This research assessed the attitudes toward postnatal care among women of childbearing age attending specialist hospitals in the Maiduguri Metropolis. A cross-sectional survey design was utilized, targeting pregnant women attending antenatal care in selected specialist hospitals in Maiduguri. The sample consisted of 384 participants, derived through stratified and accidental sampling methods. A self-developed questionnaire on attitudes towards PNC was employed to collect data, incorporating a four-point Likert scale for measurement. Validity was assessed through expert review, and reliability evaluated with a split-half coefficient of 0.81. Inferential statistics, specifically one-sample t-tests, were applied to analyze the data at a 0.05 significance level. The analysis revealed a mean attitude score of 2.1471 compared to a hypothesized neutral score of 2.5, with a p-value of 0.110, indicating no significant difference and supporting the retention of the null hypothesis. This suggests that women’s attitudes towards postnatal care in the studied hospitals do not significantly favor either positive or negative sentiments. The findings indicate a neutrality in attitudes towards postnatal care among the women surveyed, with implications for the promotion of PNC services in Maiduguri. Despite the neutral stance towards PNC, there exists an underlying negative attitude that could impact actual service utilization.  It is imperative for healthcare providers to enhance educational outreach during antenatal visits, emphasizing the critical nature of PNC. The establishment of community-based PNC services could improve accessibility.

Postnatal care (PNC) is a critical component of maternal and child health services, encompassing a range of interventions designed to support mothers and newborns in the crucial weeks following childbirth. The World Health Organization (WHO) defines the postnatal period as the first six weeks after birth and recommends that all women and newborns receive at least three postnatal contacts within this timeframe (WHO, 2022). Despite its importance, postnatal care remains one of the most neglected aspects of maternal and child health services globally, with significant variations in uptake and quality across different regions and healthcare settings (Langlois et al., 2015).

The period immediately following childbirth is a time of significant physiological and psychological changes for both mother and infant. It is also a time of elevated risk for complications that can have long-term health implications. Estimates suggest that up to 40% of maternal deaths occur during the postnatal period, with the majority of these deaths occurring within the first 24 hours after delivery (Say et al., 2014). Additionally, the neonatal period (the first 28 days of life) accounts for approximately 47% of all under-five deaths globally (UNICEF, 2021). Many of these deaths could be prevented with timely and appropriate postnatal care interventions.

Specialist hospitals play a crucial role in providing high-quality maternal and child health services, including postnatal care. These institutions are often equipped with advanced facilities and staffed by specialists, positioning them to offer comprehensive care for both routine and complicated cases. However, the utilization of postnatal care services, even in specialist hospital settings, is influenced by a complex interplay of factors, including women's attitudes towards these services. The attitude of women towards postnatal care is shaped by various socio-cultural, economic, and health system factors. Studies have shown that women's knowledge and awareness about the importance of postnatal care significantly influence their attitudes and subsequent utilization of these services (Titaley et al., 2010). In many low- and middle-income countries, where the burden of maternal and neonatal mortality is highest, awareness about the importance of postnatal care remains low, contributing to negative attitudes and poor uptake of services (Langlois et al., 2015).

Cultural beliefs and practices also play a significant role in shaping attitudes towards postnatal care. In some cultures, traditional postpartum practices may conflict with modern medical recommendations, leading to reluctance in seeking formal postnatal care services (Dennis et al., 2007). For instance, the practice of postpartum confinement, common in many Asian cultures, may deter women from attending postnatal clinics, even when these services are available at specialist hospitals (Raman et al., 2016). Socioeconomic factors, including education level, income, and employment status, have been shown to influence women's attitudes towards postnatal care. Studies have consistently demonstrated that women with higher education levels and better economic status tend to have more positive attitudes towards healthcare services, including postnatal care (Some fun & Ibis Omi, 2016). This relationship highlights the importance of addressing broader social determinants of health in efforts to improve postnatal care utilization.

The quality of care provided during pregnancy and childbirth also significantly impacts women's attitudes towards postnatal care. Positive experiences during antenatal care and delivery can foster trust in the healthcare system and promote more favorable attitudes towards postnatal services (Sacks & Kinney, 2015). Conversely, experiences of disrespect or mistreatment during facility-based childbirth can lead to negative attitudes and reluctance to engage with postnatal care services, even in specialist hospital settings (Bohren et al., 2015).

Accessibility and convenience of postnatal care services are crucial factors influencing women's attitudes. Even when specialist hospitals offer high-quality postnatal care, barriers such as distance, transportation costs, and long waiting times can contribute to negative attitudes and poor utilization of services (Gabrysch & Campbell, 2009). This underscores the need for healthcare systems to consider innovative approaches to service delivery, such as community-based postnatal care or mobile health technologies, to complement facility-based care and improve accessibility.

