**8. Barriers**

Improvements in the services related to postpartum were noticed worldwide despite the variation between countries or within the country regions. However, barriers were markedly observed in low- and middle-income countries where postnatal care utilization was low at village levels and where 70% of the mothers were settled down [39]. Financial constraints, distance from the health center, poor programming for postnatal care, women's experience during childbirth, cultural constraints, mother and family members' health literacy on postnatal care, feeling that postnatal visits were not necessary, sociocultural beliefs, and practices, whichhindered mothers from utilizing postnatal care and from having adequate nutritional intake during the postnatal period [39, 40]. Other factors were related to the health system such as insufficient staff, poor reception of clients, lack of trust and confidentiality between clients and health care providers, lack of sensitization and information, and midwives' workloads [41]. In addition, patient-centered care practices, capacities to conduct postnatal information, education, and counseling are considered among the main barriers to the use of proper postnatal care mainly in remote areas of low- and middle-income nations [39, 42].
