Perinatal Health Services Research Articles

Listening to the Perspectives of Black Women on Perinatal Health Disparities: Reversing the Tide and Improving Outcomes.

Pregnancy-related health in the USA fares worse than similarly resourced countries and the gap continues to widen. This trend however is disproportionately experienced by women of color. We have come to understand that this is due to the systems and structures that perpetuate racism. Despite our awareness of this, the voices of the community impacted by these systems have been largely left out of research. The authors aimed to utilize participatory research methods within a qualitative design to askBlack pregnant and parenting women about their lived experiences of pregnancy and perinatal health services. Over three focus groups, the authors gathered information from 12 participants. Participants were Black women currently pregnant or pregnant in the last year, ages 22-37years old. Participants shared their experiences and views on racial disparities within perinatal health care. Our analytic goal was to explore the questions: "What are Black women talking about in relation to perinatal health"; "Where do Black women get information about perinatal health disparities?"; and "How do Black women feel when they hear or talk about perinatal health risks?". In general, participants felt that the burden to understand their pregnancy risks and options was theirs alone to carry. This resulted in their utilization of and reliance on the internet, social supports, and holistic providers such as doulas for information about how to reduce their risk for maternal morbidity and mortality. Results demonstrate patients' receptivity to frank conversation about perinatal health disparities, and their willingness to partner with their providers to reduce risks in pregnancy. While interventions to reduce perinatal health risks must be systemic, they cannot move forward without including the voices of and partnering with the community they hope to positively impact.

Affordability, Accessibility, and Quality of Maternal Health Care Services and Level of Satisfaction of Mothers in Rural Areas in China

Objective: This study aimed to understand the affordability, accessibility, and quality of maternal and child health services for postpartum mothers, and their impact on satisfaction. Methods: The study utilized the Anderson model and revised the Maternal Pregnancy and Perinatal Health Service Questionnaire. A survey was conducted among 289 mothers aged 20–49 in Feicheng City. Results: Regarding accessibility, most respondents (133) reported that travel time to healthcare services exceeded 60 minutes, while 99 respondents indicated a travel time of 16–30 minutes. The issue of affordability was highlighted, with 86.85% of participants perceiving maternal healthcare services as costly, indicating a significant financial burden. More than 50% of respondents were satisfied with two specific dimensions (P < 0.05) regarding the quality of maternal healthcare services. Conclusion: The study found that accessibility, affordability, and quality significantly affect mothers’ satisfaction with maternal health services. Future research should focus on developing more suitable service pathways for rural mothers.

Screening for Postpartum Depression Risk Using Edinburgh Postnatal Depression Scale (EPDS) In Postpartum Mothers

Postpartum depression seems to be one of the prior causes of stress and anxiety for women worldwide during the current COVID-19 pandemic. This percentage is quite high in Asian countries, ranging from 26 to 85%, and 50 to 70% in Indonesia. This research aims to describe the prevalence of postpartum depression risk in postpartum mothers using EPDS in Bali Mandara Public Hospital, Bali Province. With a sample size of 75 postpartum mothers, the design of this descriptive study was the cross-sectional approach of seventh to tenth-day postpartum mothers from November to December 2022. The sampling technique involved consecutive sampling. The research instrument is the EPDS questionnaire. Approximately 41.3% of postpartum mothers who gave birth in Bali Mandara Public Hospital had a high risk of experiencing postpartum depression. The respondents are 16-20 years old, have an elementary education level, work as entrepreneurs, have middle to low economic status, and have multiparity. The majority of postpartum mothers are at high risk of experiencing postpartum depression, which is why early detection is critical and must be established as the new operational standard in perinatal health services.

Barriers and enablers to accessing perinatal health services for rural Australian women: A qualitative exploration of rural health care providers perspectives.

