Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study

Objective: To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. Methods: Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. Results: Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). Conclusion: Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal. © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.Funding text 1: This work was supported by the Ministry of Health, Rome - Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy. This study was supported by Portuguese fundings through FCT - Fundação para a Ciência e a Tecnologia, IP, in the scope of the projects EPIUnit - UIDB/04750/2020, ITR - LA/P/0064/2020, and HEILab - UIDB/05380/2020, and by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). We are grateful to the women who dedicated their time to complete the survey, to Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (APDMGP) for support with survey dissemination and to nurse Louise Semião for assistance provided in back-translation of the questionnaires. Special thanks to the IMAgiNE EURO study group for their contribution to the development of this project and support for this manuscript.; Funding text 2: This work was supported by the Ministry of Health, Rome ‐ Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste ‐ Italy. This study was supported by Portuguese fundings through FCT ‐ Fundação para a Ciência e a Tecnologia, IP, in the scope of the projects EPIUnit ‐ UIDB/04750/2020, ITR ‐ LA/P/0064/2020, and HEILab ‐ UIDB/05380/2020, and by the European Social Fund (ESF) and FCT (SFRH/BPD/117597/2016; RC postdoctoral fellowship). We are grateful to the women who dedicated their time to complete the survey, to Associação Portuguesa pelos Direitos da Mulher na Gravidez e Parto (APDMGP) for support with survey dissemination and to nurse Louise Semião for assistance provided in back‐translation of the questionnaires. Special thanks to the IMAgiNE EURO study group for their contribution to the development of this project and support for this manuscript. ; Funding text 3: IMAgiNE EURO project was supported by the Ministry of Health, Rome ‐ Italy, in collaboration with the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste ‐ Italy. This study was supported by Fundação para a Ciência e a Tecnologia; European Social Fund (ESF) Funding informatio

Barriers to accessing adequate maternal care in Latvia: A mixed-method study among women, providers and decision-makers

Introduction: Latvia has a high maternal mortality ratio compared to other European countries, as well as major inequities in accessing adequate maternal care. Adequacy refers to the extent to which services are safe, effective, timely, efficient, equitable and people-centred. This study aims to explore stakeholder views on access to adequate maternal care in Latvia and the extent to which there was consensus. Methods: This mixed-method study is based on an online survey among women who recently gave birth, as well as interviews with healthcare providers and decision-makers. The data were analysed using the method of directed qualitative content analysis. The extent of stakeholder consensus was determined by studying five access-related aspects of maternal care: availability, adequacy, affordability, approachability and acceptability. Findings: Our study identified barriers to accessing adequate maternal care related to availability (i.e. shortage of human resources, geographical distance) and appropriateness (i.e. inequalities in provider knowledge, care provision and use of clinical guidelines). Other challenges were related to providers’ approaches towards women (i.e. communication) and, to a lesser extent, maternal care acceptance by women (i.e. health literacy). Conclusions: The barriers identified in our study highlight areas that should be addressed in future reforms of maternal care. These barriers also indicate the need for micro-level indicators that can facilitate a comprehensive evaluation of maternal care in Latvia and elsewhere

Barriers and motivators for uptake of cervical cancer prevention strategies in Eastern Europe: Perspective from Latvia

Introduction The incidence of cervical cancer in Eastern European countries is high, however uptake of available prevention strategies is suboptimal. We explored the knowledge, behaviours and attitudes towards cervical cancer prevention strategies in Latvian women. Methods A mixed-methods study of Latvian women, consisting of questionnaire surveys and semi-structured interviews, was conducted in Riga, Latvia between September-October 2015. Results 158 surveys were completed and 10 interviews were conducted. 87%(n=135) had previously had a smear test. 67%(n=105) correctly identified that cervical cytology was performed to identify pre-cancerous changes. The practice of annual gynaecological reviews was prevalent and many believed it to be synonymous with cervical screening. Detailed knowledge of HPV and the HPV vaccine was deficient, although 73%(n=115) and 70%(n=90) respectively claimed to have heard of them. Negative attitudes existed regarding the HPV vaccine due to fear of potential side effects. On learning that HPV was an sexually transmitted infection, the notion of testing positive for HPV was met with shame and embarrassment. Conclusions A small proportion of Latvian women are over-screened whilst many women remain unscreened. The main contributing factor for this was their poor understanding of the roles cervical screening and HPV vaccination play in the prevention of cervical cancer

Barriers and motivators for uptake of cervical cancer prevention strategies in Eastern Europe: Perspective from Latvia

Introduction: The incidence of cervical cancer in Eastern European countries is high, however uptake of available prevention strategies is suboptimal. We explored the knowledge, behaviours and attitudes towards cervical cancer prevention strategies in Latvian women. Methods: A mixed-methods study of Latvian women, consisting of questionnaire surveys and semi-structured interviews, was conducted in Riga, Latvia between September-October 2015. Results: 158 surveys were completed and 10 interviews were conducted. 87%(n=135) had previously had a smear test. 67%(n=105) correctly identified that cervical cytology was performed to identify pre-cancerous changes. The practice of annual gynaecological reviews was prevalent and many believed it to be synonymous with cervical screening. Detailed knowledge of HPV and the HPV vaccine was deficient, although 73%(n=115) and 70%(n=90) respectively claimed to have heard of them. Negative attitudes existed regarding the HPV vaccine due to fear of potential side effects. On learning that HPV was an sexually transmitted infection, the notion of testing positive for HPV was met with shame and embarrassment. Conclusions: A small proportion of Latvian women are over-screened whilst many women remain unscreened. The main contributing factor for this was their poor understanding of the roles cervical screening and HPV vaccination play in the prevention of cervical cancer.</div