

There are a number of limitations to this study. First, postpartum care is seen through women’s 

recollection of events, which can be affected by perception and time. Because DHS does not ask for the 

content and elements of postpartum care, it may be that some women incorrectly viewed any contact with 

an attendant after birth as postpartum care. This would overestimate the real occurrence of postpartum 

care. On the other hand, the longer the event occurred in the past, the less likely the woman is to 

remember whether or not postpartum care took place. 

The recall limitation extends to the timing of postpartum care. Women may not remember the 

precise time when the first checkup occurred after delivery, with the result that there may be problems of 

heaping (i.e., concentration of responses at rounded times, such as one day or one week). 

Another limitation is the assumption that all women who delivered at a health institution received 

postpartum care. This may not necessarily be true, especially at lower levels of care (e.g., women 

delivering at health centers or small posts), where this capacity may be nonexistent and women may or 

may not have been referred to higher levels of care. 

For calculating the timing of postpartum care, it is assumed that all postpartum care at institutions 

takes place an average of 12 hours after delivery. (For this calculation all noninstitutional births coded as 

0—less than one day postpartum—were recoded as receiving postpartum care 12 hours postpartum, on 

average.) We do not know if these assumptions will overestimate or underestimate the average timing of 

first postpartum care; however, it is possible that both assumptions combined will overestimate the level 

of postpartum care received by women. Thus, the percentages obtained for all countries should be viewed 

as best-case scenarios for postpartum care. 
43

We were not able to place any value on the quality of postpartum care (because the data do not 

permit it), either for institutional or noninstitutional births. The assumption was made that any reported 

postpartum care provided the intended benefits. 

 

7.5 Conclusions 

Skilled postpartum care should be offered following all births—institutional and noninstitutional. 

Because the most serious mortality risks occur soon after birth, deliveries should be attended by a skilled 

person. If this is not possible, the skilled attendant should be present within the first few hours after 

delivery. This will allow the provider to identify whether the woman has any symptoms or signs of a lifethreatening complication, such as retention of placenta or products, excessive bleeding, high blood 

pressure, nausea/dizziness, foul vaginal discharge, etc. 

A first checkup six hours after delivery—promoted by the World Health Organization—might be 

too late for women who develop postpartum hemorrhage immediately after delivery. This poses a 

particular challenge for countries with a high proportion of noninstitutional births, or home deliveries. In 

Indonesia, however, nearly 40 percent of all noninstitutional births receive postpartum care within the 

first 24 hours after delivery, a laudable effort worth promoting in countries with high proportions of 

noninstitutional births. This information is captured in the Maternal and Neonatal Program Effort Index, a 

rating by experts on 81 items assessing status of services and policies for 49 developing countries. 

Indonesia received a score of 44 for postpartum checkup within 48 hours, three points higher than the 

average (POLICY Project, 2005). 

Such effort and commitment—either by training and providing skilled staff to reach out to all 

delivering women, or by ensuring that all women delivering at home have access to a nearby facility or 

skilled provider immediately after birth—likely contributes to important reductions in maternal and 

neonatal mortality and morbidity. In addition, because there is a period of fatigue following delivery that 

prevents women from making journeys in the immediate postpartum period, it is the skilled attendant who 

should be present at the time of delivery or shortly thereafter. This attendant can perform crucial lifesaving procedures such as removal of placenta or retained products, administer parenteral oxytocics, 

magnesium sulphate, antibiotics, or plasma expanders as needed; or stabilize and refer the woman in 

acceptable conditions, if so required. 

As with other health indicators, the occurrence of postpartum care is highly and consistently 

related to improved education and economic capacity. Countries should increase investment in girls’ 

education, free or subsidized maternal care, and improved means of transportation to emergency obstetric 

centers. While such plans are implemented, special funds should be allocated to ensure universal access to 

focused, pragmatic antenatal care, where every woman is instructed on pregnancy-related complications 

and a birth-readiness plan (that includes transportation and funds for medical care) is developed in 

conjunction with the provider and the community. Moreover, there is a need to develop a pregnancy 

tracking system whereby all pregnant women are assured of skilled attendance at their delivery or within 

a few hours, either through an outreach mechanism or through institutional delivery, regardless of 

whether they are likely to develop any complications. 
44

 Other measures to promote postpartum care include repeated health education campaigns and 

training of community volunteers to make members of the community aware of the potential dangers 

associated with each pregnancy and the need to follow one of the two steps described above, as well as 

ensuring respect of cultural values (e.g., providing for the presence of relatives or TBAs, accepting the 

inclusion of harmless traditional practices). The Ministry of Health in each country needs to take a 

leadership role in training and deploying health professionals (or skilled birth attendants) within reach of 

all populations, and creating a new performance expectation: every woman will give birth with the 

presence of a skilled attendant and receive immediate postpartum care (i.e., within 2 hours). Further 

research is needed to determine the critical components of postpartum care and how long providers 

should remain with the woman to ensure her safety. Finally, countries need to upgrade their health 

facilities to ensure that the six UN Process Indicators16 are met nationally and that facilities are able to 

perform the six to eight Signal Functions, depending on their type (Paxton et al., 2003).17

 

16 The UN Process Indicators are intermediate-level indicators measuring the readiness of facilities to provide 

emergency obstetric care. Indicators are rates of available emergency obstetric services and their distribution, 

proportion of births and obstetric complications attended, the rate of caesarean sections, and fatalities in facilities 

offering these services. 

