Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region

Abstract

<p><b>Background</b> Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID- 19 pandemic, as defined by WHO Standards, are lacking.

<p><b>Methods</b> Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.

<p><b>Findings</b> 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41¢8% (26¢1%- 63¢5%) experienced difficulties in accessing antenatal care, 62% (12¢6%-99¢0%) were not allowed a com- panion of choice, 31¢1% (16¢5%-56¢9%) received inadequate breastfeeding support, 34¢4% (5¢2%-64¢8%) reported that health workers were not always using protective personal equipment, and 31¢8% (17¢8%-53¢1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20¢1% (6¢1%-66¢0%) of spontaneous vaginal births and fundal pressure applied in 41¢2% (11¢5% -100%) of instrumental vaginal births. In addition, 23¢9% women felt they were not treated with dignity (12¢8%-59¢8%), 12¢5% (7¢0%-23¢4%) suffered abuse, and 2¢4% (0¢1%-26¢2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes.

<p><b>Interpretation</b> Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently neede