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Although a large number of Muslim refugees have resettled in the United States for the last decades, few studies have looked into maternal healthcare access and utilization among Muslim refugee women in the country. This qualitative study was conducted to explore the factors influencing maternal healthcare access and utilization among Muslim refugee women resettled in the United States. In-depth interviews were conducted among Afghan, Iraqi, and Syrian refugee women (n = 17) using an interview guide informed by Social Cognitive Theory and its key constructs. The interviews were recorded and transcribed verbatim, imported into MAXQDA 2020 (VERBI Software), and analyzed based on qualitative content analysis. Data analysis revealed several themes at the micro, meso, and macro-levels. Micro-level factors included women\'s attitudes toward hospitals and prenatal care, as well as their life skills and language proficiency. Meso-level factors, such as cultural norms and practices, social support and network, as well as health care provider characteristics, were also identified. Macro-level factors, such as the complex healthcare system and access to insurance, also appeared to influence maternal healthcare access and utilization. This study revealed the complex contextual factors that refugee populations face. Given the population\'s heterogeneity, a more nuanced understanding of refugee maternal health is required, as are more tailored programs for the most vulnerable groups of refugee women.

BACKGROUND: Midwifery continuity of carer (MCoC) is a model of care in which the same midwife or small team of midwives supports women throughout pregnancy, birth and the postnatal period. The model has been prioritised by policy makers in a number of high-income countries, but widespread implementation and sustainability has proved challenging.
METHODS: In this narrative review and synthesis of the global literature on the implementation and sustainability of midwifery continuity of carer, we identify barriers to, and facilitators of, this model of delivering maternity care. By mapping existing research evidence onto the Consolidated Framework for Implementation Research (CFIR), we identify factors for organisations to consider when planning and implementing midwifery continuity of carer as well as gaps in the current research evidence.
RESULTS: Analysing international evidence using the CFIR shows that evidence around midwifery continuity of carer implementation is patchy and fragmented, and that the impetus for change is not critically examined. Existing literature pays insufficient attention to core aspects of the innovation such as the centrality of on call working arrangements and alignment with the professional values of midwifery. There is also limited attention to the political and structural contexts into which midwifery continuity of carer is introduced.
CONCLUSIONS: By synthesizing international research evidence with the CFIR, we identify factors for organisations to consider when planning and implementing midwifery continuity of carer. We also call for more systematic and contextual evidence to aid understanding of the implementation or non-implementation of midwifery continuity of carer. Existing evidence should be critically evaluated and used more cautiously in support of claims about the model of care and its implementation, especially when implementation is occurring in different settings and contexts to the research being cited.

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This is a qualitative study that explores the perspectives and experiences of a group of Mexican women who experienced institutionalized childbirth care in the first and second waves of the COVID-19 pandemic. Through a semi-structured script, nine women who experienced childbirth care were interviewed between March and October 2020 in public and private hospitals in the city of San Luis Potosí, Mexico. Under the Grounded Theory analysis proposal, it was identified that the health strategies implemented during the pandemic brought with them a setback in the guarantee of humanized childbirth. Women described themselves as distrustful of the protocols that personnel followed to attend to their births in public sector hospitals and very confident in those implemented in the private sector. The intervention of cesarean sections without a clear justification emerged as a constant, as did early dyad separation. Healthcare personnel\'s and institutions\' willingness and conviction to guarantee, protect and defend the right of women to experience childbirth free of violence remain fragile. Resistance persists to rethink childbirth care from a non-biomedicalizing paradigm.
Estudio de tipo cualitativo que explora las perspectivas y experiencias de un grupo de mujeres mexicanas que vivieron la atención institucionalizada del parto en la primera y segunda ola de la pandemia por COVID-19. A través de un guión semiestructurado se entrevistó a nueve mujeres que vivieron la experiencia de la atención del parto entre marzo y octubre de 2020, en hospitales públicos y privados de la ciudad de San Luis Potosí, en México. Bajo la propuesta de análisis de la teoría fundamentada, se identificó que las estrategias sanitarias implementadas en el marco de la pandemia, trajeron consigo un retroceso en la garantía del parto humanizado, las mujeres se narraron desconfiadas en los protocolos que siguió el personal para la atención de sus partos en los hospitales del sector público y muy confiadas en los que se implementaron en el sector privado. La realización de cesáreas sin una justificación clara emergió como una constante, igual que la separación temprana de los binomios. Continúa frágil la disposición y el convencimiento del personal sanitario y las instituciones para garantizar, proteger y defender el derecho de las mujeres a vivir el parto libre de violencia. Persisten resistencias para repensar la atención del parto desde un paradigma no biomédicalizante.

