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IntroductionThe COVID-19 pandemic has led to a rapid implementation of telemedicine for the provision of maternal and newborn healthcare. The objective of this study was to document the experiences with providing telemedicine for maternal and newborn healthcare during the pandemic among healthcare professionals globally.MethodsThe second round of a global online survey of maternal and newborn health professionals was conducted, disseminated in 11 languages. Data were collected between 5 July and 10 September 2020. The questionnaire included questions regarding background, preparedness and response to COVID-19, and experiences with providing telemedicine. Descriptive statistics and qualitative thematic analysis were used to analyse responses, disaggregated by country income level.ResultsResponses from 1060 maternal and newborn health professionals were analysed. Telemedicine was used by 58% of health professionals and two-fifths of them reported not receiving guidelines on the provision of telemedicine. Key telemedicine practices included online birth preparedness classes, antenatal and postnatal care by video/phone, a COVID-19 helpline and online psychosocial counselling. Challenges reported lack of infrastructure and technological literacy, limited monitoring, financial and language barriers, lack of non-verbal feedback and bonding, and distrust from patients. Telemedicine was considered as an important alternative to in-person consultations. However, health providers emphasised the lower quality of care and risk of increasing the already existing inequalities in access to healthcare.ConclusionsTelemedicine has been applied globally to address disruptions of care provision during the COVID-19 pandemic. However, some crucial aspects of maternal and newborn healthcare seem difficult to deliver by telemedicine. More research regarding the effectiveness, efficacy and quality of telemedicine for maternal healthcare in different contexts is needed before considering long-term adaptations in provision of care away from face-to-face interactions. Clear guidelines for care provision and approaches to minimising socioeconomic and technological inequalities in access to care are urgently needed.

In this paper we have tried, starting from the results of an analysis of the functioning of integrated care in the Belgian Health System by Martens et al, to design a strategy that could contribute to better addressing the challenges of the 21st century in Belgium. We proposed health system changes at the macro-, meso- and micro-level. We focused on health policy development and organization of care, emphasizing the importance of a shift from a hospital-centric towards a primary care based approach. Special attention was paid to the need for institutional reforms, in order to facilitate the further development of interprofessional integrated care, that focuses on the achievement of the life-goals of a person.

PurposeCurrently, no standard instrument exists for assessing the concept of male involvement in maternal health, hampering comparison of results and interpretation of the literature. The aim of this study was to construct the key elements of a global multidimensional male involvement framework, based on the latest evidence and input of experts in the field.MethodsFor this purpose, a Delphi study, including an international panel of 26 experts, was carried out. The study consisted of three rounds, with 92% of respondents completing all three surveys. Experts were asked to rate indicators within six categories in terms of validity, feasibility, sensitivity, specificity and context robustness. Furthermore, they were encouraged to clarify their rating with open text responses. Indicators were excluded or adapted according to experts’ feedback before inclusion. A 85% agreement was used as threshold for consensus.ResultsA general consensus was reached for a global framework for assessing male involvement in maternal health, consisting of five categories: involvement in communication, involvement in decision-making, practical involvement, physical involvement and emotional involvement.ConclusionsUsing the male involvement framework as a tool to assess the concept of male involvement in maternal health at local, national, and international levels could allow improved assessment and comparison of study findings. Further research is needed for refining the indicators according to context and exploring how shared decision-making, gender equality and women’s empowerment can be assessed and facilitated within male involvement programmes.

Background Evidence suggests that many women experience mistreatment during childbirth in health facilities across the world, but the magnitude of the problem is unknown. The occurrence of disrespect and abuse (D&A) in maternity care services affects the overall quality of care and may undermine women’s trust in the health system. Studies about the occurrence of disrespect and abuse in Mozambican health facilities are scarce. The aim of this study was to explore the experience of women giving birth in hospital in different settings in Maputo City and Province, Mozambique. Methods A cross sectional descriptive survey was conducted between April and June 2018 in the Central Hospital of Maputo (HCM) and district hospitals of Manhiça and Marracuene, Maputo Province, Mozambique. Five hundred seventy-two exit interviews were conducted with women leaving the hospital after delivery. The questionnaire consisted of the following components: socio-demographic characteristics, the occurrence of disrespect and abuse, male involvement during labor and childbirth and intrapartum family planning counselling and provision. Results Prevalence of disrespect and abuse ranged from 24% in the central hospital to 80% in the district hospitals. The main types of D&A reported were lack of confidentiality/privacy, being left alone, being shouted at/scolded, and being given a treatment without permission. While very few women’s partners attended the births, the majority of women (73-80%) were in favor of involving their partner as a birth companion. Intrapartum counseling of family planning was very low (9-17%). Conclusion The occurrence of disrespect and abuse was much higher in the district hospitals compared to the central hospital, emphasizing the high need for interventions outside Maputo City. Allowing male partners as birth companions should be explored further, as women seem in favor of involving their partners. Investing in intrapartum counselling for family planning is currently a missed opportunity for improving the uptake of contraception in the country.

