IMAgiNE EURO study groupCosta, RaquelBarata, CatarinaDias, HeloísaRodrigues, CarinaSantos, TeresaMariani, IlariaCovi, BenedettaValente, Emanuelle PessaLazzerini, MarziaĆerimagić, AmiraDrandić, DanielaKurbanović, MagdalenaVirginie, Rozéede La Rochebrochard, EliseLöfgren, KristinaMiani, CélineBatram-Zantvoort, StephanieWandschneider, LisaMorano, SandraChertok, IlanaHefer, EmekArtzi-Medvedik, RadaPumpure, ElizabeteRezeberga, DaceJansone-Šantare, GitaJakovicka, DārtaKnoka, Anna RegīnaVilcāne, Katrīna PaulaLiepinaitienė, AlinaKondrakova, AndželikaMizgaitienė, MarijaJuciūtė, SimonaArendt, MaryseTasch, BarbaraNedberg, Ingvild HersougKongslien, SigrunVik, Eline SkirnisdottirBaranowska, BarbaraTataj-Puzyna, UrszulaWęgrzynowska, MariaOtelea, Marina Ruxandra2023-01-112023-01-112022-120020-7292http://hdl.handle.net/10400.14/39811Objective: 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.engChildbirthCOVID-19IMAgiNE EUROMaternal careNewborn carePortugalQuality of careRespectful maternity carejournal article10.1002/ijgo.1450785144292506PMC987822036530002000905238400011