17 Signal Functions are activities that facilities should be able to perform to qualify as able to provide basic or 

comprehensive emergency obstetric care. For basic emergency obstetric care, six functions should be performed: 

administer parenteral antibiotics, oxytocics, and anticonvulsants; perform manual removal of placenta and retained 

products; and perform assisted vaginal delivery (e.g., with vacuum extraction). For comprehensive emergency 

obstetric care, two extra functions are added: capacity to perform surgery (e.g., caesarean section) and blood 

transfusion. 
45

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47

Appendix A 

Table A.1 Proportion of women who received postpartum care for their most recent noninstitutional birth (in the five years 

preceding the survey) by provider of postpartum care and birth order, DHS surveys 1999-2004 

Birth order (noninstitutional births) 

Region and country Provider 1 2-4 5+ Total 

Sub-Saharan Africa 

Benin 2001 Health professional (3.0) 5.6 6.8 

TBA/others (97.0) 94.4 93.2 

Total (3.7) 6.3 8.1 6.4 

Number 26 96 103 225 

Burkina Faso 2003 Health professional 8.4 9.4 10.6 

 TBA/others 91.6 90.6 89.4 

 Total 13.2 14.1 17.9 15.4 

 Number 175 452 518 1,145 

Cameroon 2004 Health professional 4.8 6.4 7.3 

TBA/others 95.2 93.6 92.7 

Total 9.3 13.6 15.9 13.4 

Number 113 319 275 707 

Eritrea 2002 Health professional (5.9) 6.5 6.9 

 TBA/others (94.1) 93.5 93.1 

 Total (6.3) 7.1 7.7 7.2 

 Number 48 137 113 298 

Ethiopia 2000 Health professional 3.8 3.1 3.7 

TBA/others 96.2 96.9 96.3 

Total 4.8 4.7 5.5 5.1 

Number 66 154 183 403 

Ghana 2003 Health professional 5.5 9.0 8.8 

 TBA/others 94.5 91.0 91.2 

 Total 20.7 25.5 27.5 25.1 

 Number 116 319 224 659 

Kenya 2003 Health professional 4.1 6.1 8.4 

TBA/others 95.9 93.9 91.6 

Total 7.9 10.6 15.1 11.3 

Number 74 201 181 456 

Madagascar 2003 Health professional 13.0 12.3 8.8 

 TBA/others 87.0 87.7 91.2 

 Total 26.8 29.6 30.8 29.3 

 Number 249 568 398 1,215 

Malawi 2000 Health professional (1.8) 1.6 1.9 

TBA/others (98.2) 98.4 98.1 

Total (2.5) 2.9 4.1 3.2 

Number 42 109 107 258 

Mali 2001 Health professional 2.5 3.0 3.2 

 TBA/others 97.5 97.0 96.8 

 Total 9.9 11.4 12.9 11.8 

 Number 130 368 477 975 

Mozambique 2003 Health professional 16.0 20.5 22.1 

TBA/others 84.0 79.5 77.9 

Total 16.2 21.0 22.5 20.5 

Number 235 688 543 1,466 

Namibia 2000 Health professional 5.9 6.7 8.1 

 TBA/others 94.1 93.3 91.9 

 Total 6.1 7.7 10.6 7.8 

 Number 53 115 66 234 

Nigeria 2003 Health professional 8.1 7.1 8.7 

TBA/others 91.9 92.9 91.3 

Total 17.1 19.3 19.9 19.1 

Number 136 305 302 743 

Continued...
48

Table A.1—Continued

Birth order (noninstitutional births) 

Region and country Provider 1 2-4 5+ Total 

Rwanda 2000 Health professional (0.8) 1.1 (0.5) 

TBA/others (99.2) 98.9 (99.5) 

Total (3.7) 3.7 (2.5) 3.2 

Number 33 85 48 166 

Uganda 2000 Health professional 1.4 2.7 2.9 

 TBA/others 98.6 97.3 97.1 

 Total 3.8 4.7 5.2 4.8 

 Number 27 93 92 212 

Zambia 2001 Health professional 6.1 7.1 7.1 

TBA/others 93.9 92.9 92.9 

Total 11.5 12.5 13.1 12.5 

Number 109 250 191 550 

Zimbabwe 1999 Health professional 6.3 12.8 14.1 

 TBA/others 93.7 87.2 85.9 

 Total 6.6 13.2 15.1 11.5 

 Number 58 175 84 317 

North Africa/West Asia/Europe 

Armenia 2000 Health professional u (5.1) u 

TBA/others u (94.9) u 

Total u (5.5) u 5.1 

Number 11 45 8 64 

Egypt 2000 Health professional 3.0 4.2 5.1 

 TBA/others 97.0 95.8 94.9 

 Total 3.7 4.6 5.5 4.6 

 Number 63 202 100 365 

Jordan 2002 Health professional u u u u 

TBA/others u u u u 

Total u u u u 

Number 1 24 11 36 

Central Asia 

Turkmenistan 2000 Health professional u (3.0) (8.8) 

 TBA/others u (97.0) (91.2) 

 Total u (3.2) (8.8) 3.5 

 Number 8 49 28 85 

South/Southeast Asia 

Bangladesh 2004 Health professional 9.9 8.0 4.8 

TBA/others 90.1 92.0 95.2 

Total 19.7 16.1 14.9 16.9 

Number 291 482 137 910 

Cambodia 2000 Health professional 13.5 14.8 11.2 

 TBA/others 86.5 85.2 88.8 

 Total 40.3 43.4 45.7 43.6 

 Number 389 1,218 870 2,477 

Indonesia 2002-2003 Health professional 28.9 30.3 27.8 

TBA/others 71.1 69.7 72.2 

Total 45.8 49.8 56.7 49.3 

Number 1,959 3,448 868 6,275 

Nepal 2001 Health professional 6.6 5.6 3.4 

 TBA/others 93.4 94.4 96.6 

 Total 18.5 18.8 18.9 18.8 

 Number 183 479 228 890 

 Continued...
49

Table A.1—Continued

Birth order (noninstitutional births) 

