Trends in the quality of maternal and neonatal care in Sweden and Norway as compared to 12 WHO European countries: A cross‐sectional survey investigating maternal perspectives during the COVID‐19 pandemic
Authors: Zaigham Mehreen , Linden Karolina , Elden Helen , Delle Vedove Stefano , Mariani Ilaria , Kongslien Sigrun , Drandić Daniela , Pumpure Elizabete , Drglin Zalka , Costa Raquel , Sarantaki Antigoni , de Labrusse Claire , Miani Céline , Oțelea Marina Ruxandra , Liepinaitienė Alina , Baranowska Barbara , Rozée Virginie , Valente Emanuelle Pessa , Vik Eline Skirnisdottir , Kurbanović Magdalena , Jakovicka Dārta , Bohinec Anja , Dias Heloísa , Metallinou Dimitra , Mueller Antonia N. , Batram‐Zantvoort Stephanie , Handra Claudia Mariana , Mizgaitienė Marija , Tataj‐Puzyna Urszula , Bomben Arianna , Nedberg Ingvild Hersoug , Voitehoviča Elīna , Pinto Tiago Miguel , Lykeridou Aikaterini , Grylka‐Baeschlin Susanne , Jazdauskienė Simona , Szlendak Beata , Sacks Emma , Lazzerini Marzia ,   the IMAgiNE EURO Study group
Published: October 2024

Introduction

Maternal‐neonatal healthcare services were severely disrupted during the COVID‐19 pandemic in even high‐income countries within the World Health Organization (WHO) European Region. The objective of this study was to compare trends in the quality of maternal and neonatal care (QMNC) in Sweden and Norway to 12 other countries from the WHO European Region during the COVID‐19 pandemic, and to identify domains for improvement.

Material and Methods

This cross‐sectional study included women giving birth in Europe from March 1, 2020 to December 31, 2022. Women answered an online, anonymous questionnaire which included 40 WHO Standard‐based Quality Measures collectively scored as the total QMNC index (0–400) and separately in four subdomains (0–100): provision of care, experience of care, availability of human and physical resources, and reorganizational changes due to COVID‐19. To assess reported QMNC changes over time, we used adjusted quantile regression models. ClinicalTrials.gov Identifier: NCT04847336.

Results

Of the 45151 women included in the study, 13 117 (29.1%) were from Sweden and Norway and 32034 (70.9%) from the 12 WHO European countries. The total QMNC index for Sweden and Norway (median: 325, IQR: 285–355) was higher than the 12 WHO European countries (median: 315, IQR: 265–350, p < 0.001) as were trends in QMNC index over time (Sweden and Norway median: 310–345; 12 WHO European countries median: 305–340). Sweden and Norway also had higher scores in three‐of‐four QMNC subdomains, with the 12 WHO European countries scoring higher only for reorganizational changes due to COVID‐19. In adjusted quantile models of the total QMNC index, Sweden and Norway had higher scores, with largest differences in the lower quantiles (p < 0.001 in all percentiles).

Conclusions

Across Europe, there are significant gaps in the quality of maternal‐neonatal healthcare services. Although women giving birth in Sweden and Norway reported higher QMNC scores in all subdomains except for “reorganizational changes due to COVID‐19,” there is room for improvement and shared learning across Europe. Policymakers should prioritize long‐term investments in maternal and neonatal healthcare, ensuring that facilities are adequately equipped during public health crises and that all women have access to high‐quality, evidence‐based, equitable, and respectful care.