Open access
Protocol
Diah Puspita Sari ‍ ‍, Desy Nuri Fajarningtiyas ‍ ‍, Margareth Maya P Naibaho ‍ ‍,
Anissa Rizkianti ‍ ‍, Evalina Franciska Hutasoit ‍ ‍
To cite: Sari DP,
Fajarningtiyas DN, Naibaho MMP,
et al. Effectiveness of
postpartum care to improve
women’s health and quality of
life in Southeast Asia: a scoping
review protocol. BMJ Open
2025;15:e095974. doi:10.1136/
bmjopen-2024-095974
► Prepublication history
and additional supplemental
material for this paper are
available online. To view these
files, please visit the journal
online (https://doi.org/10.1136/​
bmjopen-2024-095974).
Received 01 November 2024
Accepted 21 May 2025
© Author(s) (or their
employer(s)) 2025. Re-­use
permitted under CC BY-­NC. No
commercial re-­use. See rights
and permissions. Published by
BMJ Group.
Research Center for Population,
National Research and
Innovation Agency Republic of
Indonesia, Jakarta Selatan, DKI
Jakarta, Indonesia
Correspondence to
Desy Nuri Fajarningtiyas;
​desy006@​brin.​go.​id
ABSTRACT
Introduction The first 3 months post partum is a
critical transition period for women and families,
which is characterised by physical, psychological and
social adaptation. The first year post partum is also a
critical phase for women’s health, given their physical
recovery and adjustment to motherhood. The WHO 2023
recommendations highlight the importance of a postnatal
care focus, including maternal health assessment, mental
health support, nutritional interventions, postpartum
contraceptive use and home care visits. This scoping
review aims to map the evidence of the effectiveness of
postpartum care on women’s health and quality of life in
the Southeast Asia region.
Methods and analysis This scoping review will be
guided by the methodological principles developed by
Arksey and O’Malley. This review will also consider
observational studies, including cohort studies, case-­
control studies and cross-­sectional studies. For inclusion,
studies should be selected for eligibility based on the
following criteria: articles investigating the uptake of
postpartum women (women who have had childbirth up to
42 days after delivery) in Southeast Asian countries. The
search will comprise peer-­reviewed articles from 2013 to
2023 from the following electronic databases: PubMed/
MEDLINE, ProQuest, EBSCO, Scopus, Web of Science and
Google Scholar. We use both keywords in the title and/
or abstract and subject headings as appropriate. We
will follow the Preferred Reporting Items for Systematic
Reviews and Meta-­Analysis (PRISMA) Protocols to develop
the protocol and use the PRISMA flow diagram to present
the results for scoping reviews.
Ethics and dissemination A scoping review is a novel
approach for examining the breadth of literature regarding
the connection between the effectiveness of postpartum
care and women’s health and quality of life and, as a
secondary analysis, does not require ethics approval. The
results of this review will be submitted for publication
in a peer-­reviewed journal and presented at relevant
conferences.
INTRODUCTION
For a long time, the primary goal of maternal
care has been focused on prenatal care.
The first 3 months post partum can also be
STRENGTHS AND LIMITATIONS OF THIS STUDY
⇒ This scoping review will provide a comprehensive
synthesis of existing evidence on the effectiveness
of postpartum care in Southeast Asia using a systematic and structured search strategy across multiple databases.
⇒ Double screening and independent critical appraisal
reduce the risk of bias in study selection and data
extraction.
⇒ To facilitate a timely review given the high number
of citations, the included studies will be limited to
observational studies, which increases the risk of
missing relevant evidence reported from the experimental studies or trials.
⇒ Due to the nature of scoping reviews, no formal risk
of bias assessment will be conducted, and the findings provide a descriptive rather than quantitative
synthesis.
challenging for many women globally. The
postpartum period begins soon after the
delivery of the placenta and ends when the
reproductive organs return to their pre-­
pregnancy state, lasting 6 weeks or 42 days.1
It is also a time of transition for a woman
and her new family, which is characterised
by physical, psychological and social adaptations.2 The year after giving birth is a particularly critical time for women’s health due to
all the changes that occur during this time,
including physical recovery from childbirth
and the shifting role of parents in caring for
their newborn.1
Globally, at least 40 million women experience long-­
term health problems caused
by childbirth every year. Postpartum-­related
health problems can last for months or years
after childbirth, including pain during sexual
intercourse (dyspareunia), low back pain,
anal and urinary incontinence, anxiety and
depression, perineal pain and fear of childbirth.3 Physical and mental health issues, in
Sari DP, et al. BMJ Open 2025;15:e095974. doi:10.1136/bmjopen-2024-095974
1
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Effectiveness of postpartum care to
improve women’s health and quality of
life in Southeast Asia: a scoping
review protocol
Open access
2
women’s health and quality of life in the Southeast Asian
region. We anticipate this scoping review will present the
coverage and effects of postpartum care among women in
the Southeast Asian region, which may also inform future
research and influence policy decisions.
