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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

Lazzerini, Marzia ; Covi, Benedetta ; Mariani, Ilaria ; Drglin, Zalka ; Arendt, Maryse ; Nedberg, Ingvild Hersoug ; Elden, Helen ; Costa, Raquel ; Drandić, Daniela and Radetić, Jelena , et al. (2022) In The Lancet regional health. Europe 13.
Abstract

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... (More)

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.

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published
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The Lancet regional health. Europe
volume
13
article number
100268
publisher
Elsevier
external identifiers
  • scopus:85121585834
  • pmid:34977838
ISSN
2666-7762
DOI
10.1016/j.lanepe.2021.100268
language
English
LU publication?
yes
additional info
© 2021 The Author(s).
id
5ee1be5f-9bfd-41bd-a9d4-8bf944197352
date added to LUP
2022-01-07 21:52:31
date last changed
2024-04-20 18:44:10
@article{5ee1be5f-9bfd-41bd-a9d4-8bf944197352,
  abstract     = {{<p>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.</p><p>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.</p><p>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.</p><p>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.</p><p>Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.</p><p>Study registration: ClinicalTrials.gov Identifier: NCT04847336.</p>}},
  author       = {{Lazzerini, Marzia and Covi, Benedetta and Mariani, Ilaria and Drglin, Zalka and Arendt, Maryse and Nedberg, Ingvild Hersoug and Elden, Helen and Costa, Raquel and Drandić, Daniela and Radetić, Jelena and Otelea, Marina Ruxandra and Miani, Céline and Brigidi, Serena and Rozée, Virginie and Ponikvar, Barbara Mihevc and Tasch, Barbara and Kongslien, Sigrun and Linden, Karolina and Barata, Catarina and Kurbanović, Magdalena and Ružičić, Jovana and Batram-Zantvoort, Stephanie and Castañeda, Lara Martín and Rochebrochard, Elise de La and Bohinec, Anja and Vik, Eline Skirnisdottir and Zaigham, Mehreen and Santos, Teresa and Wandschneider, Lisa and Viver, Ana Canales and Ćerimagić, Amira and Sacks, Emma and Valente, Emanuelle Pessa}},
  issn         = {{2666-7762}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{The Lancet regional health. Europe}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1016/j.lanepe.2021.100268}},
  doi          = {{10.1016/j.lanepe.2021.100268}},
  volume       = {{13}},
  year         = {{2022}},
}