Search

Objective: To investigate women's perspectives on the quality of maternal and new-born care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods: Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards- based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results: 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a signifi-cantly lower QMNC index for 2020 compared with 2021 (P < 0.001).Conclusion: This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate health-care strategies to improve health care for women and newborns in Latvia are required.

Objective To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. Methods Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. Results Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. Conclusion Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.

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.

Objective: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. Methods: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. Results: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n= 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 4 87, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. Conclusion: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

International audience; La PMA est désormais ouverte à toutes en France, mais des femmes continuent d’y avoir recours à l’étranger. Une recherche est en cours pour quantifier et comprendre le phénomène.

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.

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 question- naire 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 profession-alism (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 noninstru- mental 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.

Objective: To investigate potential associations between individual and country- level factors and medicalization of birth in 15 European countries during the COVID- 19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020– 2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P

Objective To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. Methods Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. Results Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. Conclusion Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.

Background In France, a national network of free sexual health centers offers prevention, diagnosis and treatment for STI and HIV. These centers help socially disadvantaged and high-risk populations to access STI/HIV testing but few detailed data are available on patients' sexual behaviors. This study aims to describe sexual behaviors among attendees of a Parisian free sexual health center for STI/HIV screening. Methods This observational study included 5130 patients who attended the center for STI/HIV testing from August 2017 through January 2020 and completed a self-administered electronic questionnaire. Data obtained from the consultation database and the questionnaire included STI results, sociodemographic characteristics and sexual behaviors. Criteria reported in the literature to define “high-risk sexual behavior (HRSB)” were used to describe sexual practices. Results Median age of patients was 26 years [Q1-Q3:23-32] and 8% had no health insurance. Slightly less than one third of patients were women who had sex with men, 37% were men who had sex exclusively with women and 18% were men who had sex with men; 22% had never had HIV testing before the consultation. Regarding sexual practices, 76% reported unprotected sexual intercourse, 3% transactional sex and 8% a history of sexual violence. Depending on the threshold used to define multiple partners (≥6 vs ≥ 2 partners during the previous year), the proportion of patients varied from 31% to 81%. Globally, the proportion of patients reporting at least one HRSB ranged from 87% to 95%. Eleven percent of patients had at least one STI (mostly chlamydia). Conclusions Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients' needs. Key messages Our sexual health center fulfills its missions as most patients consulting for STI/HIV testing reported HRSB and almost one quarter had never previously had an HIV test. The next step will be to explore profiles including sexual behavior, sociodemographic characteristics and HIV knowledge to adapt our prevention strategy to patients’ needs.

Supplemental Material, sj-pdf-1-std-10.1177_09564624211048555 for Notification of STI test results by text messaging: Why do patients refuse? Cross-sectional study in a Parisian sexual health centre by Jalal Charron, P��n��lope Troude, Elise de La Rochebrochard, Christophe Segouin and Prescillia Piron in International Journal of STD & AIDS

La jeunesse représente une période de construction et d’autonomisation avec de forts enjeux de santé sexuelle et reproductive. Dans une approche de santé publique, la santé sexuelle et reproductive doit être conçue de façon holistique, par la création d’environnements favorables. Sa promotion pourrait être favorisée par de nouveaux outils tels que les communautés participatives en ligne d’adolescents et jeunes adultes. Ces communautés permettent en effet une approche participative à travers des activités concrètes et par l’interaction sociale entre pairs sur Internet. L’objectif principal de cette recherche était d’étudier les communautés participatives en ligne comme outil de promotion de la santé sexuelle et reproductive des jeunes. Nous avons pour cela réalisé une revue systématique de la littérature pour analyser les interventions participatives en ligne de promotion de la santé sexuelle des jeunes (composantes participatives, communautés formées, méthodes de conception, de mise en œuvre et d’évaluation). Nous avons ensuite mené une étude qualitative pour analyser les avis et conseils des professionnels du domaine pour le développement de ce type d’intervention, en étudiant les risques et les limites inhérents. Finalement, nous avons mené une étude qualitative auprès des jeunes pour explorer leurs usages d’Internet, leurs consciences des risques, leurs centres d’intérêt et leurs comportements de recherche d’information. Nous avons également recueilli leurs propositions pour le développement de ce type d’intervention. À partir de ces résultats, un projet de recherche interventionnelle en santé des populations a été conceptualisé.

International audience