METHODS AND ANALYSIS
This study will employ a scoping review to examine the
effect of postpartum care on mothers’ physical health and
quality of life. A scoping review allows researchers to map,
chart and synthesise the available data based on various
published sources to understand a given study comprehensively.18 The scoping review is guided by the methodology outlined in a study by Arksey and O’Malley,19
which consists of five steps: (1) formulation of research
questions, (2) identification of relevant studies, (3)
study selection, (4) charting the data and (5) collating,
summarising and reporting the results. This scoping
review has been registered with the Open Science Framework. The protocol can be accessed at https://osf.io/​
zt9ur, providing a detailed overview of the research objectives, inclusion criteria and planned analytical approach.
We will follow the Preferred Reporting Items for Systematic Reviews and Meta-­Analysis (PRISMA) Protocols to
develop the protocol and use the PRISMA flow diagram
to present the results for scoping reviews.
Step 1: formulation of research questions
The main research question of this review is to explore
the evidence of the effectiveness of postpartum care on
the health and quality of life of postpartum women in
Southeast Asia. The specific questions are as follows:
1. What types of postpartum care interventions have been
described in the literature?
2. How does postpartum care affect the prevalence and
management of postpartum complications and mental health problems (depression, anxiety and psychological stress) among postpartum women in Southeast
Asia?
3. How does postpartum care affect fertility choice
among postpartum women in Southeast Asia, including contraceptive use and family planning decisions?
4. How does postpartum care affect the overall quality of
life of postpartum women in Southeast Asia?
Step 2: identification of relevant studies
To ensure a comprehensive and systematic identification
of relevant studies, we will conduct a structured literature
search across multiple electronic databases, including
PubMed/MEDLINE, ProQuest, EBSCO, Scopus, Web of
Science and Google Scholar. The search strategy will be
developed using a combination of Medical Subject Headings terms and free-­text keywords related to postpartum
care, maternal health, mental health, quality of life and
reproductive outcomes. Boolean operators (eg, AND,
OR) will be applied to refine the search results and maximise coverage of relevant literature. Further, the initial
Sari DP, et al. BMJ Open 2025;15:e095974. doi:10.1136/bmjopen-2024-095974
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turn, raise the likelihood of a cascade of adverse health
outcomes, such as early breastfeeding discontinuation,
delayed child’s language development, maternal-­
child
impaired bond, lower childhood immunisation and more
behavioural issues in the child.4–6
Given the potential long-­term consequences of poor
maternal health on the woman’s and her family’s well-­
being, women critically require support and careful
monitoring during the postpartum period. The 2023
WHO recommendation on postnatal care focuses on the
essential care package for both women and newborns,
including maternal health assessment, mental health and
psychological interventions, nutrition interventions, postpartum contraception and home care visits.7 In Southeast
Asia, postnatal care is generally given at least once during
the first 6 hours after delivery, the first day after delivery
and the following days up to 6 weeks.8 Despite the importance of postnatal care in promoting the health of postpartum women, traditional and cultural practices persist
in many societies in the Southeast Asian region. Many
cultural practices are still commonly followed without
awareness of their existing health benefits or potential
harm. Some of these cultural practices include confinement, purification rituals, body massage and the use of
traditional herbs or medicine, which are encouraged to
be consumed by postpartum mothers.9–11
Nevertheless, postpartum care remains a neglected
aspect of healthcare, in which the health concerns of
many postpartum women are not adequately addressed.12
These conditions have been largely neglected in many
studies, practices and policies. Lack of attention to such
fundamental issues helps explain why many countries
have failed to make significant progress in the reduction of maternal deaths over the past two decades.13 The
burden of maternal mortality and morbidity is also influenced by the main mediating factor of the quality of care
received (timely, appropriate, effective and respectful
care is required).14
It has been argued that the difficulty of accessing
health facilities due to long distances or other conditions
makes pregnant and lactating women decide not to use
health services, which can be the biggest obstacle for
mothers in improving their health.15 Other factors are
also possible due to the lack of information obtained by
women regarding long-­term physical and mental health
problems that may arise during pregnancy, childbirth
and the postpartum period, which can be the cause of
unpreparedness when facing these problems and, as a
result, women’s quality of life will decrease in the long
term.14 16 17
Studies have shown that inadequate postpartum care
contributes to long-­
term physical and mental health
issues, yet the effectiveness of various interventions
remains unclear. Existing research is often fragmented,
focusing on specific outcomes rather than a holistic
understanding of postpartum health and quality of life.
