UTILIZATION OF POSTPARTUM CARE SERVICES AMONG WOMEN LIVING WITH DISABILITIES AGED (15-49) YEARS IN GULU DISTRICT NORTHERN UGANDA.
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Introduction Despite the availability of maternal health care, the utilization of post-partum care services among women living with disabilities aged 15-49 years is still limited. There is a barely any studies that have magnified this problem in Uganda. This study therefore assessed the level of and factors associated with utilization of postpartum services among women living with disabilities in Gulu district Methods: A cross-sectional study employing mixed methods, among 293 mothers aged 1549 years living with disability with children 0-3 years were interviewed on utilization of postpartum care services in Gulu District, Northern Uganda. We interviewed women with sensory and physical impairments. Five key informant interviews and four in depth interviews were conducted with women living with disabilities of reproductive age and Health workers (midwives). Quantitative data was analyzed using Stata Version14 and qualitative interviews were analyzed using MAXQDA V12. Logistic regression was used to identify factors associated with utilization of postpartum care among women living with disabilities. Results: Among the 293 women interviewed, only 9% reported to have utilized post-partum services within the first 6 weeks after delivery. Partners who had attained secondary level of education were four times more likely to support their partners to utilize post-partum compared to those who had primary level education 4.51 [95% CI(1.10-18.43)] . In-depth and key informant interviews revealed that health workers‘ attitude, lack of knowledge on Postpartum care services, limited finances, lack of family support, lack of special care services to women living with disability, poor communication and stigmatization by the community as well as the Health workers were barriers to utilization. Facilitators included, special care services for women living with disabilities, advice from medical personnel to seek Post- partum services, access to free medical services and decision to seek Post partum care by the mother. Conclusion: In this study, utilization was at 9% which is much lower compared to level of utilization in Acholi region which is estimated at 53.5% among women in general population. The study results provided an understanding of factors associated with post- partum care service use or utilization by women living with disabilities. The study findings showed an xii association between post partum care utilization and; knowledge of post partum care among the post partum mothers living with disability, advice/knowledge on post partum care, paying for post partum care services, place of delivery, choice of birth attendance, incurring transport costs to facility, the level of education of the respondent, the partner‘s education, attitude of health workers, and availability of special care services in the facilities. Lack of awareness about post partum care services was found to be the main reason for the low utilization, lack of special care services to suit the women living with disabilities especially the sensory impaired in terms of communication and the negative attitude of health workers towards the women living with disabilities led to underutilization post partum care.