To identify perceived barriers and enablers for rural women in accessing perinatal care within their own community from the perspective of perinatal health care providers. A qualitative descriptive study design utilising reflexive thematic analysis, using the socioecological framework to organise and articulate findings. Victoria, Australia. Semi-structured interviews were conducted with nine perinatal health care providers who provide care to pregnant women or new mothers in rural communities. Participants were recruited across Victoria in 2023. Providers reported multi-level barriers and enablers that exist for rural women in accessing perinatal care within their communities. Barriers included women's personal circumstances, challenging professional relationships, inequitable service provision, ineffective collaboration between services and clinicians and government funding models and policies. Enablers included strength and resilience of rural women, social capital within rural communities, flexible care delivery and innovative practice, rural culture and continuity of care models. Rural perinatal health care providers perceived that rural women face multiple barriers that are created or sustained by complex interpersonal, organisational, community and policy factors that are intrinsic to rural health care delivery. Several addressable factors were identified that create unnecessary barriers for rural women in engaging with perinatal care. These included education regarding health systems, rights and expectations, equitable distribution of perinatal services, improved interprofessional relationships and collaborative approaches to care and equity-based funding models for perinatal services regardless of geographical location.

Resilience in the time of crisis: A review of the maternal, perinatal and reproductive health effects of COVID-19 in South Africa.

The COVID-19 pandemic had a profound effect on the health sector globally and in South Africa (SA). To review the effects of COVID-19 on maternal, perinatal and reproductive health outcomes and service utilisation in SA. Three routine national data collection systems were sourced: the District Health Information System, the Saving Mothers reports of the National Committee on Confidential Enquiry into Maternal Deaths and the Saving Babies reports from the National Perinatal Morbidity and Mortality Committee using data from the Perinatal Problem Identification Program. There were 35% and 8% increases in maternal and stillbirth mortality rates, respectively, in 2020 and 2021, which correlated with the COVID-19 waves. However, in 2022, rates returned to pre-COVID levels. Antenatal visits and facility births showed little change, but there was a shift to more rural provinces. The use of oral and injectable contraceptives and termination of pregnancy services decreased markedly in 2020 and 2021, with a sustained shift to long-acting reversible contraceptives. The increase in maternal deaths was predominantly due to COVID-19 respiratory complications, but also an increase in obstetric haemorrhage. Stillbirths increased significantly (10%) for birthweights between 2 000 g and 2 499 g, categorised mostly as unexplained stillbirths or preterm labour, but no increase in neonatal deaths was observed. Administrative avoidable factors increased by 24% in the 2020 - 2022 triennium, but there was no increase in patient/community level or healthcare provider-related avoidable factors during the pandemic years. COVID-19 caused a marked increase in maternal death and stillbirth rates in 2020 and 2021 due to both direct effects of the virus and indirect effects on functioning of the health system. The continued, although modified, health-seeking behaviour of women and the rapid return to pre-COVID-19 mortality rates demonstrates enormous resilience in women and the health system.

Fifty years of evidence on perinatal experience among refugee and asylum-seeking women in Organization for Economic Co-operation and Development (OECD) countries: A scoping review.

Members of the Organization for Economic Co-operation and Development (OECD) play a significant role in hosting and supporting refugees. Refugees and asylum seekers in OECD countries may face unique challenges in accessing perinatal healthcare. These challenges can impact their use of and experience with perinatal health services leading to poor maternal and infant outcomes. This scoping review describes the general trends in perinatal health research among refugees/asylum seekers in OECD countries over the past fifty years (1970 to 2021) as well as summarizes their perinatal experience. Databases including Embase and Medline were searched using relevant key words for "refugee/ asylum seeker", "perinatal ", and " OECD countries.". Articles were excluded if they only involved economic migrants or internally displaced persons, conducted in non-OECD countries, only assessed health behaviors and practices during pregnancy (e.g., smoking), or were published in a language other than English. The final list of articles included 82 unique studies. In the 40 years between 1970 and 2009, very few studies (n = 9) examined perinatal health among refugees/ asylum seekers in OECD countries. However, an increasing trend was observed over the past decade. Early studies (1980 to 2009) focused more on traditional perinatal outcomes; however, from 2010 onwards, studies related to perinatal experience were more likely to emerge in the global health literature. Access to timely prenatal care remains a challenge with failure to address the root causes of the problem in several OECD countries including those with a long history of hosting refugees. The limited availability of interpretation services and the lack of a patient-centered approach to care have also interfered with the perceived quality of care. In addition, perceived isolation and the limited social support experienced by this vulnerable population have negatively impacted their perinatal experiences in several OECD countries. Refugee/asylum seekers in OECD countries face a number of challenges during the perinatal period. Policy changes and further research are needed to address access barriers and identify specific interventions that can improve their well-being during this critical period.