This scoping review aims to systematically map the existing
literature on the effectiveness of postpartum care on
Open access
Step 3: study selection
The search results will be imported into Mendeley Desktop
software to identify and remove any duplicates. Following
the search, all relevant literature will be exported into
RAYYAN for screening and data extraction. Two independent pairs of reviewers will screen the titles and
abstracts to select studies related to the PICO framework
as described earlier. The decisions will be made as follows:
(1) if at least one reviewer agrees that a study is eligible
or finds the abstract/title inconclusive, it will proceed to
the second level of screening; (2) if both reviewers agree
that a study does not meet the inclusion criteria, it will be
excluded from further review.
Studies meeting the inclusion criteria will be retrieved
in full text at this stage. For studies included in this
second selection, a critical appraisal will be conducted by
five reviewers (DPS, DNF, MMPN, AR and EFH), who will
independently assess each article and discuss emerging
themes. Although scoping reviews do not typically require
a formal risk of bias assessment, a basic critical appraisal
will be performed to evaluate the methodological rigour
of the included studies and reduce randomness. Each
study will be evaluated based on study design appropriateness, sample size and representativeness, validity and
reliability of measures used and unambiguous findings.
Any disagreements will be resolved through consensus,
and if consensus cannot be reached, a third reviewer will
be consulted. If a study has multiple publications, only
the most recent version will be retained.
Full-­text studies that do not meet the inclusion criteria
will be excluded, with reasons for exclusion documented
in the final report. Exclusion criteria were applied
using a predefined list of exclusion reasons in RAYYAN,
including background article, wrong population, inappropriate study setting, incorrect publication type, irrelevant outcome, unsuitable study design or incorrect study
duration. The final search results will be comprehensively
reported in the final manuscript and presented in accordance with the PRISMA Extension for Scoping Reviews
Table 1 The population, intervention, comparators and outcomes framework for eligible studies
Elements
Inclusion criteria
Exclusion criteria
P (population)
Postpartum women, postnatal women (defined as women who have
had a childbirth up to 42 days after delivery)
Postpartum care, postnatal care, postnatal contact, postnatal
checkups, maternal healthcare, maternal health service, perineal
care, family planning, contraceptive use, postpartum contraceptives,
postpartum counselling, postpartum treatment, home visits
Women outside the postpartum
period
Antenatal care, birth care, prenatal
care, newborn care
Traditional care, traditional practices, traditional rituals, traditional
medicine, postpartum massage, postnatal massage
Physical health, physical functioning, postpartum haemorrhage,
perineal pain, vaginal pain, postpartum fatigue, pelvic floor disorders,
postpartum infection, sepsis, puerperal fever, cardiovascular diseases,
cardiomyopathy, pulmonary embolism, stroke, hypertension,
preeclampsia, amniotic fluid embolism, mastitis, breast pain,
incontinence, constipation, haemorrhoids, mental health, mental
distress, postpartum depression, baby blues, anxiety, quality of life, life
satisfaction, vitality, sleep deprivation, breastfeeding, baby weaning,
fertility choice, marital intimacy, dyspareunia, pelvic discomfort, sexual
pain disorder
Prenatal massage, labour massage
I (intervention)
C (comparison)
O (outcome)
Sari DP, et al. BMJ Open 2025;15:e095974. doi:10.1136/bmjopen-2024-095974
Child health, infant health,
HIV/AIDS, and other sexually
transmitted infections
3
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search will be conducted without geographic restrictions
to avoid excluding relevant studies without explicitly
mentioning Southeast Asia. A geographic filter will be
applied during the study selection process to include
only studies conducted in Southeast Asian countries. This
filtering will be done by screening the study setting and
population details in the titles, abstracts and full texts.
In this scoping review, only open-­
access articles
published in English between January 2013 and December
2023 will be considered. All types of reviews, protocols,
book chapters, editorial letters and technical reports will
be excluded. A pilot search was performed in PubMed/
MEDLINE to evaluate the appropriateness of keywords
and ensure that relevant studies were being retrieved (see
online supplemental file 1). Additionally, a hand search
of the reference lists in the included studies will also be
conducted to identify other potentially relevant literature.
This scoping review will consider observational studies
including prospective and retrospective cohort studies,
case-­control studies and analytical cross-­sectional studies.
This review will also include descriptive observational
study designs, such as case series, case reports and descriptive cross-­
sectional studies, for inclusion. Quantitative
studies focused on maternal healthcare and treatment
during postnatal will be considered. We will take any relevant publications regardless of the age of the postpartum
women. Studies on newborn care will be excluded. The
eligibility criteria for the studies are further explained
comprehensively using the population, intervention,
comparators and outcomes (PICO) framework, as
detailed in table 1.
