**Abstract**

The postnatal period remains the most at-risk period for the mother-infant dyad. Most maternal and neonatal deaths occur in the immediate postnatal period, contributing to the greatest burden of child mortality. Appropriate care for mothers and newborns during this critical period is essential to improve their survival. However, access to quality care during this period remains a challenge, especially in resource-limited settings. This chapter examines challenges to postnatal care (PNC) in sub-Saharan Africa (SSA), drawing on existing evidence. A comprehensive review of critically appraised literature was undertaken. The findings indicate suboptimal uptake of PNC, resulting in high maternal and neonatal morbidity and mortality in the postnatal period. Challenges to the delivery of quality PNC include poor healthcare infrastructure and access to basic health services, and underlying structural determinants such as widespread poverty, illiteracy, harmful cultural practices, marginalization of women, and inadequate political will by governments. These challenges underscore the need for intensified efforts to improve PNC in the region. Innovative approaches to increasing demand and reaching mothers with PNC services within communities are critically needed to improve access and utilization of PNC in SSA, improve maternal and child health outcomes, and contribute to achieving the sustainable development goals in 2030.

**Keywords:** postnatal care, maternal and newborn care, neonatal care, health systems, sub-Saharan Africa
