Background The magnitude of maternal and neonatal death and morbidity during the postnatal period remains too high. In contrast to the decline in global mortality rates, maternal and neonatal deaths continue to occur at the highest rate in sub-Saharan Africa. Appropriate care during the postpartum period is vital to prevent neonatal and maternal deaths. This study is aimed at delivering evidence on the pooled prevalence and associated factors of adequate postnatal care using the recent demographic and health surveys from 20 sub-Saharan African countries. Methods Data from the recent demographic and health surveys of 20 countries in sub-Saharan Africa conducted between 2015 and 2022 were used. A total weighted sample of 90,251 women aged 15-49 years with live births in the 2 years preceding the survey was included in the study. Multilevel logistic regression was used to determine the factors associated with the outcome variable. Intra-class correlation coefficient, likelihood ratio test, median odds ratio, and deviance (-2LLR) values were used for model comparison and fitness. Finally, variables with a p-value < 0.05 were declared statistically significant. Results The overall pooled prevalence of adequate postnatal care among women aged 15-49 years in SSA countries was 27.42% (95% CI: 27.13%, 27.71%). Factors like age [AOR = 1.10; 95% CI (1.05, 1.16)], educational status [AOR = 1.52; 95% CI (1.39, 1.67)], marital status [AOR = 0.83; 95% CI (0.79, 0.88)], working status [AOR = 0.81; 95% CI (0.78, 0.84)], media exposure [AOR = 1.05; 95% CI (1.01, 1.09)], sex of the household head [AOR = 1.13; 95% CI (1.08, 1.18)], household size [AOR = 1.07; 95% CI (1.03, 1.12)], number of ANC visits [AOR = 3.38; 95% CI (3.04, 3.75)], place of delivery [AOR = 3.77; 95% CI (3.57, 3.99)], prenatal community health workers visit [AOR = 1.45; 95% CI (1.39, 1.51)], and residence [AOR = 1.26; 95% CI (1.21, 1.32)] were significantly associated with adequate postnatal care. Conclusion Only nearly three out of ten women received adequate postnatal care in sub-Saharan African countries. Adequacy of postnatal care was determined by the age of respondents, educational status, current marital status, working status, media exposure, sex of the household head, household size, number of ANC visits, place of delivery, prenatal community health workers visit, and residence. Therefore, women's empowerment through education, employment, and decision-making involvement; strengthening ANC service utilization and health facility delivery; information dissemination through media; promoting prenatal care through community health workers home-to-home visits; and giving special attention to unmarried, young, and non-working women are strongly recommended.
