**Background:** Postnatal care (PNC) is a critical component of maternal and newborn health services, yet it remains underutilized, particularly in sub-Saharan Africa. Over 60% of maternal deaths occur in the postpartum period, and low PNC utilization contributes to high maternal mortality in Nigeria. Despite WHO recommendations for 4 PNC visits, practice in Enugu is skewed toward a single 6-week visit, and reported PNC utilization in Nigeria ranges from 16.9% to 41.2%. This study aimed to assess the prevalence of 6th week PNC use, reasons for default, and determinants of attendance among mothers attending child immunization clinics in Enugu.
**Methods:** This cross-sectional comparative study was conducted from June 2019 to September 2019 at the Institute of Child Health of the University of Nigeria Teaching Hospital (UNTH) and Enugu State University Teaching Hospital (ESUTH). A total of 400 consecutive nursing mothers presenting for the second dose of Oral Polio Vaccine (OPV2) at 10 weeks postpartum were enrolled. Women who defaulted from 6th week PNC were recruited into the study group, and the next woman who attended PNC, matched for parity, was recruited into the control group. Data were collected using an interviewer-administered questionnaire covering socio-demographic characteristics, obstetric history, PNC awareness and attendance, and reasons for non-attendance. Social classification was determined using the Olusanya et al. method based on maternal education and husband's occupation. Statistical analysis was performed using SPSS version 22.0, with chi-square tests for categorical variables and logistic regression for multivariate analysis. A p-value < 0.05 was considered statistically significant.
**Key Results:** Of the 400 participants, 235 (59%) attended the 6th week postnatal clinic, while 165 (41%) did not. The majority of participants were aged 26-30 years (37.3%) and 31-35 years (35.8%), married (99.5%), Christian (100%), Igbo (95%), had tertiary education (72.3%), and were multiparous (57.8%). Although 74% (n=296) of women were aware of PNC, only 59% attended. Among women who had antenatal care by skilled birth attendants, 60.6% attended PNC, compared to none (0%) of those attended by non-skilled birth attendants (χ² = 17.619, p < 0.001). The primary reason for non-attendance among defaulters was lack of awareness (61.8%), followed by feeling healthy (21.2%), no time (7.9%), forgot (5.5%), distant hospital location (2.4%), and poor attitude of birth attendants (1.2%). Socioeconomic status was significantly associated with PNC attendance (χ² = 56.874, p < 0.001), with attendance increasing from 20.8% in the lowest class (Class 5) to 70.5% in the highest (Class 1). Age and marital status were not significantly associated. Women who attended antenatal in a hospital were more likely to attend PNC (OR = 3.706, 95% CI: 2.105–6.524, p < 0.001), while those with normal delivery were less likely compared to cesarean section (OR = 0.382, 95% CI: 0.242–0.605, p < 0.001). PNC awareness (χ² = 200.164, p < 0.001), hospital delivery (χ² = 46.620, p < 0.001), complications during pregnancy (χ² = 11.494, p = 0.009) and delivery (χ² = 9.707, p = 0.002), and exclusive breastfeeding (χ² = 4.313, p = 0.038) were all significantly associated with PNC attendance. After multivariate analysis, only place of antenatal (hospital vs. health center) (OR = 2.870, 95% CI: 1.590–5.180, p < 0.001) and mode of delivery (normal delivery vs. cesarean section) (OR = 0.452, 95% CI: 0.280–0.728, p = 0.001) remained significant predictors.
**Clinical Implications:** The 59% PNC attendance rate, while higher than some previous Nigerian studies (16.9%–41.2%), remains suboptimal and indicates that over 40% of postpartum women are missing a critical opportunity for health assessment and intervention. The finding that lack of awareness is the dominant reason for default (61.8%) suggests that current health education efforts are insufficient. The strong association between skilled antenatal care and PNC attendance underscores the importance of continuous, quality care throughout the pregnancy-postpartum continuum. The lower attendance among women with normal vaginal delivery (who may perceive themselves as healthy) highlights a dangerous misconception, as postpartum complications can occur regardless of delivery mode. The significant socioeconomic gradient in attendance indicates that financial and access barriers persist even in a setting where immunization is mostly free. Healthcare professionals should prioritize creating awareness about PNC benefits, particularly targeting women who deliver outside hospitals, those with normal deliveries, and those of lower socioeconomic status. Government efforts to make healthcare more available and affordable, and to discourage patronage of unskilled birth attendants, are essential to improving maternal and child health outcomes in Enugu and similar settings.