UNASSIGNED: High mortality rates for pregnant women and their new-borns are one of Africa\'s most intractable public health issues today, and Ethiopia is one of the countries most afflicted. Behavioral interventions are needed to increase maternal health service utilizations to improve outcomes. Hence, this trial aimed to evaluate effectiveness of trained religious leaders\' engagement in maternal health education on maternal health service utilization.
UNASSIGNED: The study employed a cluster-randomized controlled community trial that included baseline and end-line measurements. Data on end points were gathered from 593 pregnant mothers, comprising 292 and 301 individuals in the intervention and control groups, respectively. In the intervention group, the trained religious leaders delivered the behavioral change education on maternal health based on intervention protocol. Unlike the other group, the control group only received regular maternal health information and no additional training from religious leaders. Binary generalized estimating equation regression analysis adjusted for baseline factors were used to test effects of the intervention on maternal health service utilization.
UNASSIGNED: Following the trial\'s implementation, the proportion of optimal antenatal care in the intervention arm increased by 21.4% from the baseline (50.90 vs. 72.3, p ≤ 0.001) and the proportion of institutional delivery in the intervention group increased by 20% from the baseline (46.1% vs. 66.1%, p ≤ 0.001). Pregnant mothers in the intervention group significantly showed an increase of proportion of PNC by 22.3% from baseline (26% vs. 48.3%, p ≤ 0.001). A statistically significant difference was observed between in ANC4 (AOR = 2.09, 95% CI: 1.69, 2.57), institutional delivery (AOR = 2.36, 95% CI: 1.94, 2.87) and postnatal care service utilization (AOR = 2.26, 95% CI: 1.79, 2.85) between the intervention and control groups.
UNASSIGNED: This research indicated that involving religious leaders who have received training in maternal health education led to positive outcomes in enhancing the utilization of maternal health services. Leveraging the influential position of these religious leaders could be an effective strategy for improving maternal health service utilization. Consequently, promoting maternal health education through religious leaders is advisable to enhance maternal health service utilization.Clinical trial registration: [https://clinicaltrials.gov/], identifier [NCT05716178].

BACKGROUND: In 2018, the Dutch government initiated the Solid Start program to provide each child with the best start in life. Key program elements are a biopsychosocial perspective on pregnancy and children\'s development and stimulating local collaborations between social and health domains, with a specific focus on (future) families in vulnerable situations. Two programs for interprofessional collaboration between maternity and social care professionals to optimize care for pregnant women in vulnerable situations were developed and implemented, in Groningen in 2017 and in South Limburg in 2021. This paper describes the extent of implementation of these programs and the perceptions of involved professionals about determinants that influence program implementation.
METHODS: We conducted a mixed-methods study in 2021 and 2022 in two Dutch regions, Groningen and South Limburg. Questionnaires were sent to primary care midwives, hospital-based midwives, obstetricians (i.e. maternity care professionals), (coordinating) youth health care nurses and social workers (i.e. social care professionals), involved in the execution of the programs. Semi-structured interviews were held with involved professionals to enrich the quantitative data. Quantitative and qualitative data were collected and analyzed using Fleuren\'s implementation model.
RESULTS: The findings of the questionnaire (n = 60) and interviews (n = 28) indicate that professionals in both regions are generally positive about the implemented programs. However, there was limited knowledge and use of the program in Groningen. Promoting factors for implementation were mentioned on the determinants for the innovation and the user. Maternity care professionals prefer a general, conversational way to identify vulnerabilities that connects to midwives\' daily practice. Low-threshold, personal contact with clear agreements for referral and consultation between professionals contributes to implementation. Professionals agree that properly identifying vulnerabilities and referring women to appropriate care is an important task and contributes to better care. On the determinants of the organization, professionals indicate some preconditions for successful implementation, such as clearly described roles and responsibilities, interprofessional training, time and financial resources.
CONCLUSIONS: Areas for improvement for the implementation of interprofessional collaboration between maternity care and social care focus mainly on determinants of the organization, which should be addressed both regionally and nationally. In addition, sustainable implementation requires continuous awareness of influencing factors and a process of evaluation, adaptation and support of the target group.

