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

Marzia Lazzerini (1) , Benedetta Covi (1) , Ilaria Mariani (1) , Zalka Drglin (2) , Maryse Arendt , Ingvild Hersoug Nedberg (3) , Helen Elden (4, 5) , Raquel Costa (6, 7) , Daniela Drandić , Jelena Radetić , Marina Ruxandra Otelea (8) , Céline Miani (9, 10) , Serena Brigidi (11) , Virginie Rozée (10) , Barbara Mihevc Ponikvar (2) , Barbara Tasch (12) , Sigrun Kongslien (3) , Karolina Linden (4) , Catarina Barata (13) , Magdalena Kurbanović (14) , Jovana Ružičić , Stephanie Batram-Zantvoort (9) , Lara Martín Castañeda (15) , Elise de La Rochebrochard (10, 16) , Anja Bohinec (2) , Eline Skirnisdottir Vik (17) , Mehreen Zaigham (18) , Teresa Santos (19, 20) , Lisa Wandschneider (9) , Ana Canales Viver , Amira Ćerimagić , Emma Sacks (21) , Emanuelle Pessa Valente (1)

1 Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” [Trieste]
2 National Institute of Public Health of the Republic of Slovenia
3 UiT - The Arctic University of Norway [Tromsø, Norway]
4 GU - Göteborgs Universitet = University of Gothenburg
5 Sahlgrenska University Hospital [Gothenburg]
6 Universidade do Porto = University of Porto
7 Lusófona University [Lisbon]
8 UMPCD - University of Medicine and Pharmacy “Carol Davila” Bucharest
9 Universität Bielefeld = Bielefeld University
10 UR14 - Santé et droits sexuels et reproductifs (Unité de recherche Ined en partenariat avec Inserm - Université Paris Saclay - UVSQ)
11 IISPV - Rovira i Virgili University [Reus, Spain]
12 CHL - Centre Hospitalier de Luxembourg [Luxembourg]
13 ULISBOA - Universidade de Lisboa = University of Lisbon
14 University of Rijeka
15 ICS - Institut Català de la Salut
16 CESP - Centre de recherche en épidémiologie et santé des populations
17 Western Norway University of Applied Sciences
18 Skane University Hospital [Lund]
19 Universidade Europeia – Laureate International Universities
20 Universidade Católica Portuguesa [Porto]
21 JHU - Johns Hopkins University

BACKGROUND. Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS. 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. FINDINGS. 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 companion 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. INTERPRETATION. 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 needed. FUNDING. The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION. ClinicalTrials.gov Identifier: NCT04847336

Mots clés: COVID-19; European Region; maternal; newborn; facility; quality of care; questionnaire; respectful maternity care; survey; WHO

Domaines: Santé publique et épidémiologie; Gynécologie et obstétrique

Marzia Lazzerini, Benedetta Covi, Ilaria Mariani, Zalka Drglin, Maryse Arendt, et al.. 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. The Lancet Regional Health - Europe, 2022, 13, pp.100268. ⟨10.1016/j.lanepe.2021.100268⟩. ⟨hal-03696291⟩