Open access
Step 4: charting the data
Data from the included studies will be collected and
charted by two or more independent reviewers using a
data extraction tool based on compliance with the PICO
model. The use of a data extraction tool will ensure consistency in data collection. The extracted data will include
details on the study details (design), research objectives,
study population, methods, specific interventions and
key findings relevant to the review questions. The data
extraction tool will be modified and refined as needed
throughout the extraction process, with any modifications documented in the final scoping review. Authors of
studies with unclear or missing data will be contacted for
clarification. Any disagreements between reviewers will be
resolved through discussion, or if necessary, by consulting
a third reviewer. Data will be extracted in tabular form and
entered into Google Sheets to present the findings. The
data extraction table will include at least the following key
elements:
1. Author(s)
2. Study title
3. Year of publication
4. Type of study
5. Country of origin/study settings
6. Study population
7. Methods
8. Specific intervention(s)
9. Outcome(s)
Figure 1
4
10. Key findings, related to the scoping review questions
Step 5: collating, summarising and reporting the results
In this final stage, the extracted data will be collated,
summarised and reported in accordance with the objectives of the scoping review. A descriptive analysis will
be performed, and comparable data segments will be
grouped thematically. The findings will be organised in
tabular format and visually represented using graphs or
charts where applicable. Given the nature of a scoping
review, no formal statistical heterogeneity analysis will
be conducted. However, heterogeneity among included
studies will be assessed qualitatively by examining variations in study design, postpartum care interventions and
outcome measures. A narrative synthesis will be used to
highlight key themes emerging from the data based on
commonalities in interventions and outcomes, ensuring a
comprehensive interpretation of the effectiveness of postpartum care on women’s physical health, mental health,
fertility choices and overall quality of life in Southeast
Asia. The results will be critically discussed to identify
existing gaps in the literature and provide recommendations for future research and policy implementation.
ETHICS AND DISSEMINATION
As this scoping review involves a secondary analysis of
publicly available literature, ethics approval is not required.
The review findings will be disseminated through publication in a peer-­reviewed journal and presented at relevant conferences. By systematically mapping the evidence
on postpartum care effectiveness in Southeast Asia, this
Preferred Reporting Items for Systematic Reviews and Meta-­Analyses flow diagram.
Sari DP, et al. BMJ Open 2025;15:e095974. doi:10.1136/bmjopen-2024-095974
BMJ Open: first published as 10.1136/bmjopen-2024-095974 on 5 June 2025. Downloaded from http://bmjopen.bmj.com/ on January 6, 2026 by guest .
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guidelines to enhance transparency. As shown in figure 1,
a PRISMA flow diagram will illustrate the number of
studies retained at each stage of the selection process.
Open access
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Sari DP, et al. BMJ Open 2025;15:e095974. doi:10.1136/bmjopen-2024-095974
5
Contributors All authors have made substantial contributions to the development
of the manuscript. DPS and AR led the conceptualisation and design of this work.
DNF, MMPN and EFH designed the search strategy methods. All authors reviewed
titles and abstracts and made decisions on full-­text articles to be included in
the review. All authors were involved in data extraction. All authors were also
responsible for the manuscript draft, revision and final version.The guarantor of this
manuscript is DPS.
Funding The authors have not declared a specific grant for this research from any
funding agency in the public, commercial or not-­for-­profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in
the design, conduct, reporting or dissemination plans of this research.
Patient consent for publication Not applicable.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has
not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been
peer-­reviewed. Any opinions or recommendations discussed are solely those
of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and
responsibility arising from any reliance placed on the content. Where the content
includes any translated material, BMJ does not warrant the accuracy and reliability
of the translations (including but not limited to local regulations, clinical guidelines,
terminology, drug names and drug dosages), and is not responsible for any error
and/or omissions arising from translation and adaptation or otherwise.
Open access This is an open access article distributed in accordance with the
Creative Commons Attribution Non Commercial (CC BY-­NC 4.0) license, which
permits others to distribute, remix, adapt, build upon this work non-­commercially,
and license their derivative works on different terms, provided the original work is
properly cited, appropriate credit is given, any changes made indicated, and the use
is non-­commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
ORCID iDs
Diah Puspita Sari http://orcid.org/0000-0001-6900-1026
Desy Nuri Fajarningtiyas http://orcid.org/0000-0003-3757-6858
Margareth Maya P Naibaho http://orcid.org/0000-0003-1295-5579
Anissa Rizkianti http://orcid.org/0000-0002-1255-5199
Evalina Franciska Hutasoit http://orcid.org/0000-0001-5114-6024
REFERENCES
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review aims to inform future research, guide healthcare
policies and contribute to the development of evidence-­
based interventions that improve maternal health and
quality of life.