O71 - What were we thinking? Impact and experiences of changes in access to maternity health care during pregnancy, findings from the Covid-19: Outcomes for Sleep, and Maternity care a global pregnancy Study: COSMOS.

Access to maternity care changed during the Covid-19 pandemic, the impact of lock downs, and transitioning to virtual maternity health care have had unexpected consequences. We analysed global survey data with an aim to understand how changes to health care during the COVID-19 Pandemic were experienced by pregnant women internationally. A global cross-sectional survey served from April 2020 to Oct 2022. Using multinomial and binary logistic regression models, we present associations (odds ratios) between several self-report measures of health care service changes and women's engagement with services with country income (low, lower-middle and upper-middle compared to high). OR's were adjusted for Universal Health Care Service Coverage Index (SCI) and maternal education, parity, gestation, and perceived pregnancy risk. Survey respondents were 2,651 women from 147 countries. Compared to women from high income countries, women in low and low-middle income countries had higher odds of reporting the following: their in-person visits had reduced; they were not allowed to keep in-person appointments; that some services had become obsolete; and, they had both delayed and avoided accessing health care services. Interestingly, higher SCI across country income groups was associated with significantly higher odds of reporting that in-person visits had reduced compared to remaining the same. Stopping or changing access to maternity services can result in women delaying or avoiding accessing maternity health care services. Unintended consequences of this kind of avoidance could include increased risk of outcomes that can be detected during in person visits but more difficult to detect if the pregnancy is not monitored in person such as Fetal Growth restriction. When planning for any future disruption to maternity care provision by wide-scale health events, the impact of women delaying or avoiding care should be balanced against risks and benefits associated with strategies such as 'lock-downs'. [ABSTRACT FROM AUTHOR]