Psychometric properties of the European Portuguese version of the modified perinatal PTSD questionnaire (PPQ-II)

Childbirth-related posttraumatic stress symptoms (CB-PTSS) are prevalent and have pervasive consequences for the entire family. The development and validation of tools for screening CB-PTSS are deemed necessary to maximize prevention and intervention efforts. This study aims to examine the psychometric properties of the modified perinatal PTSD questionnaire (PPQ-II) in a sample of European Portuguese mothers. Four hundred and fifty-one women, from 1 to 18 months postpartum, participated in an online cross-sectional study that was conducted between February and March 2020. Participants completed the PPQ-II and the Depression Anxiety Stress Scales – 21 (DASS-21). Factor structure was estimated through an Exploratory (EFA; n = 229) and Confirmatory factor analysis (CFA; n = 222). Convergent and known-groups validity and internal consistency of the scale were also computed. The EFA suggested a 2-structure factor (Factor 1 “Arousal”, containing 7 items; and Factor 2 “Avoidance and Intrusion”, containing 4 items), accounting for 48.3% of the total variance of the scale. This factor structure was supported by the CFA, showing an adequate fit to the data. Convergent validity was shown by significant associations between the PPQ-II and DASS-21 subscales. Overall, the scale discriminated between at-risk and low-risk mothers. The McDonald’ omega coefficients attested the high reliability of the PPQ-2 (ranging from 0.78 to 0.89). The PPQ-II is a valid and reliable instrument to routinely screen for CB-PTSS in perinatal health services. It also adds to prior studies demonstrating its cross-cultural validity.

Trends, influencing factors and prediction analysis of under-five and maternal mortality rates in China from 1991 to 2020.

Under-five mortality rate (U5MR) and maternal mortality rate (MMR) are important indicators for evaluating the quality of perinatal health and child health services in a country or region, and are research priorities for promoting maternal and infant safety and maternal and child health. This paper aimed to analysis and predict the trends of U5MR and MMR in China, to explore the impact of social health services and economic factors on U5MR and MMR, and to provide a basis for relevant departments to formulate relevant policies and measures. The JoinPoint regression model was established to conduct time trend analysis and describe the trend of neonatal mortality rate (NMR), infant mortality rate (IMR), U5MR and MMR in China from 1991 to 2020. The linear mixed effect model was used to assess the fixed effects of maternal health care services and socioeconomic factors on U5MR and MMR were explored, with year as a random effect to minimize the effect of collinearity. Auto regressive integrated moving average models (ARIMA) were built to predict U5MR and MMR from 2021 to 2025. The NMR, IMR, U5MR and MMR from 1991 to 2020 in China among national, urban and rural areas showed continuous downward trends. The NMR, IMR, U5MR and MMR were significantly negatively correlated with gross domestic product (GDP), the proportion of the total health expenditure (THE) to GDP, system management rate, prenatal care rate, post-natal visit rate and hospital delivery rate. The predicted values of national U5MR from 2021 to 2025 were 7.3 ‰, 7.2 ‰, 7.1 ‰, 7.1 ‰ and 7.2 ‰ and the predicted values of national MMR were 13.8/100000, 12.1/100000, 10.6/100000, 9.6/100000 and 8.3/100000. China has made great achievements in reducing the U5MR and MMR. It is necessary for achieving the goals of Healthy China 2030 by promoting the equalization of basic public health services and further optimizing the allocation of government health resources. China's experience in reducing U5MR and MMR can be used as a reference for developing countries to realize the SDGs.

Engaging culturally diverse fathers in maternal and family healthcare: Experiences and perspectives of healthcare professionals.

Australian maternal, family and child services increasingly espouse the value of being 'father-inclusive'. However, fathers report feeling excluded or marginalised during healthcare visits with their partners/infants, and experience barriers to engaging in perinatal healthcare at the community, individual and healthcare service level. These barriers may be amplified in men who are members of minority groups, such as those from culturally and linguistically diverse (CALD) backgrounds. This research investigated healthcare professionals' perceptions and experiences of providing perinatal health services to families from CALD backgrounds. Semi-structured interviews were held with healthcare professionals from multiple disciplinary backgrounds providing services to families in the perinatal period. Interviews were audio recorded, transcribed and analysed thematically to identify key themes and sub-themes. Ten healthcare professionals were interviewed. Participants acknowledged that inclusion of fathers in care is important as involvement enables fathers to support their pregnant partners and children, manage their own mental health, and helps to transform harmful gender roles. Overall, healthcare professionals are willing to include culturally diverse fathers. However, the ability of culturally diverse families to engage with healthcare services is impacted by the cultural competency of the services. So what? Healthcare delivered during pregnancy, childbirth and postpartum year may be improved by adopting a whole-family approach, which considers the needs and perspectives of fathers and partners. However, particular attention is needed to ensure healthcare policies and practices are culturally competent to meet the needs of fathers from culturally diverse backgrounds.

