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

by Marzia Lazzerini, Benedetta Covi, Ilaria Mariani, Zalka Drglin, Maryse Arendt and 28 others, on behalf of IMAgiNE EURO study group

Lancet Regional Health Europe, 24 December 2021  (Open Access)


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 1 March 2020 – 15 March 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 pre-labour 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.

PHOTO: Maternal Health, UNFPA Eastern Europe and Central Asia