Determinants and expert-validated strategies for enhancing postnatal care utilisation among mothers in Oromia, Ethiopia: a cross-sectional study

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Background Postnatal care (PNC) is a critical intervention for reducing maternal and neonatal morbidity and mortality. Despite its importance, utilisation of PNC services remains low in Ethiopia, particularly in the Oromia region. This study aimed to identify determinants of PNC utilisation among postpartum women and develop expert-validated strategies to improve service uptake. Methods A facility-based cross-sectional study was conducted among 156 postpartum women aged 18–49 years who had delivered within the preceding six weeks and attended Ambo General Hospital in Oromia, Ethiopia. PNC utilisation was defined as receipt of at least one postnatal care visit within six weeks after delivery. Data were collected using a structured, pretested questionnaire and analysed using descriptive statistics and multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were used to identify factors associated with PNC utilisation. Determinants were interpreted using the Andersen Health Services Utilisation Model and the Three Delays Model. Evidence-informed strategies to improve PNC utilisation were subsequently developed and refined through a two-round Delphi consensus process involving maternal and child health experts. Results Overall, 31% of women reported utilising PNC services within six weeks following childbirth. Factors independently associated with PNC utilisation included higher maternal education (AOR=2.1; 95% CI: 1.1–9.1), urban residence (AOR=2.6; 95% CI: 1.29–5.17), higher household income (AOR=1.05; 95% CI: 1.01–1.10), facility-based delivery (AOR=5.1; 95% CI: 2.38–10.92), and access to free maternal health services (AOR=2.0; 95% CI: 1.20–3.30). The Delphi process achieved expert consensus on a range of community-, facility-, and policy-level strategies to strengthen awareness, accessibility, affordability, and continuity of postnatal care services. Conclusions Postnatal care utilisation in Oromia remains suboptimal and is shaped by socioeconomic, geographic, and health system factors. The expert-validated strategies developed in this study provide a practical, evidence-informed framework for improving PNC uptake. Future implementation studies are needed to assess the feasibility, acceptability, and effectiveness of these strategies in routine practice.