My Body Needs To Rest: Barriers and Facilitators to Postpartum Physical Activity among Zambian Women- A Mixed Methods Study

Balogun OJ, Nkhata LA, Mweshi MM and Moyo G

Published on: 2025-12-31

Abstract

Background: Despite documented benefits, postpartum women in low- and middle-income countries demonstrate low physical activity engagement. Understanding context-specific barriers and facilitators is essential for designing effective interventions. This study explored multilevel barriers and facilitators to postpartum physical activity among Zambian women using a mixed methods approach.

Methods: An explanatory sequential mixed methods design was employed in Lusaka, Zambia. The quantitative phase involved a cross-sectional survey (n=420 postpartum women), identifying prevalence of physical activity practice and associated factors. The qualitative phase comprised focus group discussions (n=8 groups, 64 participants) and in-depth interviews (n=20), purposively sampling women representing diverse exercise practices, delivery modes, and sociodemographic characteristics. Thematic analysis was conducted using Braun and Clarke's framework. Integration occurred through joint display analysis connecting quantitative findings with qualitative themes using a socioecological framework.

Results: Only 24.3% of women engaged in regular postpartum physical activity. Thematic analysis revealed barriers operating at multiple levels: (1) Individual: physical discomfort post-caesarean section, fatigue from childcare demands, and knowledge gaps regarding safe exercise timing; (2) Interpersonal: lack of partner support, competing family expectations, and social isolation; (3) Healthcare system: absence of structured exercise counseling, fragmented postnatal care, and provider knowledge deficits; (4) Community/cultural: traditional postpartum confinement practices ("kukaya"), beliefs about protecting the womb, concerns about breastfeeding impact, and lack of mother-friendly exercise facilities. Facilitators included prior positive exercise experiences during pregnancy, family encouragement, healthcare provider endorsement, visible role models, and integration of infant care with physical activity. Women who overcame barriers employed creative strategies: home-based exercise with infant involvement, peer support networks, and adapting traditional activities into structured exercise.

Conclusion: Postpartum physical activity in Zambia is constrained by deeply rooted cultural practices, healthcare system gaps, and practical realities of motherhood. However, women demonstrate resilience and creativity in navigating these barriers when supported. Multi-level interventions must address cultural beliefs through community engagement, strengthen healthcare provider capacity for counseling, create accessible mother-baby exercise programs, and leverage social support systems. Future implementation research should test culturally adapted intervention packages addressing identified barriers across ecological levels.