Region and country Provider 1 2-4 5+ Total 

Latin America/Caribbean 

Colombia 2000 Health professional u (2.1) u 

TBA/others u (97.9) u 

Total u (2.1) u 2.1 

Number 15 41 19 75 

Dominican Republic 2002 Health professional u (0.7) u 

 TBA/others u (99.3) u 

 Total u (0.7) u 0.9 

 Number 13 33 21 67 

Haiti 2000 Health professional 6.3 8.3 5.8 

TBA/others 93.7 91.7 94.2 

Total 17.9 19.4 19.5 19.1 

Number 171 349 290 810 

Nicaragua 2001 Health professional 5.4 8.9 12.7 

 TBA/others 94.6 91.1 87.3 

 Total 5.4 8.9 12.7 8.7 

 Number 79 203 137 419 

Peru 2000 Health professional 9.1 13.7 19.2 

TBA/others 90.9 86.3 80.8 

Total 9.5 14.1 19.7 13.9 

Number 270 665 394 1,329 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (information not available) 
50

Table A.2 Proportion of women who received postpartum care for their most recent noninstitutional birth (in the 

five years preceding the survey), by provider of postpartum care and residence, DHS surveys 1999-2004 

 Residence (noninstitutional births) 

Region and country Provider Urban Rural Total 

Sub-Saharan Africa 

Benin 2001 Health professional 4.4 6.1 

TBA/others 0.5 1.1 

Total 4.9 7.2 6.4 

Number 57 168 225 

Burkina Faso 2003 Health professional 4.8 10.6 

 TBA/others 0.4 6.5 

 Total 5.2 17.1 15.4 

 Number 55 1,090 1,145 

Cameroon 2004 Health professional 5.9 6.6 

TBA/others 1.6 11.8 

Total 7.5 18.4 13.4 

Number 184 523 707 

Eritrea 2002 Health professional 4 7.9 

 TBA/others 0.5 0.7 

 Total 4.5 8.6 7.2 

 Number 65 233 298 

Ethiopia 2000 Health professional 8.7 2.8 

TBA/others 1.2 1.6 

Total 9.9 4.4 5.1 

Number 89 314 403 

Ghana 2003 Health professional 7.1 8.9 

 TBA/others 6.1 22.8 

 Total 13.2 31.7 25.1 

 Number 124 535 659 

Kenya 2003 Health professional (3.8) 6.9 

TBA/others (2) 5.8 

Total (5.8) 12.7 11.3 

Number 48 407 455 

Madagascar 2003 Health professional 19 9.6 

 TBA/others 11.6 19.4 

 Total 30.6 29 29.3 

 Number 249 966 1,215 

Malawi 2000 Health professional u 1.9 

TBA/others u 1.7 

Total u 3.6 3.2 

Number 9 248 257 

Mali 2001 Health professional 5 2.5 

 TBA/others 3.3 10.5 

 Total 8.3 13 11.8 

 Number 167 808 975 

Mozambique 2003 Health professional 9.9 24.8 

TBA/others 0.2 0.5 

Total 10.1 25.3 20.5 

Number 226 1,240 1,466 

Namibia 2000 Health professional (2.7) 9.2 

 TBA/others (0.8) 1.2 

 Total (3.5) 10.4 7.8 

 Number 38 195 233 

Nigeria 2003 Health professional 9.7 7.2 

TBA/others 7.6 12.7 

Total 17.3 19.9 19.1 

Number 198 547 745 

Continued...
51

Table A.2—Continued

 Residence (noninstitutional births) 

Region and country Provider Urban Rural Total 

Rwanda 2000 Health professional u 0.7 

TBA/others u 2.6 

Total u 3.3 3.2 

Number 22 144 166 

Uganda 2000 Health professional u 2.7 

 TBA/others u 2.3 

 Total u 5 4.8 

 Number 19 193 212 

Zambia 2001 Health professional 7.9 6.3 

TBA/others 2.1 7.5 

Total 10.0 13.8 12.5 

Number 149 401 550 

Zimbabwe 1999 Health professional (5.3) 14.1 

 TBA/others (0.0) 0.7 

 Total (5.3) 14.8 11.5 

 Number 50 267 317 

North Africa/West Asia/Europe 

Armenia 2000 Health professional u 9.6 

TBA/others u 0.5 

Total u 10.1 5.1 

Number 5 59 64 

Egypt 2000 Health professional 2.4 5.3 

 TBA/others 0.1 0.7 

 Total 2.5 6 4.6 

 Number 81 285 366 

Jordan 2002 Health professional u u 

TBA/others u u 

Total u u 0.9 

Number 29 6 35 

Central Asia 

Turkmenistan 2000 Health professional u 4.7 

 TBA/others u 0.1 

 Total u 4.8 3.5 

 Number 17 68 85 

South/Southeast Asia 

Bangladesh 2004 Health professional 10.2 7.4 

TBA/others 5.2 9.9 

Total 15.4 17.3 16.9 

Number 171 738 909 

Cambodia 2000 Health professional 17.2 12.6 

 TBA/others 17.9 32.4 

 Total 35.1 45 43.6 

 Number 273 2,204 2,477 

Indonesia 2002-2003 Health professional 22.0 36.0 

TBA/others 11.3 27.3 

Total 33.3 63.3 49.3 

Number 1,986 4,288 6,274 

Nepal 2001 Health professional (9.3) 5.0 

 TBA/others (1.1) 14.4 

 Total (10.4) 19.4 18.8 

 Number 34 856 890 

 Continued...
52

Table A.2—Continued

 Residence (noninstitutional births) 

Region and country Provider Urban Rural Total 

Latin America/Caribbean 

Colombia 2000 Health professional (1.2) (4.5) 

TBA/others (0.0) (0.0) 

