Analysis | Postpartum in the U.S. vs Africa

Comprehensive Analysis of Critical Postpartum Knowledge for Women in the United States and Africa: A Comparative Study

Written By: Lydia Simmons; Motherocity Inc.

Abstract
This paper provides an in-depth examination of essential postpartum information for women in the United States and Africa, emphasizing the recognition and management of postpartum health issues. Despite significant differences in healthcare infrastructure, socioeconomic conditions, and cultural contexts, women in both regions face similar physiological challenges during the postpartum period. This study aims to elucidate these shared experiences while highlighting region-specific concerns and disparities in care.

Introduction

The postpartum period, traditionally defined as the first six weeks following childbirth, is a critical time for maternal health and well-being. Recent research suggests that this period of vulnerability extends well beyond six weeks, with some experts advocating for a "fourth trimester" concept that spans up to 12 months post-delivery [1]. While experiences may differ between the United States and Africa due to variations in healthcare access, cultural practices, and socioeconomic factors, the fundamental physiological processes remain consistent. This paper aims to provide a comprehensive overview of the most crucial information for postpartum women in both regions.

Key Findings

1. Recognition and Management of Postpartum Complications:

a) Postpartum Hemorrhage (PPH)
Postpartum hemorrhage remains a leading cause of maternal mortality worldwide. In Africa, it accounts for approximately 34% of maternal deaths, while in the U.S., it contributes to 11% of pregnancy-related deaths [2,3].

- Definition and Incidence: PPH is defined as blood loss of 500 ml or more within 24 hours after birth. Severe PPH is blood loss of 1000 ml or more within the same timeframe [4].
- U.S. Statistics: The prevalence of PPH increased from 4.3% in 1980-1981 to 21.2% in 2013-2014 in the United States [5].
- African Statistics: In sub-Saharan Africa, the prevalence of PPH ranges from 1.9% to 29.7%, depending on the region [6].

Women should be educated to recognize signs such as soaking through more than one pad per hour, passing large clots (larger than a golf ball), or feeling dizzy and faint. Immediate medical attention is crucial in these cases.

b) Puerperal Infections
Infections account for about 15% of maternal deaths in developing countries [7].

- Types: Common infections include endometritis, urinary tract infections, and mastitis.
- Incidence: In the U.S., the rate of postpartum infections is approximately 5-7% [8]. In Africa, rates can be as high as 10-15% in some regions [9].
- Risk Factors: Cesarean deliveries, prolonged labor, and poor hygiene conditions increase infection risk.

Symptoms warranting urgent medical attention include fever (temperature above 100.4°F or 38°C), severe abdominal pain, foul-smelling vaginal discharge, or breast redness and pain.

c) Postpartum Mental Health Disorders
Mental health issues affect up to 20% of women in the postpartum period globally [10].

- Postpartum Depression (PPD)
- U.S.: Approximately 1 in 8 women experience symptoms of PPD [11].
- Africa: Rates vary widely but can be as high as 30-50% in some regions [12].

- Postpartum Anxiety
- U.S.: Affects up to 17% of postpartum women [13].
- Africa: Limited data available, but studies suggest rates between 11-33% [14].

- Postpartum Psychosis
- Rare but severe, affecting 1-2 per 1000 women after childbirth [15].
- Requires immediate medical intervention due to risk of harm to mother or infant.

Women should be educated about symptoms such as persistent sadness, anxiety, difficulty bonding with the baby, and in severe cases, hallucinations or delusions. Early intervention is crucial for better outcomes.

2. Importance of Postpartum Care

a) United States:
- The American College of Obstetricians and Gynecologists (ACOG) recommends ongoing care with an initial assessment within the first 3 weeks postpartum, followed by ongoing care as needed, concluding with a comprehensive postpartum visit no later than 12 weeks after birth [16].
- Despite these recommendations, only 40% of women attend a postpartum visit [17].

b) Africa
- WHO guidelines recommend at least three postpartum visits: within 24 hours of birth, on day 3, and between days 7-14 [18].
- In many African countries, these guidelines are often not met due to various barriers including distance to health facilities, cost, and cultural practices.
- Postpartum care utilization rates vary widely, from as low as 25% in some countries to over 70% in others [19].

3. Breastfeeding Support and Education

Exclusive breastfeeding for the first six months is recommended by WHO for optimal infant nutrition. However, rates vary significantly between and within countries.

a) United States
- Initiation rate: 84.1% of infants are breastfed at birth [20].
- Duration: Only 25.6% of infants are exclusively breastfed at 6 months [20].
- Disparities: Significant racial and socioeconomic disparities exist in breastfeeding rates [21].

b) Africa
- Initiation rates are generally high, often over 90% [22].
- Exclusive breastfeeding rates at 6 months range from 23% to 56% across different countries [22].
- Challenges include lack of support, cultural practices of early introduction of complementary foods, and misinformation about breastfeeding [23].

Access to lactation support and education is crucial in both regions. Evidence-based interventions, such as peer counseling and professional support, have been shown to improve breastfeeding outcomes [24].

