Background Despite the recognized importance of postnatal care, utilization of postnatal care services remains markedly low in Ethiopia, particularly in rural areas. Objective This study aims to identify the multilevel determinants of postnatal care (PNC) service utilization among rural women in Ethiopia using a multilevel analysis of secondary data from the Ethiopian Demographic and Health Survey (EDHS-2019). Methods This study utilized secondary data from the 2019 EDHS. The study population included 2,900 (weighted sample) of 15-49 years women residing in rural areas of Ethiopia who had experienced at least one birth. The data were analyzed using Stata version 17 software. A multilevel mixed-effects logistic regression model was employed to identity the independent determinants by using adjusted odds ratio with 95% CI (p-value <0.05). Model diagnostics were done to assess the goodness-of-fit and validity of the regression model by AIC, BIC, ICC and the log-likelihood ratio test. Results Among 2,900 women, only 283 (9.7%) sought postnatal care (PNC) services within the first six weeks after delivery. Several determinants of PNC service utilization at the individual level were identified, including being in the middle wealth index (AOR=1.481.04, 2.14), having fewer than four antenatal care visits (AOR=2.171.66, 2.82), having an institutional delivery (AOR=1.421.08, 1.89), delivering via cesarean section (AOR= 1.601.01, 2.57), having a third birth order (AOR=1.541.09, 2.19), having a birth order of four or more (AOR=1.771.18, 2.69) and being informed about family planning methods (AOR=3.671.51, 9.39). Conclusions The findings of this study showed that in rural Ethiopia, socio-economic, maternal and health facility-related factors are significant determinants of PNC service utilization. Therefore, addressing individual-level factors such as socio-economic status, ANC attendance, delivery location, birth order, and awareness of family planning methods is essential to enhance the uptake of PNC services in these areas.
Tamiru et al. (2026) studied this question.