The role of partners and family members in shaping women's attitudes towards postnatal care cannot be overstated. In many contexts, decisions about healthcare utilization are made collectively within families. Studies have shown that women whose partners and families support and encourage the use of postnatal care services are more likely to have positive attitudes and higher utilization rates (Jungari, 2019). This highlights the importance of engaging not only women but also their partners and wider family networks in education and awareness efforts about postnatal care. In recent years, there has been growing recognition of the need to improve postnatal care services and promote positive attitudes towards their utilization. The WHO's 2022 guidelines on maternal and newborn care for a positive postnatal experience emphasize the importance of woman-centered care, continuity of care, and community involvement in promoting positive attitudes and behaviors towards postnatal care (WHO, 2022).

Hypothesis

There is no significant attitude towards post-natal care among women of child bearing age attending specialist hospitals in Maiduguri Metropolis, Borno state.

The study adopted survey research design. Survey research design is a type of non-experimental research design that involves collecting data through self-reported questionnaires or interviews from a sample of individuals (Kumar, 2016). The purpose of a survey is to collect information about a particular topic, attitude, or behavior from a large number of people (Fowler, 2013).

The population for this study comprises all pregnant women attending antenatal care in specialist hospitals in Maiduguri Metropolis, Borno state. This specialist hospital is state specialist hospital, Umar Shehu ultra-modern hospital, Muhammed Shuwa hospital (Nursing home) and Maryam abatcha women and children hospital. With population of numbering seven hundred and fifty (750). (Borno State Hospital Management, 2023). The sample size for the study is three hundred and eighty-four (380). Di stage sampling procedure will be used to select respondents. That is, proportionate sampling techniques and accidental sampling techniques. The proportionate sampling techniques will be used to distribute questionnaires to each specialist hospitals in Maiduguri Metropolis, Borno state. While, accidental sampling techniques will be used to a administer to the respondents.

The research instrument used for this study was a self-developed questionnaire on attitude towards Post Natal Care Among Women Of Child Bearing Age Attending Specialist Hospitals (APNCWCBASH). The questionnaire was divided be into two sections A, and B. Section “A” on demographic information of the respondents. Section “B” on Knowledge of Post Natal Care Among Women Of Child Bearing Age Attending Specialist Hospitals. A 4-point Likert type scale respond mode was used. The statements of the questionnaire afforded the respondents to answer by ticking one respond, for example, the respondents were requested to indicate their opinion by ticking in the appropriate column as follows; SA=Strongly Agree, A=Agree, D= Disagree, SD=Strongly Disagree. In validating the research instrument, a draft copy of the questionnaire was scrutinized and reviewed by experts in the Department of Nursing science. To determine the reliability of the instrument, split- half test was used to determine the reliability coefficient test for which reliability was calculated and administered and reliability coefficient was 0.81

The completed questionnaire was collated and coded. Inferential statistics of one sampled t-test was used to answer research the formulated hypotheses at 0.05 significance level.

Hypothesis

There is no significant attitude towards post-natal care among women of child bearing age attending specialist hospitals in Maiduguri Metropolis, Borno state.

Table 1: Summary of One-Sample t-test on attitude towards post-natal care among women of child bearing age attending specialist hospitals in Maiduguri Metropolis, Borno state

Table 1, indicted that p-value is greater than the conventional significance level of 0.05, indicating that the result is not statistically significant. The null hypothesis is retained, suggesting that there is no significant difference between the sample mean and the hypothesized population mean. The p-value (0.110) is greater than the conventional significance level of 0.05. This indicates that the difference between the observed mean attitude (2.1471) and the hypothesized neutral attitude (2.5) is not statistically significant. Based on the statistical analysis, we retain the null hypothesis that there is no significant attitude towards postnatal care among women of childbearing age attending specialist hospitals in Maiduguri Metropolis. Although the sample mean (2.1471) is numerically lower than the hypothesized neutral point (2.5), this difference is not statistically significant. This suggests that the attitudes towards postnatal care in the studied population do not significantly differ. 

Discussion 

There are significant attitudes Towards Postnatal Care Among Women of Childbearing Age Attending Specialist Hospitals in Maiduguri Metropolis, Borno state. Studies have shown that women who are well-informed about the importance of postnatal care are more likely to have positive attitudes towards these services and utilize them effectively (Titaley et al., 2010). In specialist hospital settings, where access to information and healthcare professionals is generally higher, women tend to have better knowledge about postnatal care. However, disparities still exist, particularly among women from lower socioeconomic backgrounds or those with limited health literacy (Langlois et al., 2015). Research conducted by Kebede et al. (2019) in Ethiopia found that women who received antenatal care education were 2.72 times more likely to have good knowledge about postnatal care compared to those who did not. This highlights the importance of integrating postnatal care education into antenatal services to foster positive attitudes and behaviors.

