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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 This research was funded by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste Italy.

The presence of intestinal and extraintestinal symptoms was investigated by a symptom questionnaire in crew members (n = 190) - and as controls in age and sex matched ground based administrative employees (n = 100) - of a charter carrier and was related to the actual flight schedule of the flying staff during one month. In addition, health and illness behaviors and personal, job and life satisfaction were assessed and related to symptom scores and flight schedules. Flying staff did report significantly more dyspeptic symptoms than did ground staff, and this was found mainly with long-distance flying, since staff with short-haul experience only did not report as much upper intestinal complaints. Also, cabin crew reported significantly more intestinal symptoms than did cockpit members, and part of the upper GI symptoms could be explained by different eating behaviors, specifically more fibre intake in flying staff. With increasing intestinal symptom frequency, doctor visits and sick-days increased, and satisfaction with job and personal life decreased. Flying staff had, however, more awareness of the importance of health behaviors. It is concluded that frequent flying specifically on long distances may result in increased intestinal symptoms, presumably due to time-shift.