Background Increasing male involvement during pregnancy is considered an important, but often overlooked intervention for improving maternal health in sub-Saharan Africa. Intervention studies aimed at improving maternal health mostly target mothers hereby ignoring the crucial role their partners play in their ability to access antenatal care (ANC) and to prevent and treat infectious diseases like HIV and malaria. Very little is known about the current level of male involvement and barriers at different levels. This study explores the attitudes and beliefs of health policymakers, health care providers and local communities regarding men’s involvement in maternal health in southern Mozambique. Methods Ten key informant interviews with stakeholders were carried out to assess their attitudes and perspectives regarding male involvement in programmes addressing maternal health, followed by 11 days of semi structured observations in health care centers. Subsequently 16 focus group discussions were conducted in the community and at provider level, followed by three in depth couple interviews. Analysis was done by applying a socio-ecological systems theory in thematic analysis. Results Results show a lack of strategy and coherence at policy level to stimulate male involvement in maternal health programmes. Invitation cards for men are used as an isolated intervention in health facilities but these have not lead to the expected success. Providers have a rather passive attitude towards male involvement initiatives. In the community however, male attendance at ANC is considered important and men are willing to take a more participating role. Main barriers are the association of male attendance at ANC with being HIV infected and strong social norms and gender roles. On the one hand men are seen as caretakers of the family by providing money and making the decisions. On the other hand, men supporting their wife by showing interest in their health or sharing household tasks are seen as weak or as a manifestation of HIV seropositivity. Conclusion A clear strategy at policy level and a multi-level approach is needed. Gender-equitable relationships between men and women should be encouraged in all maternal health interventions and providers should be trained to involve men in ANC.

Current state of undergraduate teaching Exposure to family medicine and primary health care Exposure to family medicine and primary health care (PHC) varied considerably, from some programmes with no clinical exposure (i.e. Aga Khan University in Kenya and Tanzania, Amoud University in Somaliland) to 52 weeks in the new curriculum at Stellenbosch University, South Africa ( Table 1). Country Institution Exposure to family medicine teaching Weeks of clinical exposure Exposure to family medicine clinical training Somaliland Amoud University Family physicians contribute extensively to the general curriculum 0 None, previously 4 weeks in 6th year South Africa University of Cape Town 18-months ‘Becoming a doctor’ course in years 2–3; 6-week ‘Health in context’ integrated course in year 4 5 1 week in 4th year and 4 weeks in 6th year (20% of students have longitudinal rural clerkship) Kenya Moi University PBL across years 1 to 6; CDM/palliative care in year 6 30 COBES across years 1 to 5 Nigeria Bowen University Didactic lectures on family medicine principles in years 4–5 14 Case-based discussions and PBL at the bedside in tertiary hospital and in community, direct observation of procedural skills South Africa Stellenbosch University Teaching in all modules years 1–3 32–52 Exposure to PHC every 2 weeks in years 1–3; final year is a distributed apprenticeship in DHS. Uganda Makerere University Lectures for 1-week in 4th year 4 4-weeks clinical placement PBL, problem based learning; CDM, chronic disease management; COBES, community based education and service; PHC, primary health care; DHS, district health services; PH, public health; FM, family medicine; DH, district hospital; DRC, Democratic Republic of Congo. Family physicians might contribute to the learning of consultation and communication skills, population health management, medical ethics, emergency medicine, health systems, leadership, and clinical governance.

