1.1  Why is effective postnatal care so important?

The time when effective postnatal care can make the most difference to the health and life chances of mothers and newborns is in the early neonatal period, the time just after the delivery and through the first seven days of life. However, the whole of the neonatal period, from birth to the 28th day after the birth, is a time of increased risk. Deaths during the first 28 days of babies who were born alive is reported by all countries in the world as the neonatal mortality rate (the number of babies who die in the first 28 days) per 1,000 live births. Similarly, reports of maternal mortality include deaths of women from complications associated with postnatal problems, not just problems arising during the birth. Both these rates are important indicators of the effectiveness of postnatal care.

So the first reason why you need to focus more care and attention on the postnatal period is that this is a very critical time for the mother and her newborn baby. The national maternal mortality ratio (MMR) in Ethiopia is one of the highest in the world: at the last Demographic and Health Survey in 2005 (European calendar) 673 mothers died per 100,000 live births. Similarly, the early neonatal mortality rate was also very high, with 39 babies dying in the first week of life per 1,000 live births (EDHS, 2005). Ethiopia is one of five African countries that (together) account for half of all the newborn deaths in the whole of Africa.

This high risk period is also the time with the lowest coverage of maternal and child health care in Ethiopia. This is the second reason why you need to focus more attention on postnatal care.

If all newborns received high impact and cost-effective interventions during the postnatal period, it is estimated that neonatal mortality could be reduced by between 10-27%. In other words, high postnatal care coverage could save up to 60,000 newborn lives a year in Ethiopia, and help the country to meet the Millennium Development Goal of reducing under-five child mortality by two-thirds by the year 2015.

Ideally, postnatal care is best delivered in a health facility. However, due to many socio-economic and cultural reasons, such as the distance to travel and the cost of attending, most rural mothers give birth at home. Therefore, in the Ethiopian context, the most realistic way of providing optimum postnatal care for the foreseeable future is likely to be through home visits by a skilled health care worker such as you.

Learning Outcomes for Study Session 1

1.2  When do most mothers and newborns die in the postnatal period?