In many societies, traditional practices during the postpartum period may conflict with modern medical recommendations, leading to negative attitudes towards formal postnatal care services (Dennis et al., 2007). For instance, in some cultures, there is a belief in the need for a period of confinement after childbirth, which may discourage women from seeking postnatal care outside the home. A study by Raman et al. (2016) in India found that cultural practices, such as dietary restrictions and traditional healing methods, significantly influenced women's decisions to utilize postnatal care services. Even among women attending specialist hospitals, these cultural factors can persist and affect their attitudes towards postnatal care.

Women who have had positive experiences with healthcare providers during pregnancy and childbirth are more likely to have favorable attitudes towards postnatal care services (Sacks & Kinney, 2015). Specialist hospitals, with their advanced facilities and expert staff, often inspire greater confidence among patients. However, negative experiences, such as disrespectful care or long waiting times, can significantly impact attitudes and future utilization of services. A systematic review by Bohren et al. (2015) highlighted the importance of respectful maternity care in shaping women's attitudes towards maternal health services, including postnatal care. The review found that women who experienced mistreatment during childbirth were less likely to seek postnatal care, even in specialist hospital settings. Factors such as distance to healthcare facilities, transportation costs, and waiting times can affect women's willingness to seek postnatal care (Gabrysch & Campbell, 2009). While specialist hospitals often offer comprehensive services, they may be located far from some communities, potentially leading to negative attitudes towards postnatal care among women who find it challenging to access these facilities. A study by Zamawe et al. (2015) in Malawi found that women living closer to health facilities were more likely to have positive attitudes towards postnatal care and utilize these services. This underscores the need for decentralized postnatal care services or innovative approaches like mobile clinics to improve accessibility.

Women who recognize the potential complications that can arise during the postpartum period and the importance of early intervention are more likely to have positive attitudes towards postnatal care (Titaley et al., 2010). Specialist hospitals play a vital role in educating women about these benefits, potentially fostering more favorable attitudes among their patients. Research by Probandari et al. (2017) in Indonesia found that women who perceived postnatal care as necessary for their health and their baby's well-being were more likely to utilize these services. This highlights the importance of education and awareness campaigns in specialist hospitals to emphasize the value of postnatal care. A study by Some fun and Ibis Omi (2016) in Nigeria found that women from wealthier households were more likely to have positive attitudes towards postnatal care and utilize these services. This underscores the need for financial support mechanisms or insurance coverage to promote positive attitudes and utilization of postnatal care services across all socioeconomic groups.

In conclusion, while the study did not find significantly positive or negative attitudes towards postnatal care, the statistical analysis revealed that there is no significant difference between the observed mean attitude (2.1471) and the hypothesized neutral attitude (2.5) towards postnatal care. This suggests that women's attitudes towards PNC in the studied population do not significantly different. The retention of the null hypothesis indicates that there is negative attitude towards postnatal care among the sampled women. 

Recommendations 

Based on the findings the followings were recommended:

1. During antenatal care (ANC) visits and immediately after childbirth, healthcare providers should offer detailed educational sessions on the importance of postnatal care. These sessions should cover the benefits of PNC for both the mother and the baby, such as early detection of complications, support for breastfeeding, and mental health support.
2. There should be hospital-based postnatal care, establish community-based postnatal care clinics or outreach services to reach women who may not be able to visit hospitals regularly. These mobile or community-based clinics can provide basic postnatal check-ups and services closer to home, ensuring that more women have access to PNC.
3. Train healthcare providers in cultural competence to help them understand the beliefs and practices surrounding childbirth and postnatal care in Maiduguri. This will enable them to offer respectful care that acknowledges and integrates local customs while still promoting the benefits of modern medical practices.
4. In Maiduguri and other parts of northern Nigeria, Traditional Birth Attendants (TBAs) play a significant role in maternal health. Engage and train TBAs to provide basic postnatal care and refer women to hospitals for more comprehensive services. This collaboration can bridge the gap between traditional practices and modern healthcare.
5. Some women may have religious beliefs that influence their health-seeking behavior. Engage religious leaders in health education and awareness programs to promote the importance of postnatal care within the framework of their beliefs. Religious leaders can also help in addressing misconceptions about PNC.
6. Some women may avoid PNC due to societal stigma or the perception that postnatal visits are unnecessary. Launch stigma reduction campaigns that challenge these misconceptions and emphasize the importance of PNC for the well-being of both mother and child.