Antenatal health education with early postnatal booking and postnatal clinic attendance in primary health care centers in Bahrain: a quasi-experimental study

Introduction Postnatal care detects and manages complications in the weeks after delivery, yet in 2019 only 29% of women attending antenatal clinics in Bahrain’s primary health care (PHC) centers went on to attend the postnatal visit. We asked whether an antenatal intervention combining a standardized health-education session with early postnatal booking was associated with better knowledge of and attitudes toward postnatal care, and with higher postnatal clinic attendance. Methods In a non-randomized quasi-experimental study, pregnant women at 36 weeks of gestation or above were enrolled at four PHC centers (two intervention, two control) between 21 March and 20 June 2024. Intervention-group women received a midwife-delivered education session, QR-coded material, and an early postnatal appointment; controls received standard care. Knowledge and attitude were measured before and immediately after the session in the intervention arm and once, at enrolment, in the control arm. Attendance was ascertained from electronic mother-and-child health records in both arms. Groups were compared with t -tests, chi-square or Fisher’s exact tests, and logistic regression adjusted for baseline differences. Results Of 193 women approached, 175 (81 intervention, 94 control) were enrolled. Within the intervention arm, knowledge rose from 2.16 to 8.48 of 9 and attitude from 25.79 to 35.89 of 40 (both p < 0.001); because the control arm was assessed only once, these within-group changes cannot be attributed to the intervention. Attendance was 72.7% in the intervention arm versus 41.3% in controls (odds ratio 3.79, 95% CI 1.98–7.27; adjusted odds ratio 5.55, 95% CI 2.04–15.08). Knowledge and attitude did not independently predict attendance. Attendance varied widely between the two control centers (26.5 and 58.1%), and the intraclass correlation of 0.091 implies an effective sample of about 36 women. Conclusion Antenatal education with early postnatal booking was associated with substantially higher postnatal clinic attendance. With four non-randomized centers and between-center variation as large as the difference between arms, the design cannot separate an intervention effect from center-level differences. Early booking with structured counseling may be a feasible strategy for improving postnatal-care uptake and warrants evaluation in a cluster-randomized design.