The relationship between postpartum care uptake and postpartum morbidity and their determinants in Morocco: a secondary analysis from a national survey

Background: Postpartum care (PPC) utilisation is essential to prevent maternal mortality and morbidity, particularly in low-and middle-income countries where 95% of maternal deaths occur. In Morocco, PPC remain underused. This study examines sociodemographic, environmental and obstetric factors associated with PPC utilisation and postpartum morbidity (PPM), and the relationship between PPC and PPM. Methods: A secondary data analysis of a nationally representative dataset of 5,593 women of childbearing age was conducted. Univariate and multivariate logistic regression assessed the associations between determinants and PPC utilisation and PPM. Findings: About 53.6% of women received PPC consultation before discharge, 21.8% within 6 weeks post-delivery (later PPC, LPPC) and 28.3% reported PPM. Determinants positively associated with PPC utilisation included women’s education above primary level (AOR=1.34, 95% CI:1.11-1.63), high household wealth index (AOR=1.42, 95%CI:1.02-1.98), antenatal care (AOR=1.64, 95% CI:1.08-2.47), caesarean delivery (AOR=2.50, 95%CI:1.89-3.31), and newborn postnatal care (AOR=6.97, 95% CI:5.89-8.25). Absence of doctors during midwives-led delivery reduced LPPC uptake (AOR=0.63, 95% CI:0.48-0.83). Secondary or higher education (AOR=0.71, 95% CI:0.54-0.93) and antenatal care (AOR=0.30, 95% CI:0.14-0.65) reduced PPM risk, while instrumental delivery (AOR=1.24, 95% CI:1.04-1.48) and pregnancy morbidities (AOR=2.10, 95% CI:1.72-2.56) increased it. Early PPC (EPPC) provision during hospitalisation lowered PPM risk (AOR=0.65, 95% CI:0.52-0.79), whereas LPPC utilisation was associated with PPM occurrence (AOR=1.36, 95% CI:1.08-1.71). Conclusion: PPC utilisation remains low, even during delivery-led hospitalisation, and PPM persists, reflecting health inequities. Interventions toward women with low sociodemographic characteristics are needed to increase PPC utilisation and prevent PPM. Further qualitative research is essential to explore behavioral and cultural influences and to address women’s and health professionals’ perceptions of PPC.