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

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

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

“…These measures were based on the WHO ‘Standards for improving quality of maternal and newborn care in health facilities’ and subsequently validated and used for an online survey. This was done in order to collect the viewpoints of women who gave birth during the COVID-19 pandemic across the WHO European Region [ 21 ].…”

WHO Standards-based questionnaire to measure health workers’ perspective on the quality of care around the time of childbirth in the WHO European region: development and mixed-methods validation in six countries

“…To our knowledge, no other similar online tool, explicitly based on the WHO Maternal and Newborn Quality of Care Standards,23 has been developed for health workers. This questionnaire complements an existing WHO Standards23-based questionnaire dedicated to collect service users’ (mothers’) perspectives on the QMNC 34. The availability of unified comprehensive approaches to measure QMNC as defined by the WHO Quality Measures, through validated tools, allows comparisons of data across settings and over time, allows triangulation with routinely collected official data and may support decision makers on designing and implementing future quality improvement initiatives that might improve health outcomes.…”

“…The process of developing this questionnaire was based on existing guidance32–37 and had several strengths. The questionnaire was based on previous pilot studies 29–33 75.…”

“…Since 2016, the WHO Collaborating Centre for Maternal and Child Health Burlo Garofolo, Trieste, Italy, has worked on developing and validating tools to collect data on priority WHO Quality Measures. Pilot studies were conducted in Italy between 2016 and 201929–33 and were scaled up in a multicountry project in the WHO European Region, called IMAgiNE (Improving Maternal Newborn CarE) 34…”

“…Pilot studies were conducted in Italy between 2016 and 2019 29–33 and were scaled up in a multicountry project in the WHO European Region, called IMAgiNE (Improving Maternal Newborn CarE). 34 …”