**8. Conclusions and recommendations**

Postnatal care is beneficial and essential for maternal and newborn survival, yet access and utilization of these services are still low in SSA and vary among nations. This chapter demonstrates how individual, health system and contextual factors influence postnatal care access and utilization in sub-Saharan Africa.

In summary, postnatal care in SSA is confronted with significant challenges, including a lack of access to basic healthcare services, poor infrastructure, inadequate staffing and training, and limited resources. Cultural beliefs and practices as well as socio-economic factors that hinder women's autonomy and ability to make decisions regarding their health also play a role in hindering access to quality postnatal care. These challenges, coupled with high rates of maternal and infant mortality, underscore the need for targeted interventions and resources to improve postnatal care in the region. Efforts such as empowering women socially and economically, providing education, training healthcare professionals, and building or upgrading healthcare infrastructure can help to address these challenges and improve access, quality and utilization of postnatal care for mothers and babies in sub-Saharan Africa.

The fact that a high proportion of childbirths occur outside of healthcare institutions is one of the biggest obstacles to providing postnatal care in sub-Saharan Africa [37]. To address this challenge, postnatal care services must be made available in a vicinity near the home or at home, especially for women who give birth outside of medical facilities [14]. This is particularly important in communities where access to early postnatal care is restricted by cultural, socioeconomic, and geographic constraints. Currently, WHO and UNICEF, through the "Every Woman and Newborn" Initiative [5] are supporting countries to strengthen their routine health information systems to capture information on "early routine postnatal care utilization" (within 2 days of birth), to facilitate the achievement of the global target of 80% coverage of "early postnatal care" and national target of 90% of countries with >60% coverage [42]. Increasing coverage of skilled birth attendance is also likely to impact uptake of PNC significantly within the SSA region.

To accelerate progress in reaching the SDG global targets, it is essential to promote the completion of the maternal and newborn continuum of care, which includes care during the postnatal period, especially within 2 days after birth, due to the vital role of care during this period in improving the survival of mothers and their babies [5]. It is also essential to attain high-quality postnatal care with equity in all countries. Such efforts are likely to improve health outcomes for women and children and contribute to achieving sustainable development goals (2030).