Total (1.2) (4.5) 2.1 

Number 29 46 75 

Dominican Republic 2002 Health professional (0.6) (1.2) 

 TBA/others (0.0) (0.2) 

 Total (0.6) (1.4) 0.9 

 Number 32 37 69 

Haiti 2000 Health professional 7.9 6.4 

TBA/others 8.3 14.3 

Total 16.2 20.7 19.1 

Number 242 568 810 

Nicaragua 2001 Health professional 4.9 13.1 

 TBA/others 0.0 0.0 

 Total 4.9 13.1 8.7 

 Number 129 291 420 

Peru 2000 Health professional 8.0 21.2 

TBA/others 0.2 0.8 

Total 8.2 22.0 13.9 

Number 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (information not available) 
53

Table A.3 Proportion of women who received postpartum care for their most recent noninstitutional birth (in the five 

years preceding the survey), by provider of postpartum care and women's level of education, DHS surveys 

1999-2004 

Woman’s level of education (noninstitutional births) 

Region and country Provider 

No 

education Primary 

Secondary 

or higher Total 

Sub-Saharan Africa 

Benin 2001 Health professional 6.3 (4.4) u 

TBA/others 1.1 (9.4) u 

Total 7.4 (5.0) u 6.4 

Number 188 34 3 225 

Burkina Faso 2003 Health professional 10.4 (6.2) u 

 TBA/others 6.0 (17.2) u 

 Total 16.4 (11.0) u 15.4 

 Number 1,062 70 13 1,145 

Cameroon 2004 Health professional 8.1 6.9 3.9 

TBA/others 16.5 5.4 0.6 

Total 24.6 12.3 4.5 13.4 

Number 365 270 72 707 

Eritrea 2002 Health professional 7.2 6.6 u 

 TBA/others 0.9 0.4 u 

 Total 8.1 7.0 u 7.2 

 Number 209 74 15 

Ethiopia 2000 Health professional 2.9 5.0 (8.5) 

TBA/others 1.5 2.6 (17.7) 

Total 4.4 7.6 (9.2) 5.1 

Number 288 76 39 403 

Ghana 2003 Health professional 11.0 7.2 6.1 

 TBA/others 17.8 22.8 12.4 

 Total 28.8 30 18.5 25.1 

 Number 294 176 190 660 

Kenya 2003 Health professional 7.5 6.6 5.1 

TBA/others 3.9 5.8 3.3 

Total 11.4 12.4 8.4 11.3 

Number 66 312 78 456 

Madagascar 2003 Health professional 4.1 10.2 21.7 

 TBA/others 22.0 20.3 8.6 

 Total 26.1 30.5 30.3 29.3 

 Number 280 641 294 1,215 

Malawi 2000 Health professional 1.4 2.0 u 

TBA/others 1.1 1.8 u 

Total 2.5 3.8 u 3.2 

Number 63 190 4 257 

Mali 2001 Health professional 2.8 4.6 u 

 TBA/others 9.6 6.3 u 

 Total 12.4 10.9 u 11.8 

 Number 856 99 19 974 

Mozambique 2003 Health professional 24.3 17.9 u 

TBA/others 0.5 0.5 u 

Total 24.8 18.4 u 20.5 

Number 780 672 14 1,466 

Namibia 2000 Health professional (10.2) 9.0 4.3 

 TBA/others (1.7) 1.3 0.8 

 Total (11.9) 10.3 5.1 7.8 

 Number 44 110 80 234 

Nigeria 2003 Health professional 8.1 8.3 7.3 

TBA/others 14.5 11.0 4.8 

Total 22.6 19.3 12.1 19.1 

Number 447 176 122 745 

Continued...
54

Table A.3—Continued

Woman’s level of education (noninstitutional births) 

Region and country Provider 

No 

education Primary 

Secondary 

or higher Total 

Rwanda 2000 Health professional (0.5) 1.0 u 

TBA/others (2.1) 2.9 u 

Total (2.6) 3.9 u 3.2 

Number 47 111 9 167 

Uganda 2000 Health professional 2.8 2.5 u 

 TBA/others 2.3 2.3 u 

 Total 5.1 4.8 u 4.8 

 Number 55 134 22 

Zambia 2001 Health professional 6.7 7.9 4.4 

TBA/others 4.9 6.7 3.3 

Total 11.6 14.6 7.7 12.5 

Number 71 397 82 550 

Zimbabwe 1999 Health professional (21.7) 13.4 7.5 

 TBA/others (1.7) 0.9 0 

 Total (23.4) 14.3 7.5 11.5 

 Number 42 172 103 317 

North Africa/West Asia/Europe 

Armenia 2000 Health professional u u 4.9 

TBA/others u u 0.2 

Total u u 5.1 5.1 

Number 0 0 64 64 

Egypt 2000 Health professional 4.5 4.6 3.7 

 TBA/others 0.5 0.4 0.4 

 Total 5 5 4.1 4.6 

 Number 155 63 147 365 

Jordan 2002 Health professional u u (1.0) 

TBA/others u u (0.0) 

Total u u (1.0) 0.9 

Number 1 3 32 36 

Central Asia 

Turkmenistan 2000 Health professional u u 3.3 

 TBA/others u u 0.1 

 Total u u 3.4 3.5 

 Number 2 1 82 85 

South/Southeast Asia 

Bangladesh 2004 Health professional 4.5 7.6 12.4 

TBA/others 8.1 9.9 8.8 

Total 12.6 17.5 21.2 16.9 

Number 252 285 373 910 

Cambodia 2000 Health professional 8.5 13.5 24.1 

 TBA/others 36.1 31.1 13.9 

 Total 44.6 44.6 38 43.6 

 Number 812 1,357 309 2,478 

Indonesia 2002-2003 Health professional 22.7 32.0 27.7 

TBA/others 45.0 29.4 7.3 

Total 67.7 61.4 35.0 49.3 

Number 392 3,799 2,083 6,274 

Nepal 2001 Health professional 4.1 6.1 10.7 

 TBA/others 16.7 7.4 2.8 

 Total 20.8 13.5 13.5 18.8 

 Number 714 92 84 890 

Continued...
55

Table A.3—Continued

Woman’s level of education (noninstitutional births) 

