Introduction: The postnatal period is a good opportunity to detect medical problems of the mother and neonate and reduce morbidity and mortality. This study was conducted to determine factors associated with low postnatal care uptake in Bikita. Methods: A 1:1 unmatched case-control study was conducted. Random sampling was used to select cases and controls from antenatal care and postnatal care registers at health centres. An interviewer-administered questionnaire using constructs of the Health Belief Model was used. A focus group discussion was conducted with women who had come for antenatal and postnatal care. Results: A total of 150 cases and 150 controls were recruited. Independent factors associated with non-uptake of postnatal care uptake were: practising seclusion until umbilical cord fell off (adjusted odds ratio (AOR) 3.43; 95% confidence interval (CI): 1.73-6.81); residing in village/resettlement (AOR 3.71; 95% Cl: 1.30-9.90); delivering at home (AOR 6.0; 95% CI: 3.50-12.71); and staying more than 5 km from health centre (AOR 1.73; 95% CI: 1.03-2.89). Factors associated with postnatal care uptake were secondary/tertiary level of education (AOR 0.25; 95% CI: 0.11-0.73) and ability of mother to attend postnatal care within 48 hours after at-home delivery (AOR 0.60; 95% CI: 0.21-0.96). Discussion and Conclusion: Factors associated with reduced likelihood of the 10-day postnatal care uptake in Bikita district were: practising seclusion until umbilical cord fell off; residing in a village or resettlement; delivering at home; and living more than 5 km from the nearest health centre. Outreach services have been launched for postnatal care and to ensure that village health workers are trained in basic postnatal care.