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

• Main Author: Costa, Raquel
• Publication Date: 2022
• Other Authors: Barata, Catarina, Dias, Heloísa, Rodrigues, Carina, Santos, Teresa, Mariani, Ilaria, Valente, Emanuelle Pessa, Lazzerini, Marzia, Covi, Benedetta
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: http://hdl.handle.net/10451/55680
• topic: Childbirth; COVID- 19; IMAgiNE EURO; Maternal care; Newborn care; Portugal; Quality of care; Respectful maternity care

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.