Region and country Provider 

No 

education Primary 

Secondary 

or higher Total 

Latin America/Caribbean 

Colombia 2000 Health professional u 3.7 u 

TBA/others u 0.0 u 

Total u 3.7 u 2.1 

Number 9 50 16 75 

Dominican Republic 2002 Health professional u (0.8) (0.7) 

 TBA/others u (0.1) (0.0) 

 Total u (0.9) (0.7) 0.9 

 Number 10 33 25 68 

Haiti 2000 Health professional 6.3 5.7 11.6 

TBA/others 13.2 13.7 6.1 

Total 19.5 19.4 17.7 19.1 

Number 306 373 131 810 

Nicaragua 2001 Health professional 13.9 10.8 3.5 

 TBA/others 0.1 0.0 0.0 

 Total 14.0 10.8 3.5 8.7 

 Number 128 228 64 420 

Peru 2000 Health professional 17.3 21.0 8.1 

TBA/others 1.4 0.6 0.2 

Total 18.7 21.6 8.3 13.9 

Number 129 756 444 1,329 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (information not available) 
56

Table A.4 Proportion of women who received postpartum care for their most recent noninstitutional birth (in the five years preceding 

the survey), by provider of postpartum care and wealth index quintile, DHS surveys 1999-2004 

Wealth index quintile (noninstitutional births) 

Region and country Provider Lowest Second Middle Fourth Highest Total 

Sub-Saharan Africa 

Benin 2001 Health professional 10.9 7.2 (4.9) u u 

TBA/others 1.9 0.9 (0.9) u u 

Total 12.8 8.1 (5.8) u u 6.4 

Number 99 60 42 20 5 226 

Burkina Faso 2003 Health professional 9.5 9.5 12.5 10.4 4.9 

 TBA/others 6.0 6.0 6.4 7.2 2.2 

 Total 15.5 15.5 18.9 17.6 7.1 15.4 

 Number 214 236 373 235 87 1,145 

Cameroon 2004 Health professional 6.4 7.8 7.9 5.2 (3.8) 

TBA/others 15.1 12.4 3.5 1.4 (0.3) 

Total 21.5 20.2 11.4 6.6 (4.1) 13.4 

Number 270 209 124 67 37 707 

Eritrea 2002 Health professional 8.1 7.6 7.4 7.3 u 

 TBA/others 0.8 0.6 1.1 0.4 u 

 Total 8.9 8.2 8.5 7.7 u 7.2 

 Number 74 71 75 66 12 298 

Ethiopia 2000 Health professional 2.4 1.9 2.0 4.2 7.9 

TBA/others 1.2 1.9 1.3 2.1 1.2 

Total 3.6 3.8 3.3 6.3 9.1 5.1 

Number 59 64 55 101 124 403 

Ghana 2003 Health professional 9.8 11.1 8.0 5.6 (5.1) 

 TBA/others 20.8 23.4 23.6 10.1 (1.7) 

 Total 30.6 34.5 31.6 15.7 (6.8) 25.1 

 Number 197 191 167 74 29 658 

Kenya 2003 Health professional 6.7 7.4 6.4 7.4 3.8 

TBA/others 9.1 4.5 5.5 2.7 2.8 

Total 15.8 11.9 11.9 10.1 6.6 11.3 

Number 137 98 92 73 56 456 

Madagascar 2003 Health professional 6.0 5.6 7.8 14.8 25.9 

 TBA/others 25.1 24.8 21.9 10.4 3.3 

 Total 31.1 30.4 29.7 25.2 29.2 29.3 

 Number 344 227 253 176 216 1,216 

Malawi 2000 Health professional 1.4 2.1 2.1 (1.8) u 

TBA/others 2.0 1.7 2.0 (1.2) u 

Total 3.4 3.8 4.1 (3.0) u 3.2 

Number 58 59 73 44 23 257 

Mali 2001 Health professional 0.9 2.2 3.0 4.7 4.4 

 TBA/others 13.0 10.2 9.4 8.6 2.0 

 Total 13.9 12.4 12.4 13.3 6.4 11.8 

 Number 236 208 212 220 95 971 

Mozambique 2003 Health professional 23.5 26.3 22.2 18.7 7.6 

TBA/others 0.8 0.4 0.5 0.2 0.2 

Total 24.3 26.7 22.7 18.9 7.8 20.5 

Number 442 360 333 232 99 1,466 

Namibia 2000 Health professional 9.2 8.5 7.6 (5.9) u 

 TBA/others 1.7 1.7 1.1 (1.0) u 

 Total 10.9 10.2 8.7 (6.9) u 7.8 

 Number 61 57 54 45 16 233 

Nigeria 2003 Health professional 4.4 7.3 10.1 10.2 8.1 

TBA/others 95.6 92.7 89.9 89.8 91.9 

Total 19.4 19.7 22.8 20.9 11.5 19.1 

Number 164 166 184 153 77 744 

Continued...
57

Table A.4—Continued

Wealth index quintile (noninstitutional births) 

Region and country Provider Lowest Second Middle Fourth Highest Total 

Rwanda 2000 Health professional (0.8) (0.8) (0.3) (0.9) 1.3 

TBA/others (99.2) (99.2) (99.7) (99.1) 98.7 

Total (3.9) (3.2) (2.6) (3.8) 2.5 3.2 

Number 27 39 26 48 25 165 

Uganda 2000 Health professional 2.2 (1.9) (2.3) (3.8) (3.0) 

