Anna Galle

Objective: This study explored the quality of maternal and newborn care (QMNC) in Belgium, focusing on women’s experience with care and their mental health (MH). Design: We conducted a cross-sectional survey using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. Setting: All women who gave birth in a health facility in Belgium were included. Participants: Data were collected from 621 women who gave birth between March 2022 and January 2025. Primary and secondary outcome measures: Descriptive statistics summarised QMNC and MH outcomes, while logistic regression examined factors associated with negative emotional childbirth experiences. Results: The median QMNC index was 260/300, suggesting high adherence to WHO quality standards. However, 33.5% of respondents reported ineffective communication, 34.0% a lack of involvement in decision-making, 8.7% no emotional support from healthcare providers and 8.2% reported abuse. Overall, 40.9% of women reported emotional difficulties related to childbirth, with 10% reporting a negative impact on well-being. MH screening and support were not structurally embedded in perinatal care. Emergency caesarean deliveries (adjusted odds ratio (aOR): 14.94), instrumental births (aOR: 2.36), fundal pressure (aOR: 4.11) and abuse (aOR: 3.74) were significantly associated with emotional difficulties around childbirth. The presence of an obstetric consultant (aOR: 0.44) and higher QMNC scores (aOR: 0.97) were associated with a lower likelihood of reporting emotional difficulties. Conclusions: Belgium shows a high level of QMNC, yet significant gaps remain in communication, MH screening and support and adherence to evidence-based practices. Our study highlights a strong association between certain childbirth interventions and a negative emotional birth experience, emphasising the need for further research into the underlying causal patterns and contextual factors shaping women’s childbirth experiences.

Background: In Belgium, maternal and newborn health indicators indicate high quality of care compared to other countries of Europe. However, some challenges still persist in the quality of maternal and newborn care (QMNC) and little is known regarding women’s experience with care and their mental health (MH). Methods: We conducted a cross-sectional survey among 621 women who gave birth between March 2022 and January 2025 in Belgium, using the WHO-based IMAgiNE EURO questionnaire, updated with MH items. Descriptive statistics summarized QMNC and MH outcomes, while multivariate logistic regression examined factors associated with negative emotional childbirth experiences. Results: The median QMNC index was 260/300, suggesting high adherence to WHO quality standards. However, 33.5% of respondents reported ineffective communication, 34.0% a lack of involvement in decision-making, 8.7% no emotional support from health care providers, and 8.2% reported abuse. Overall, 40.9% of women reported emotional difficulties related to childbirth, with 10% reporting a negative impact on wellbeing. MH screening and support were not structurally embedded in perinatal care. Emergency caesarean sections (aOR 14.94, 95%CI), instrumental births (aOR 2.36), fundal pressure (aOR 4.11), and abuse (aOR 3.74) were significantly associated with emotional difficulties around childbirth. Protective factors included higher QMNC scores (aOR 0.97) and the presence of an obstetric consultant (aOR: 0.44). Conclusion: Belgium shows a high level of QMNC, yet significant gaps remain in communication, MH screening and support, and adherence to evidence-based practices. Our study highlights a strong association between certain childbirth interventions and a negative emotional birth experience, emphasizing the need for further research into the underlying causal patterns and contextual factors shaping women’s childbirth experiences. Strengths and Limitations: The study used a validated WHO standards–based questionnaire, ensuring comparable measurement of quality of care indicators. The updated questionnaire incorporated measures of emotional childbirth experience and perinatal mental health, addressing an important evidence gap in Belgian maternity care research. The overrepresentation of Dutch-speaking and highly educated women may limit applicability to the entire Belgian population. Participation was voluntary and data were self-reported, potentially leading to over- or underestimation of key outcomes, especially for sensitive topics such as mental health difficulties and experiences of abuse.

Background: 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. Objective: 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. Methods: 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. Results: 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). Conclusions: 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.

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.

Objective: Despite advancements in maternity quality care worldwide, mistreatment of women during childbirth persists. Currently, there is a gap of knowledge on the occurrence of disrespect and abuse during childbirth in the World Health Organization (WHO) European region. Methods: Within the IMAgiNE EURO (Improving Maternal Newborn Care in the WHO European Region During COVID‐19 Pandemic) study, women 18 years and older who gave birth in healthcare facilities in the WHO European region, were invited to complete an online validated questionnaire regarding quality of maternity care. Data were collected between March 2020 and May 2023, declared as the COVID‐19 pandemic. A mixed‐method analysis was conducted on women's experiences of abuse, involving descriptives and multivariate logistic regression for quantitative data and thematic analysis for qualitative data. Results: Of 50 617 participants among 22 countries, 7683 (15.2%) reported experiences of abuse ranging from 6.4% in Israel to 30.7% in Bosnia‐Herzegovina, with significant differences by country, age, and birth mode. Emotional, verbal, and physical abuses were reported by 10.3%, 7.3%, and 2.4%, respectively. The thematic analysis, including 737 responses, identified several shortcomings in care that women perceived as abusive, the experience associated with abuse, and the elicited emotions. Experiences of disrespect and abuse were often linked to a sequence of actions, resulting in women feeling violated and treated as an object. Conclusion: Disrespectful maternity care was common during the COVID‐19 pandemic in the WHO European region. Efforts are needed to improve communication, implementation of evidence‐based practices, and respect for women's rights. Constant monitoring of disrespect and abuse indicators is needed. A paradigm shift must happen, ensuring safe and respectful care for all.

BACKGROUND 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. OBJECTIVE 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. METHODS 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. RESULTS 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). CONCLUSIONS 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.

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the Improving MAternal Newborn carE in the EURO region study in Belgium. Participants Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID‐19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann‐Kendall test. Results 897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores>75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (−20.4 in the 50th percentile with pConclusions and relevance Our study showed several gaps in QMNC in Belgium, underlying causes of these gaps should be explored to design appropriate interventions and policies. Trial registration number NCT04847336.

Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. Design A cross-sectional observational study. Setting Data of the IMAgiNE EURO study in Belgium. Participants Women giving birth in a Belgian facility from March 1, 2020, to May 1, 2023, responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources, and organizational changes related to COVID-19. Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann-Kendall test. Results 897 women were included in the analysis, 67%(n=601) with spontaneous vaginal birth, 13.3%(n=119) with instrumental vaginal birth and 19.7%(n=177) with cesarean section. We found high QMNC scores but also specific gaps in all domains of QMNC. On provision of care, 21.0%(n=166) of women who experienced labor and 14.7%(n=26) of women with a cesarean reported inadequate pain relief; 64.7%(n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1%(n=279) reported unclear communication, 32.9%(n=295) reported that they were not involved in choices,11.5%(n=104) stated not being treated with dignity and 8.1%(n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). The multivariable analyses showed significantly lower QMNC scores for women with an instrumental vaginal birth. Over time there was a significant increase in QMNC score for ‘experience of care’ and ‘key organizational changes due to COVID-19’. Conclusions and relevance Although overall QMNC scores were high, findings also suggest gaps in QMNC. Underlying causes of these gaps should be explored to design appropriate interventions and policies.

The African Journal of Primary Health & Family Medicine welcomes submissions that encourage scholarly exchange between family medicine and primary health care researchers and practitioners across Africa and the developing world, whilst providing a contextual and holistic view of family medicine as practiced across the continent.

Objectives The 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). Design This is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi, DRC, using stratified random sampling. Participants We included 604 women (15–49 years) who were pregnant between March 2020 and May 2021. Outcome measures A 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. Results One-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; pConclusion During 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.