Determinants of the utilization of postpartum family visits: Evidence from rural areas of Eastern China

BACKGROUND Postpartum Family Visits (PFVs) have been advocated as a way to improve health outcomes for puerperal women and their newborns. This study aimed to identify individual factors associated with the utilization of PFVs in rural Jiangsu Province, China. METHODS We employed responses of the household survey in Jiangsu province, part of the National Health Service Survey (NHSS), a nationally representative survey in China. The data analysis framework was designed based on Andersen's behavioral model. The outcome variables included nonuse and deficient use of PFVs, and the explanatory variables were organized into three hierarchical levels: predisposing, enabling and need factors. Univariate analysis and multivariate logistic regression analysis were conducted to examine the impact of the three hierarchical levels on PFVs utilization. RESULTS A total of 884 rural women who had a childbearing history in the prior five years answered PFVs questions. About 23.4% of them had never received any PFVs, and 40.4% received <3 visits. In the results of multivariate logistic regression, educational level (OR = 0.43, 95% CI: 0.24-0.77), income (OR = 0.62, 95% CI: 0.43-0.88), the distance from the nearest hospital (OR = 1.49, 95% CI: 1.07-2.07) and parity (OR = 2.17, 95% CI: 1.54-3.05) had significant relationship with nonuse. Factors significantly associated with deficient use of PFVs included employment (OR = 0.62, 95% CI: 0.39-0.98), the distance from the nearest hospital (OR = 1.73, 95% CI: 1.26-2.36), level of delivery institution (OR = 1.57, 95% CI: 1.14-2.17), and parity (OR = 1.45, 95% CI: 1.03-2.05). CONCLUSION The study found lower Social Economic Status (SES), long distance with primary health institutions, and the increased need for services stemming from multi-parity reduced the likelihood of nonuse or deficient use of PFVs in rural areas. Multiparous, low SES women and those living far away from primary health institutions should be paid more attention to assure the coverage of postpartum care.