 TBA/others 97.8 (98.1) (97.7) (96.2) (97.0) 

 Total 5.4 (4.4) (4.1) (5.9) (4.0) 4.8 

 Number 53 41 37 49 32 212 

Zambia 2001 Health professional 6.8 6.6 7.4 9.3 (3.9) 

TBA/others 93.2 93.4 92.6 90.7 (96.1) 

Total 12.6 15.9 15.1 12.0 (5.0) 12.5 

Number 99 165 144 105 37 550 

Zimbabwe 1999 Health professional 18.0 15.8 10.6 7.6 u 

 TBA/others 82.0 84.2 89.4 92.4 u 

 Total 19.1 16.2 11.5 7.9 u 11.5 

 Number 97 88 59 56 18 318 

North Africa/West Asia/Europe 

Armenia 2000 Health professional (11.4) (8.4) u u u 

TBA/others (88.6) (91.6) u u u 

Total (12.2) (8.8) u u u 5.1 

Number 33 24 3 4 1 65 

Egypt 2000 Health professional 5.1 5.1 5.2 3.5 (2.0) 

 TBA/others 94.9 94.9 94.8 96.5 (98.0) 

 Total 6.1 5.7 5.5 3.7 (2.1) 4.6 

 Number 95 86 89 64 32 366 

Jordan 2002 Health professional u u (1.1) (0.4) u 

TBA/others u u (98.9) (99.6) u 

Total u u 1.1 0.4 u 0.9 

Number 1 3 32 29 6 71 

Central Asia 

Turkmenistan Health professional u u u u u 

 TBA/others u u u u u 

 Total u u u u u 

 Number u u u u u 85 

South/Southeast Asia 

Bangladesh 2004 Health professional 3.4 5.8 7.6 10.6 14.7 

TBA/others 96.6 94.2 92.4 89.4 85.3 

Total 12.7 16.2 15.6 21.3 20.3 16.9 

Number 165 182 163 211 188 909 

Cambodia 2000 Health professional 6.4 9.5 11.7 20.3 24.9 

 TBA/others 93.6 90.5 88.3 79.7 75.1 

 Total 42.4 45.8 44.1 49.1 34.6 43.6 

 Number 607 577 503 512 279 2,478 

Indonesia 2002-2003 Health professional 33.1 36.0 32.2 31.5 13.4 

TBA/others 66.9 64.0 67.8 68.5 86.6 

Total 68.6 63.2 52.3 40.9 16.8 49.3 

Number 1,946 1,566 1,351 1,020 392 6,275 

Nepal 2001 Health professional 2.0 4.0 5.4 7.0 10.1 

 TBA/others 98.0 96.0 94.6 93.0 89.9 

 Total 12.0 19.3 29.6 19.0 14.9 18.8 

 Number 142 195 272 175 106 890 

Continued...
58

Table A.4—Continued

Wealth index quintile (noninstitutional births) 

Region and country Provider Lowest Second Middle Fourth Highest Total 

Latin America/Caribbean 

Colombia 2000 Health professional (5.6) (3.1) u u u 

TBA/others (94.4) (96.9) u u u 

Total (5.6) (3.1) u u u 2.1 

Number 42 25 7 1 1 76 

Dominican Republic 2002 Health professional u u u u u 

 TBA/others u u u u u 

 Total u u u u u 0.9 

 Number 0 0 0 0 0 68 

Haiti 2000 Health professional 3.7 6.5 10.0 8.8 5.7 

TBA/others 96.3 93.5 90.0 91.2 94.3 

Total 19.7 19.7 23.3 21.3 10.1 19.1 

Number 171 171 191 203 75 811 

Nicaragua 2001 Health professional 14.3 12.0 7.2 (5.3) u 

 TBA/others 85.7 88.0 92.8 (94.7) u 

 Total 14.4 12.0 7.2 (5.3) u 8.7 

 Number 163 123 68 48 17 419 

Peru 2000 Health professional 19.4 20.4 13.2 5.7 (2.0) 

TBA/others 80.6 79.6 86.8 94.3 (98.0) 

Total 20.4 20.8 13.4 6.0 (2.0) 13.9 

Number 477 457 267 101 27 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (information not available) 
59

Table A.5 Proportion of women who received postpartum care for their most recent noninstitutional birth (in the five years preceding 

the survey), by provider of postpartum care and antenatal care, DHS surveys 1999-2004 

Antenatal care (noninstitutional births) 

Region and country Provider No Yes 

No 

visits 

1-3 

visits 

4+ 

visits 

Don’t 

know/

missing Total 

Sub-Saharan Africa 

Benin 2001 Health professional 8.7 5.1 (9.8) 7.7 3.9 u 

TBA/others 3.7 0.5 (2.8) 1.5 0.4 u 

Total 12.4 5.6 (12.6) 9.2 4.3 u 6.4 

Number 53 172 41 86 94 4 225 

Burkina Faso 2003 Health professional 4.3 11.7 4.1 11.7 11.8 u 

 TBA/others 6.8 5.3 6.8 5.4 4.8 u 

 Total 11.1 17 10.9 17.1 16.6 u 15.4 

 Number 218 927 211 697 217 19 1,144 

Cameroon 2004 Health professional 4.5 6.7 4.5 9.0 5.7 u 

TBA/others 21.0 4.3 21.2 7.8 3.0 u 

Total 25.5 11 25.7 16.8 8.7 u 13.4 

Number 221 486 219 199 278 10 706 

Eritrea 2002 Health professional 4.8 7.2 4.8 8.4 6.1 u 

 TBA/others 0.8 0.6 0.8 0.6 0.5 u 

 Total 5.6 7.8 5.6 9 6.6 u 7.2 

 Number 68 231 67 110 113 8 298 

Ethiopia 2000 Health professional 2.1 7.4 2.0 6.4 9.0 u 

TBA/others 1.4 1.9 1.4 1.7 1.9 u 

Total 3.5 9.3 3.4 8.1 10.9 u 5.1 

Number 200 203 198 105 91 9 403 

Ghana 2003 Health professional 3.7 (8.5) (3.4) 7.3 8.3 (20.9) 