Excessive infant crying affects approximately 20% of families and can lead to parental distress, anxiety, and strained relationships. Despite its prevalence, many parents report feeling misunderstood and unsupported during these challenging periods. This study aimed to gain in-depth insight into mothers' perceptions of being understood and supported in the context of excessive infant crying, focusing on three key stakeholder groups: partners, the personal network, and health care professionals. Based on these results, the study sought to develop a maternal support framework regarding excessive crying that could guide future research and practice, as well as support strategies. Using a qualitative approach supplemented by quantitative measures, through an online survey, three open-ended questions were included on how mothers would like to be understood and supported by the three stakeholder groups (ideal situation) and six 6-point Likert scales on mothers' current perceived understanding and support regarding the three stakeholder groups (current situation). Descriptive statistics were used to examine current levels of understanding and support, and an inductive thematic analysis was applied to identify the ideal key support elements. Data were collected from 432 mothers (n=238, 55.1% Dutch; n=194, 44.9% Flemish; mean age 33 years, range 21-45 years). Regarding the current situation, mothers rated health care professionals lowest in perceived understanding and support, with 50.6% (n=219) feeling little or no understanding and 47.1% (n=203) reporting little or no support. Similar patterns were found in the personal network (n=184, 42.6%, and n=164, 38%, respectively). Partners were perceived as most supportive, with only 17.6% (n=76) of mothers reporting little or no understanding and 21.8% (n=94) reporting little or no support. Based on the thematic analysis of the qualitative data, the ideal situation was framed in the newly developed maternal support framework. This framework identifies 25 distinct support forms, of which 12 (48%) are common support forms (partner, personal network, health care professionals, eg, listen actively), 6 (24%) are related to partners (eg, be physically present), 6 (24%) concern the support of health care professionals (eg, refer appropriately), and 1 (4%) is specific to the personal network (cope with the crying). This study underscores the need for holistic, family-centered approaches to supporting families with excessively crying infants. The proposed maternal support framework offers a foundation for developing tailored interventions that reflect the diverse roles of partners, personal networks, and health care professionals in maternal well-being.

Background Midwifery care plays a vital role in the reduction of preventable maternal and newborn mortality and morbidity. There is a growing concern about the quality of care during facility based childbirth and the occurrence of disrespect and abuse (D&A) worldwide. While several studies have reported a high prevalence of D&A, evidence about the drivers of D&A is scarce. This study aims to explore midwives’ professional identity and perspectives on the occurrence of D&A in urban Mozambique. Methods A qualitative study took place in the central hospital of Maputo, Mozambique. Nine focus group discussions with midwives were conducted, interviewing 54 midwives. RQDA software was used for analysing the data by open coding and thematic analysis from a grounded theory perspective. Results Midwives felt proud of their profession but felt they were disrespected by the institution and wider society because of their inferior status compared to doctors. Furthermore, they felt blamed for poor health outcomes. The occurrence of D&A seemed more likely in emergency situations but midwives tended to blame this on women being “uncooperative”. The involvement of birth companions was a protective factor against D&A together with supervision. Conclusion In order to improve quality of care and reduce the occurrence of D&A midwives will need to be treated with more respect within the health system. Furthermore, they should be trained in handling obstetric emergency situations with respect and dignity for the patient. Systematic and constructive supervision might be another promising strategy for preventing D&A.

ObjectivesThe continuum of maternal care along antenatal (ANC), intrapartum and postnatal care (PNC) is fundamental for protecting women’s and newborns’ health. The COVID-19 pandemic interrupted the provision and use of these essential services globally. This study examines maternal healthcare utilisation along the continuum during the COVID-19 pandemic in the Democratic Republic of the Congo (DRC).DesignThis is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi, DRC, using stratified random sampling.ParticipantsWe included 604 women (15–49 years) who were pregnant between March 2020 and May 2021.Outcome measuresA structured interview involved questions on sociodemographic characteristics, attitudes regarding COVID-19 and maternal service use and cost. Complete continuum of care was defined as receiving ANC 4+ consultations, skilled birth attendance and at least one PNC check for both mother and newborn. Data were analysed in SPSS using descriptive statistics and multivariable logistic regression.ResultsOne-third (36%) of women who gave birth during the COVID-19 pandemic completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.ConclusionDuring the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to improve access to maternal healthcare.

The core functions of primary care are first contact access, comprehensiveness, continuity, coordination and person-centredness. These five core functions are highlighted as essential aspects of quality by the new WHO’s measurement framework. In low-income and middle-income countries, the core functions are rarely measured and routinely collected data does not support their measurement. Existing international tools to measure the quality of primary care may evaluate some aspects of these core functions, but none of the reviewed tools focused on all of them. In sub-Saharan Africa, the Primary Care Assessment Tool has been developed over the last decade and a regional version of the tool has been validated to only measure the core functions as defined by the WHO. The tool uses exit interviews with users as recommended by the WHO. The tool has been piloted in South Africa, Uganda and Benin and will now be implemented in 11 African countries. The tool can enable low-income and middle-income countries to measure the core functions and plan interventions to improve the quality of primary care.