Factors associated with non-uptake of postpartum home visits by midwives in France: results from the 2021 French national perinatal survey.

BACKGROUND: Postnatal home visits by midwives (subsequently simplified as "home visits") represent an important component of postnatal care. We aimed to examine the factors associated with the non-uptake of home visits within the first 2 months postpartum in France. METHODS: We used data from the 2021 National Perinatal Survey (ENP and ENP-DROM). We analysed women who completed the 2-month postpartum questionnaire after giving birth at term to a healthy singleton (n = 7828). The outcome was the absence of home visits within 2 months postpartum. Weighted analyses and multilevel logistic regressions, with women nested within maternity units, were conducted by sequentially introducing contextual, individual and antenatal care variables. RESULTS: Overall, 18.2% of women did not receive any home visits. Marked regional disparities persisted after adjustment. Foreign nationality, social deprivation and lower education were associated with lower uptake. The absence of the French home-based postnatal discharge support programme ("PRADO"), lower midwife availability, birth in smaller maternity units, birth in a university hospital and prolonged postpartum hospital stay were also associated with lower uptake. By contrast, childbirth preparation classes, antenatal midwife home visits and follow-up by independent midwives were associated with higher uptake. Non-uptake showed a high degree of clustering within maternity units (ICC 39.6%), which persisted after multivariable adjustment (ICC 28.9%). CONCLUSION: Uptake of postpartum home visits in France is influenced by individual vulnerability and structural factors related to maternity practices, antenatal care and midwife availability. Strengthening antenatal engagement and improving hospital-community coordination are essential to ensure equitable access to postnatal care. STATEMENT OF SIGNIFICANCE: Problem or issue: High-quality postpartum care is essential for both maternal and infant health and for continuity of care after hospital discharge. In France, postnatal home visits by midwives represent a key component of recommended postpartum follow-up. However, little is known about their actual uptake or the factors associated with non-uptake. WHAT IS ALREADY KNOWN: Previous research suggests that individual and social factors influence women's care pathways during pregnancy and around childbirth. WHAT THIS PAPER ADDS: Using a large national sample, this study provides the first assessment of the uptake of postnatal home visits by midwives in France, documenting substantial regional variations and highlighting the role of care organisation and structural determinants.