 TBA/others 14.3 (17.1) (14.5) 29.0 14.0 (5.8) 

 Total 18 (25.6) (17.9) 36.3 22.3 (26.7) 25.1 

 Number 31 628 30 198 406 25 659 

Kenya 2003 Health professional 5.4 (6.4) (5.0) 7.1 5.9 u 

TBA/others 4.2 (5.1) (3.3) 5.9 4.3 u 

Total 9.6 (11.5) (8.3) 13 10.2 u 11.3 

Number 39 416 32 186 215 21 454 

Madagascar 2003 Health professional 2.4 13.1 2.4 8.9 17.2 (15.2) 

 TBA/others 21.6 17.3 21.4 19.6 15.0 (17.9) 

 Total 24 30.4 23.8 28.5 32.2 (33.1) 29.3 

 Number 164 1,051 162 482 531 40 1,215 

Malawi 2000 Health professional u 1.7 u 2.1 1.5 u 

TBA/others u 1.5 u 1.4 1.5 u 

Total u 3.2 u 3.5 3 u 3.2 

Number 12 245 11 107 137 2 257 

Mali 2001 Health professional 1.9 3.8 1.9 3.7 4.1 (3.0) 

 TBA/others 11.4 6.9 11.5 10.2 4.6 (5.8) 

 Total 13.3 10.7 13.4 13.9 8.7 (8.8) 11.8 

 Number 468 507 467 254 215 39 975 

Mozambique 2003 Health professional 10.5 21.8 10.6 23.9 20.5 u 

TBA/others 0.8 0.4 0.8 0.6 0.3 u 

Total 11.3 22.2 11.4 24.5 20.8 u 20.5 

Number 121 1,345 119 540 791 17 1,467 

Namibia 2000 Health professional u 6.6 u (8.1) 6.4 6.1 

 TBA/others u 1.0 u (2.0) 0.8 2.5 

 Total u 7.6 u (10.1) 7.2 8.6 7.8 

 Number 22 211 15 48 149 22 234 

Nigeria 2003 Health professional 4.9 9.8 4.9 9.8 10.1 u 

TBA/others 14.6 9.1 14.5 11.2 9.3 u 

Total 19.5 18.9 19.4 21 19.4 u 19.1 

Number 461 283 279 112 334 19 744 

Continued...
60

Table A.5—Continued

Antenatal care (noninstitutional births) 

Region and country Provider No Yes 

No 

visits 

1-3 

visits 

4+ 

visits 

Don’t 

know/ 

missing Total 

Rwanda 2000 Health professional u 0.8 u 0.7 u 0.0 

TBA/others u 2.5 u 2.6 u 0.0 

Total u 3.3 u 3.3 u 0 3.2 

Number 8 158 8 137 21 0 166 

Uganda 2000 Health professional u 2.7 u 2.5 3.0 u 

 TBA/others u 2.2 u 2.3 2.2 u 

 Total 2.2 4.9 u 4.8 5.2 u 4.8 

 Number 6 206 6 106 98 2 212 

Zambia 2001 Health professional u 7.1 u 6.7 7.2 u 

TBA/others u 5.5 u 4.9 5.9 u 

Total u 12.6 u 11.6 13.1 u 12.5 

Number 24 526 21 111 412 5 549 

Zimbabwe 1999 Health professional u 11.4 u 12.4 11.5 u 

 TBA/others u 0.4 u 1.1 0.5 u 

 Total u 11.8 u 13.5 12 u 11.5 

 Number 13 305 8 61 214 34 317 

North Africa/West Asia/Europe 

Armenia 2000 Health professional u 3.9 u 9.9 u u 

TBA/others u u u u 

Total u 4.1 u 10.2 u u 5.1 

Number 17 47 17 31 14 2 64 

Egypt 2000 Health professional 4.5 4.0 4.5 4.7 3.6 u 

 TBA/others 0.7 0.2 0.7 0.5 0.2 u 

 Total 5.2 4.2 5.2 5.2 3.8 u 4.6 

 Number 181 184 181 53 112 19 365 

Jordan 2002 Health professional u (0.9) u u (0.9) u 

TBA/others u (0.0) u u (0.0) u 

Total u (0.9) u u (0.9) u 0.9 

Number 1 35 0 5 30 0 35 

Central Asia 

Turkmenistan 2000 Health professional u 3.3 u u 3.0 u 

 TBA/others u 0.1 u u 0.0 u 

 Total u 3.4 u u 3.0 u 3.5 

 Number 3 82 3 12 59 11 85 

South/Southeast Asia 

Bangladesh 2004 Health professional 3.9 12.4 3.6 9.4 16.8 0.0 

TBA/others 9.7 8.0 8.5 10.3 6.6 0.0 

Total 13.6 20.4 12.1 19.7 23.4 0 16.9 

Number 376 534 288 422 198 0 908 

Cambodia 2000 Health professional 8.6 19.4 8.5 18.0 26.2 u 

 TBA/others 34.7 24.7 34.8 27.2 16.6 u 

 Total 43.3 44.1 43.3 45.2 42.8 u 43.6 

 Number 1,362 1,116 1,360 885 215 17 2,477 

Indonesia 2002-2003 Health professional 15.4 30.3 13.0 27.7 30.8 24.7 

TBA/others 38.2 18.8 39.6 39.0 15.2 32.9 

Total 53.6 49.1 52.6 66.7 46 57.6 49.3 

Number 342 5,933 294 1,178 4,733 69 6,274 

Nepal 2001 Health professional 2.0 8.7 2.0 7.8 10.9 u 

 TBA/others 11.8 15.3 11.7 19.1 5.8 u 

 Total 13.8 24 13.7 26.9 16.7 u 18.8 

 Number 334 556 332 441 113 4 890 

Continued...
61

Table A.5—Continued

Antenatal care (Noninstitutional births) 

