The relationship between postpartum care uptake and postpartum morbidity and their determinants in Morocco: evidence from a national survey

Abstract

ABSTRACT Background PPC utilisation is essential to prevent maternal mortality and morbidity, particularly in low-and middle-income countries where 95% of maternal deaths occur. In Morocco, PPC remain underused. This study examines factors associated with PPC utilisation and postpartum morbidity (PPM), and their relationship. Methods A secondary analysis was conducted using a nationally representative dataset of 5,593 women of childbearing age. Univariate and multivariate logistic regression assessed the associations of sociodemographic, environmental and obstetrical determinants with PPC and PPM. Results 62.6% of women reported early PPC (EPPC), 21.3% used later PPC (LPPC) and 28.3% declared PPM. Facilitators associated with LPPC included education above primary level (AOR=1.34, 95%CI:1.11-1.63), high socioeconomic status (AOR=1.42, 95%CI:1.02-1.98), antenatal care (AOR=1.64, 95%CI:1.08-2.47), caesarean delivery (AOR=2.50, 95%CI:1.89-3.31), and newborn postnatal care (AOR=6.97, 95%CI:5.89-8.25). Absence of doctors during midwives-led delivery reduced LPPC uptake (AOR=0.63, 95% CI:0.48-0.83). Secondary or higher education (AOR=0.71, 95%CI:0.54-0.93) and antenatal care (AOR=0.30, 95%CI:0.14-0.64) reduced PPM risk, while instrumental delivery (AOR=1.24, 95%CI:1.04-1.48) and pregnancy morbidities (AOR=2.10, 95%CI:1.72-2.56) increased it. EPPC lowered PPM risk (AOR=0.65, 95%CI:0.52-0.79), whereas LPPC utilisation was associated with PPM (AOR=1.36, 95%CI:1.08-1.71). Conclusion LPPC utilisation remains low, and PPM persists, reflecting health inequities. Targeted interventions for disadvantaged women and further qualitative research into behavioural and cultural influences, and women’s and health professionals’ perceptions of PPC are recommended.