Predictors of Inadequate Postnatal Care Utilization in Malawi An Analysis of Demographic and Health Survey (DHS) Data

Postnatal care (PNC) is essential for reducing maternal and neonatal complications, yet many women in low- and middle-income countries, including Malawi, fail to receive adequate care. This study examined predictors of inadequate PNC utilization in Malawi using data from the 2016–2017 Demographic and Health Survey (DHS). A secondary cross-sectional analysis was conducted among 13,144 women who met the inclusion criteria. Data cleaning and validation were performed to ensure accuracy, and missing data were addressed using appropriate techniques. Descriptive statistics summarized participants’ characteristics, while multivariate logistic regression identified factors associated with inadequate PNC utilization, controlling for potential confounders. Overall, PNC utilization in Malawi was 45%, indicating that over half of women received inadequate postnatal care. Multivariate analysis revealed that being Muslim (AOR = 1.3462; 95% CI: 1.1058–1.6388; p = 0.003), residing in the Central (AOR = 1.8407; 95% CI: 1.5354–2.2067; p < 0.001) or Southern regions (AOR = 1.5401; 95% CI: 1.2844–1.8468; p < 0.001), and having seven or more children (AOR = 1.2213; 95% CI: 1.0378–1.4373; p = 0.016) were associated with higher odds of inadequate PNC. Protective factors included receiving adequate antenatal care (AOR = 0.5766; 95% CI: 0.5286–0.6290; p < 0.001), perceiving distance to health facilities as not a major problem (AOR = 0.8577; 95% CI: 0.7738–0.9507; p = 0.004), visits by field workers (AOR = 0.6116; 95% CI: 0.5363–0.6974; p < 0.001), and higher maternal education (AOR = 0.5187; 95% CI: 0.3425–0.7855; p = 0.002). These findings highlight the role of socio-demographic, geographic, and health system factors in shaping PNC utilization in Malawi. Interventions that promote female education, improve antenatal care quality, expand community outreach, and address geographic barriers are critical to enhancing postnatal service uptake. Future research should explore cultural and religious barriers, monitor intervention outcomes, and evaluate innovative PNC delivery models to improve maternal and neonatal health outcomes.