4. Nutrition and Hydration

Adequate nutrition and hydration are vital for recovery and, if breastfeeding, for milk production.

a) United States
- Recommendations include consuming an additional 330-400 calories per day while breastfeeding [25].
- Focus on nutrient-dense foods and continued prenatal or postnatal vitamin supplementation. 
- Hydration needs increase by about 700-1000 ml/day during lactation [26].

b) Africa
- In resource-limited settings, nutritional needs become even more critical due to pre-existing deficiencies.
- Iron deficiency anemia affects up to 50% of pregnant women in developing countries [27].
- Micronutrient supplementation programs have shown positive effects on maternal and infant outcomes [28].

5. Physical Recovery and Pelvic Floor Health

a) United States
- Pelvic floor disorders affect up to 25% of women after vaginal delivery [29].
- ACOG recommends pelvic floor muscle training to reduce the risk of urinary incontinence [30].

b) Africa
- Limited data on pelvic floor disorders, but studies suggest high prevalence of obstetric fistula in some regions (1.57 per 1000 women in sub-Saharan Africa) [31].
- Lack of access to specialized care for pelvic floor disorders is a significant issue.

Conclusion
While the postpartum experiences of women in the U.S. and Africa may differ due to socioeconomic factors and healthcare access, the fundamental physiological processes and potential complications remain similar. Empowering women with knowledge about recognizing danger signs, the importance of postpartum care, breastfeeding support, nutrition, and physical recovery is crucial for improving maternal outcomes in both regions.

The disparities in healthcare access and outcomes between and within these regions highlight the need for targeted interventions and policy changes. In the U.S., efforts should focus on addressing racial and socioeconomic disparities in postpartum care and outcomes. In Africa, improving access to skilled birth attendants, enhancing postpartum care utilization, and addressing nutritional deficiencies should be prioritized.

Future research should focus on developing culturally appropriate interventions to improve postpartum care access and utilization, particularly in resource-limited settings. Additionally, longitudinal studies examining the long-term impacts of various postpartum care models could inform policy and practice in both regions.

References

[1] Tully, K. P., et al. (2017). Journal of Midwifery & Women's Health, 62(1), 90-95.
[2] World Health Organization. (2019). Trends in maternal mortality: 2000 to 2017.
[3] Creanga, A. A., et al. (2017). Obstetrics & Gynecology, 130(2), 366-373.
[4] World Health Organization. (2012). WHO recommendations for the prevention and treatment of postpartum haemorrhage.
[5] Bateman, B. T., et al. (2019). Anesthesia & Analgesia, 128(6), 1056-1064.
[6] Calvert, C., et al. (2012). BMC Pregnancy and Childbirth, 12, 112.
[7] Say, L., et al. (2014). The Lancet Global Health, 2(6), e323-e333.
[8] Yokoe, D. S., et al. (2001). American Journal of Infection Control, 29(2), 109-119.
[9] Seale, A. C., et al. (2009). The Lancet Infectious Diseases, 9(7), 428-438.
[10] World Health Organization. (2020). Maternal mental health.
[11] Centers for Disease Control and Prevention. (2020). Depression Among Women.
[12] Sawyer, A., et al. (2010). Archives of Women's Mental Health, 13(5), 395-409.
[13] Goodman, J. H., et al. (2016). Journal of Women's Health, 25(10), 1019-1031.
[14] Sawyer, A., et al. (2010). Archives of Women's Mental Health, 13(5), 395-409.
[15] VanderKruik, R., et al. (2017). BMC Psychiatry, 17(1), 272.
[16] American College of Obstetricians and Gynecologists. (2018). Obstetrics & Gynecology, 131(5), e140-e150.
[17] Almeida, L. M., et al. (2019). Journal of Women's Health, 28(1), 20-27.
[18] World Health Organization. (2013). WHO recommendations on postnatal care of the mother and newborn.
[19] Langlois, É. V., et al. (2015). Bulletin of the World Health Organization, 93, 259-270G.
[20] Centers for Disease Control and Prevention. (2020). Breastfeeding Report Card.
[21] Jones, K. M., et al. (2015). Pediatrics, 136(2), 225-232.
[22] UNICEF. (2019). Infant and young child feeding.
[23] Rollins, N. C., et al. (2016). The Lancet, 387(10017), 491-504.
[24] McFadden, A., et al. (2017). Cochrane Database of Systematic Reviews, 2, CD001141.
[25] Institute of Medicine. (2009). Weight Gain During Pregnancy: Reexamining the Guidelines.
[26] Neville, M. C., et al. (2014). American Journal of Clinical Nutrition, 100(2), 565-572.
[27] World Health Organization. (2015). The global prevalence of anaemia in 2011.
[28] Haider, B. A., & Bhutta, Z. A. (2017). Cochrane Database of Systematic Reviews, 4, CD004905.
[29] Handa, V. L., et al. (2012). Obstetrics & Gynecology, 119(2 Pt 1), 273-280.
[30] American College of Obstetricians and Gynecologists. (2020). Obstetrics & Gynecology, 135(3), e42-e56.
[31] Adler, A. J., et al. (2013). BJOG: An International Journal of Obstetrics & Gynaecology, 120(6), 653-661.