BACKGROUND: Women Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles.
OBJECTIVE: To explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy\'s values and principles.
METHODS: Women who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women\'s experiences according to the Strategy\'s values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported.
RESULTS: The survey was completed by 1750 women. A proportion of women perceived the Strategy\'s values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period.
CONCLUSIONS: Despite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women\'s access to and experiences of care across the entire maternity episode.

BACKGROUND: Adverse perinatal health outcomes are notably high among African-born women living in Australia. This problem is partly attributed to their lower engagement in maternity care services as compared to Australian-born women. Various barriers might limit African-born women\'s access to and use of services; however, these barriers are not well documented. Therefore, this review aimed to synthesise current qualitative evidence on barriers and facilitators of access to maternity care for African-born women living in Australia.
METHODS: The search was conducted in MEDLINE, CINAHL, Embase, PsychInfo, and Maternity and Infant Care databases on 16 April 2023. All articles retrieved were meticulously screened for eligibility by two independent reviewers with any disagreements resolved through discussion. The quality of the included articles was evaluated using the Mixed Methods Appraisal Tool. Studies were screened in Covidence and analysed in NVivo. The findings were organised and presented using Levesque\'s framework of healthcare access.
RESULTS: Out of 558 identified papers, 11 studies comprising a total of 472 participants met the eligibility criteria. The review highlighted provider-side barriers such as shortage of information, unmet cultural needs, long waiting times, low engagement of women in care, discrimination, and lack of continuity of care. User-side barriers identified include communication issues, difficulty navigating the health system, and lack of trustful relationships with healthcare providers. In contrast, the review pinpointed provider-side facilitators including positive staff attitudes, service availability, and the proximity of facilities to residential homes, while user-side facilitators such as cultural assimilation and feeling valued by healthcare providers were noted.
CONCLUSIONS: This review identified barriers and facilitators of access to maternity care for African-born women living in Australia. Empirical evidence that would inform potential changes to policy and practice to address African-born women\'s unique health needs was highlighted. Designing and implementing a culturally safe service delivery model could remove the identified access barriers and improve African-born women\'s engagement in maternity care. Moreover, reinforcing factors associated with positive healthcare experiences is essential for improving maternity care access for this priority population.
BACKGROUND: PROSPERO CRD42023405458.

BACKGROUND: Women who suffer an early pregnancy loss require specific clinical care, aftercare, and ongoing support. In the UK, the clinical management of early pregnancy complications, including loss is provided mainly through specialist Early Pregnancy Assessment Units. The COVID-19 pandemic fundamentally changed the way in which maternity and gynaecological care was delivered, as health systems moved to rapidly reconfigure and re-organise services, aiming to reduce the risk and spread of SARS-CoV-2 infection. PUDDLES is an international collaboration investigating the pandemic\'s impact on care for people who suffered a perinatal bereavement. Presented here are initial qualitative findings undertaken with UK-based women who suffered early pregnancy losses during the pandemic, about how they navigated the healthcare system and its restrictions, and how they were supported.
METHODS: In-keeping with a qualitative research design, in-depth semi-structured interviews were undertaken with an opportunity sample of women (N = 32) who suffered any early pregnancy loss during the COVID-19 pandemic. Data were analysed using a template analysis to understand women\'s access to services, care, and networks of support, during the pandemic following their pregnancy loss. The thematic template was based on findings from parents who had suffered a late-miscarriage, stillbirth, or neonatal death in the UK, during the pandemic.
RESULTS: All women had experienced reconfigured maternity and early pregnancy services. Data supported themes of: 1) COVID-19 Restrictions as Impractical & Impersonal; 2) Alone, with Only Staff to Support Them; 3) Reduction in Service Provision Leading to Perceived Devaluation in Care; and 4) Seeking Their Own Support. Results suggest access to early pregnancy loss services was reduced and pandemic-related restrictions were often impractical (i.e., restrictions added to burden of accessing or receiving care). Women often reported being isolated and, concerningly, aspects of early pregnancy loss services were reported as sub-optimal.
CONCLUSIONS: These findings provide important insight for the recovery and rebuilding of health services in the post-pandemic period and help us prepare for providing a higher standard of care in the future and through any other health system shocks. Conclusions made can inform future policy and planning to ensure best possible support for women who experience early pregnancy loss.