Postnatal Care Service Provision, Uptake among Women, and Stakeholder Perceptions in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Background: Postnatal care (PNC) is essential for identifying complications, promoting maternal and newborn wellbeing, and preventing avoidable deaths. However, service availability does not necessarily translate into utilisation (uptake). This review examined PNC provision, uptake among women, and stakeholders’ perceptions in sub-Saharan Africa. Methods: This review examined mixed evidence from quantitative, qualitative and mixed-methods studies in accordance with PRISMA guidelines. Relevant studies were retrieved from PubMed, ScienceDirect and African Journals Online electronic databases. The search was limited to English language studies published between 2016 and 2026. The extracted data was synthesised narratively. A random-effects meta-analysis was done to estimate pooled PNC service uptake using RevMan Web software application. Results: Evidence from sub-Saharan Africa indicated that PNC service availability ranged from 85.4% to 97.6% across surveyed settings. Home visits reached approximately 52% of women, while 64% received routine health education. Across studies involving 5,828 women (mostly from Ethiopia and Uganda), the pooled uptake of PNC was 42% (95% confidence interval: 24–62%). Providers identified inadequate staffing, insufficient supplies, heavy workloads, weak supervision and dysfunctional referral systems as major drivers of PNC under-utilisation. The women emphasised limited knowledge, sociocultural beliefs, transportation costs, disrespectful treatment from care providers, and inadequate privacy as issues discouraging them from utilising PNC services. Both groups identified long waiting times and poor communication of postnatal schedules as barriers to poor service utilisation. Conclusion: PNC uptake is still inconsistent despite relatively high reported service availability. Strengthening health-system capacity, accessibility, respectful care, and communication may improve utilisation. Integrated interventions addressing both service-delivery constraints and women's needs are recommended.