Prevalence, determinants, and urban–rural disparities in postnatal care service utilization within two days of birth among newborns in low- and middle-income countries: a mixed effect and decomposition analysis

Abstract

The first two days of life represent the most critical period for neonatal survival, yet many preventable newborn deaths still occur during this period, particularly in low- and middle-income countries (LMICs). Early postnatal care (PNC) is essential for identifying and managing life-threatening complications; however, its coverage and timely use remain inadequate, with marked urban–rural disparities. This study aimed to estimate the prevalence, determinants, and urban–rural disparities of early PNC utilization in LMICs. We analyzed the most recent Demographic and Health Surveys (2015–2024) from 46 LMICs, including a weighted sample of 256,437 women aged 15–49 years with a live birth in the preceding two years. Data were analyzed using STATA version 17. Mixed-effects multilevel logistic regression identified predictors of early PNC utilization, with statistical significance set at p < 0.05. A logit-based multivariate decomposition analysis was conducted to assess urban–rural disparities. Early PNC utilization among newborns in LMICs was 66.83% (95% CI: 66.65–67.01). Utilization was higher among women with 1–3 ANC visits (AOR = 3.07, 95% CI: 2.93–3.21) and ≥ 4 visits (AOR = 4.34, 95% CI: 4.16–4.54), facility delivery (AOR = 9.19, 95% CI: 8.89–9.50), cesarean birth (AOR = 1.29, 95% CI: 1.24–1.34), age at first birth > 18 years (AOR = 1.18, 95% CI: 1.15–1.21), iron supplementation (AOR = 1.43, 95% CI: 1.38–1.48), correct ovulatory knowledge (AOR = 1.34, 95% CI: 1.28–1.40), decision-making autonomy (AOR = 1.10, 95% CI: 1.07–1.13), and lower distance barriers (AOR = 1.26, 95% CI: 1.21–1.31). Community-level factors, including higher media exposure (AOR = 1.90, 95% CI: 1.82–1.98) and education (AOR = 1.09, 95% CI: 1.05–1.14), also increased utilization. Most urban–rural disparity was explained by differences in characteristics (97.28%), with minimal contribution from differences in effects (2.72%). Early PNC utilization shows progress and is driven by maternal healthcare access, women’s empowerment, and supportive community factors, with urban–rural disparities reflecting persistent inequities. Improving coverage and quality of newborn PNC is essential to advance SDG 3.1 and 3.2.