In developing countries, hundreds of thousands of women still die shortly after giving birth and thousands who make it to survive suffer with short-term or longterm health problems related to pregnancy and childbirth that impact their quality of life. However, empirical evidence shows that the majority of these women did not receive any care after delivery. Unlike antenatal and obstetric care, relatively little is known about the factors that explain levels of postpartum care use. This thesis examines the utilisation of postpartum care services in the context of Thailand, which is best known among the developing countries for its success on maternal and child healthcare improvement. Thailand's maternal mortality rate is low (12 deaths per 100,000 live births) and 92 per cent of women have at least four antenatal visits and 97 per cent of women deliver in hospitals. However, rates of postpartum service use remain low at 61.2 per cent. The thesis considers the explanations for low levels of postpartum service use observed in Thailand from a range of perspectives: women, health providers, policy actors and interrelationships among them. Using sequential mixed methods, the study first examines quantitatively the contemporary context of postpartum services and the individual-level factors influencing the use of postpartum services. This is followed by a qualitative analysis which explores the attitudes and perceptions of women, health providers and policy actors towards postpartum care services. Analyses reveal interacting influences that facilitate and impede women's use of postpartum care service. Whilst the quantitative study reveals several demographic, socio-economic and motivating factors, the qualitative study shows that women's perception of the content of postpartum care services and healthcare systems, as well as their experience of encounters with health providers, have significant impact on decisions whether to use postpartum services. The health service delivery system has some significant negative impacts on women's use of postpartum services. Although Thailand has had postpartum care policies in place since the 1960s, the significance of postpartum care for the mother's health has been neglected. The study finds that there is a complex array of individual, health system-related and political factors that influence the utilisation of postpartum care services. Unless adequate attention is given to these factors and their interrelation, it is unlikely that women's use of postpartum care services will be improved.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:599989 |
| Date | January 2010 |
| Creators | Pothisiri, Wiraporn |
| Publisher | London School of Economics and Political Science (University of London) |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://etheses.lse.ac.uk/2205/ |
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