Region and country Provider No Yes 

No 

visits 

1-3 

visits 

4+ 

visits 

Don’t 

know/ 

missing Total 

Latin America/Caribbean 

Colombia 2000 Health professional u 2.0 u u 1.8 u 

TBA/others u 0.0 u u 0.0 u 

Total u 2.0 u u 1.8 u 2.1 

Number 11 64 11 11 51 2 75 

Dominican Republic 2002 Health professional u 0.7 u u 0.8 u 

 TBA/others u 0.1 u u 0.0 u 

 Total u 0.8 u u 0.8 u 0.9 

 Number 4 64 2 8 55 3 68 

Haiti 2000 Health professional 1.2 8.4 1.3 5.7 10.2 u 

TBA/others 12.7 12.0 12.3 16.4 8.8 u 

Total 13.9 20.4 13.6 22.1 19 u 19.1 

Number 114 696 109 334 355 11 809 

Nicaragua 2001 Health professional 11.3 8.2 11.3 12.4 7.5 u 

 TBA/others 0.1 0.0 0.1 0.0 0.0 u 

 Total 11.4 8.2 11.4 12.4 7.5 u 8.7 

 Number 76 344 76 82 259 4 421 

Peru 2000 Health professional 12.9 13.7 11.4 19.3 12.6 u 

TBA/others 0.5 0.4 0.5 0.5 0.4 u 

Total 13.4 14.1 11.9 19.8 13 u 13.9 

Number 216 1,113 176 296 851 6 1,329 

Note: Figures in parentheses are based on 25-49 unweighted cases. 

u = Unknown (information not available) 
62

Table A.6 Background indicators of selected countries 

Indicator 

Burkina 

Faso Cambodia Egypt Ethiopia Haiti Indonesia Nepal Peru Rwanda 

GDP/capita1 $1,200 

(2005) 

$2,200 

(2005) 

$4,400 

(2005) 

$800 

(2005) 

$1,600 

(2005) 

$865 

(2005) 

$1,500 

(2005) 

$6,100 

(2005) 

$1,300 

(2005) 

Percent 

population living 

below US$2/day2 81 78 44 78 u 73 81 38 84 

 

Unemployment 

rate1 na 

2.5 

(2000) 

10.9 

(2004) u 

66.0 

(2002) 

11.8 

(2005) 

47.0 

(2001) 

9.6 

(2004) u 

 

Percent rural2 93 85 57 85 64 81 86 27 83 

Population 

density 

(per sq mile)2 132 191 191 182 774 65.0 446 56 858 

 

Percent illiterate 

women3

83.9 

(2003) 

32.4 

(2000) 

49.8 

(2000) 

87.5 

(2000) 

41.3 

(2000) 

13.0 

(2003) 

64.5 

(2001) 

7.4 

(2004) 

33.8 

(2001) 

 

Number of 

television 

broadcasting 

stations1 1 7 98 1 2 54 1 13 2 

 

Total fertility rate 

(children/woman)3

5.9 

(2003) 

4.0 

(2000) 

3.5 

(2000) 

5.9 

(2000) 

4.7 

(2000) 

2.6 

(2004) 

4.1 

(2001) 

2.8 

(2000) 

5.8 

(2001) 

 

Maternal mortality 

ratio (per 100,000 

live births)4

484 

(1994-

1998) 

437 

(1994-

2000) 

84 

(1993- 

2000) 

871 

(1994- 

2000) 

523 

(1995-

2000) 

307 

(1998- 

2003) 

539 

(1990-

1996) 

185 

(1994-

2000) 

1,071 

(1996- 

2000) 

 

Infant mortality 

rate (per 1,000 

births)3

81.4 

(2003) 

95 

(2000) 

43.5 

(2000) 

112.9 

(2000) 

80.3 

(2000) 

35.0 

(2003) 

64.4 

(2001) 

33.3 

(2000) 

107.4 

(2001) 

 

Safe Motherhood 

Program5

Maternal 

and 

Neonatal 

Health 

(MNH) 

Program 

to 

increase 

the use 

of skilled 

providers 

at birth 

Home 

Birth Kits 

(HBK) 

distributed 

to the 

birth 

attendants 

Safe 

Motherhood 

Committees 

(SMC) 

formulated 

at 

government 

levels 

Ethiopia has 

various 

organizations 

like UNFPA 

supporting 

the Safe 

Motherhood 

Initiative 

Global 

Health 

Action 

(GHA) 

work 

towards 

training 

community 

health 

workers 

and TBAs 

MotherCare, 

DELIVERY, 

and 

Indonesia 

Health 

Services 

Program 

(HSP) 

funded by 

USAID 

MNH 

Program 

MNH 

Program 

MotherBaby 

Survival 

Project and 

prevention 

of motherto-child 

transmission 

of HIV 

project 

na = Not applicable 

u = Unknown (information not available) 

1

 The World Fact Book: http://www.cia.gov/cia/publications/factbook/geos/uv.html 2

 2005 World Population Data Sheet of the Population Reference Bureau: http://www.prb.org/pdf05/05WorldDataSheet_Eng.pdf 3

 Demographic and Health Surveys 

4

 WHO et al., 2004 

5

 Other web search