Qualitative Study on Maternal and Perinatal Health Services in Primary Health Care Facility in Banten Province


 
 
 Objective: To determine the effect of clinical governance in PHCs on maternal and perinatal health in Banten Province, Indonesia.Methods: This was an observational analytic study with cross sectional method performed on the PHCs on Banten Province, Indonesia. All PHCs in Banten Province having maternal and perinatal health services were included in the study. Clinical governance and services were measured using a self-made questionnaire filled by the representative of the PHC. Characteristics analyzed in this study were age, education level, completed training, and occupation. Clinical governance aspects analyzed in this study were leadership, culture, competence, governance, and readiness. The services analyzed in this study were antenatal, pathology, and emergency service. Results: There were 117 PHC representatives who were recruited to the study. The PHC which were categorized as “outstanding” for leadership, culture, competence, governance, and readiness were 23.1%, 41%, 98%, 81.2%, and 83.8%, respectively. The PHC which were categorized as having “good” antenatal, pathology, and emergency services were 92.3%, 51.3%, and 90.6%, respectively. The PHCs with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care.Conclusions: Primary health cares with better clinical governance aspects delivered better antenatal, pathology, and emergency services for maternal and perinatal care. Therefore, improving clinical governance is essential to improve maternal and perinatal health services quality in Banten Province, IndonesiaKeywords: clinical governance, health service, maternal health, quality assurance.AbstrakTujuan: Untuk mengetahui pengaruh tata kelola klinik di Puskesmas terhadap kesehatan ibu dan perinatal di Provinsi Banten, Indonesia.Metode: Penelitian observasional analitik dengan metode potong lintang yang dilakukan di Puskesmas di Provinsi Banten, Indonesia. Semua Puskesmas di Provinsi Banten yang memiliki layanan kesehatan ibu dan perinatal diikutsertakan dalam penelitian ini. Tata kelola dan layanan klinis diukur menggunakan kuesioner buatan sendiri yang diisi oleh perwakilan Puskesmas. Karakteristik yang dianalisis dalam penelitian ini adalah usia, tingkat pendidikan, pelatihan yang diselesaikan, dan pekerjaan. Aspek tata kelola klinis yang dianalisis dalam penelitian ini adalah kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan. Pelayanan yang dianalisis dalam penelitian ini adalah pelayanan antenatal, patologi, dan gawat darurat.Hasil: Terdapat 117 perwakilan Puskesmas yang direkrut untuk penelitian. Puskesmas yang dikategorikan “sangat baik” untuk kepemimpinan, budaya, kompetensi, tata kelola, dan kesiapan masing-masing adalah 23,1%, 41%, 98%, 81,2%, dan 83,8%. Puskesmas yang memiliki pelayanan antenatal, patologi, dan gawat darurat yang tergolong “baik” berturut-turut adalah 92,3%, 51,3%, dan 90,6%. Puskesmas dengan aspek tata kelola klinis yang lebih baik memberikan layanan antenatal, patologi, dan darurat yang lebih baik untuk perawatan ibu dan perinatal.Kesimpulan: Pelayanan kesehatan primer dengan aspek tata kelola klinis yang lebih baik menghasilkan pelayanan antenatal, patologi, dan kegawatdaruratan yang lebih baik untuk pelayanan ibu dan perinatal. Oleh karena itu, peningkatan tata kelola klinis sangat penting untuk meningkatkan kualitas pelayanan kesehatan maternal dan perinatal di Provinsi Banten, IndonesiaKata kunci: kesehatan ibu, pelayanan kesehatan, penjaminan mutu, tata kelola klinik.
 
 

Cerebral palsy as a public health indicator.

Cerebral palsy as a public health indicator.

Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada.

The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period. To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada. This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design. The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period. Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

Toward recovery-oriented perinatal healthcare: A participatory qualitative exploration of persons with lived experience and health providers' views and experiences.

Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression. We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis. We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration. This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.

Perinatal Care Changes During COVID-19: A Population-Based Analysis by Race/Ethnicity

The COVID-19 public health emergency created unprecedented disruptions in the use of healthcare services, which could have affected long-standing racial‒ethnic disparities in maternal care use and outcomes. This study evaluates population-level changes in perinatal health services associated with the COVID-19 pandemic overall and by maternal race‒ethnicity. In this analysis of all U.S. live births from 2016 to 2020, interrupted time-series analysis was used to estimate the change in the mean number of prenatal care visits and rates of hospital birth, labor induction, and cesarean delivery associated with the start of the pandemic (March 2020) overall and by maternal race‒ethnicity. Analyses were conducted in 2022. The start of the pandemic was associated with overall decreases in the mean number of prenatal care visits, decreases in hospital birth rates, and increases in labor induction rates. The mean number of prenatal care visits decreased similarly for all racial‒ethnic groups, whereas reductions in hospital births were largest for non-Hispanic White individuals, and increases in labor induction were largest for non-Hispanic White and non-Hispanic Asian or Pacific Islander individuals. Among all U.S. live births, the COVID-19 pandemic was associated with modest overall changes in perinatal care, with differential changes by maternal race‒ethnicity. Differential changes in perinatal services may have implications for racial-ethnic maternal health disparities.

Effects of the COVID-19 pandemic on maternal and perinatal health service utilisation and outcomes in Mozambique: an interrupted time series analysis

ObjectivesTo measure the effects of the COVID-19 pandemic on maternal and perinatal health services and outcomes in Mozambique.DesignThis is an observational study analysing routine service delivery data using interrupted time...

Antenatal preventative pelvic floor muscle exercise intervention led by midwives to reduce postnatal urinary incontinence (APPEAL): protocol for a feasibility and pilot cluster randomised controlled trial

BackgroundAntenatal pelvic floor muscle exercises (PFME) in women without prior urinary incontinence (UI) are effective in reducing postnatal UI; however, UK midwives often do not provide advice and information to women on undertaking PFME, with evidence that among women who do receive advice, many do not perform PFME.MethodsThe primary aim of this feasibility and pilot cluster randomised controlled trial is to provide a potential assessment of the feasibility of undertaking a future definitive trial of a midwifery-led antenatal intervention to support women to perform PFME in pregnancy and reduce UI postnatally.Community midwifery teams in participating NHS sites comprise trial clusters (n = 17). Midwives in teams randomised to the intervention will be trained on how to teach PFME to women and how to support them in undertaking PFME in pregnancy. Women whose community midwifery teams are allocated to control will receive standard antenatal care only.All pregnant women who give birth over a pre-selected sample month who receive antenatal care from participating community midwifery teams (clusters) will be sent a questionnaire at 10–12 weeks postpartum (around 1400–1500 women). Process evaluation data will include interviews with midwives to assess if the intervention could be implemented as planned. Interviews with women in both trial arms will explore their experiences of support from midwives to perform PFME during pregnancy. Data will be stored securely at the Universities of Birmingham and Exeter.Results will be disseminated through publications aimed at maternity service users, clinicians, and academics and inform a potential definitive trial of effectiveness. The West Midlands–Edgbaston Research Ethics Committee approved the study protocol.DiscussionTrial outcomes will determine if criteria to progress to a definitive cluster trial are met. These include women’s questionnaire return rates, prevalence of UI, and other health outcomes as reported by women at 10–12 weeks postpartum. Progress to a definitive trial however is likely to be prevented in the UK context by new perinatal pelvic health service, although this may be possible elsewhere.Trial registrationhttps://doi.org/10.1186/ISRCTN10833250. Registered 09/03/2020

The impact of depression on satisfaction with prenatal care in Kazakhstan during COVID-19 pandemic

Abstract Background Depression and anxiety are common during perinatal periods, representing a considerable public health concern during global pandemic. Only few studies have examined the influence of emotional disturbances on satisfaction with maternity care. This study aimed to assess the prevalence of satisfaction with prenatal care and to examine its association with depression and anxiety among pregnant women in Kazakhstan. Methods Participants were recruited to this online cross-sectional survey in the outpatient clinic in Novoshamalgan, Almaty region (n = 174) in December-January, 2022. A single-item measure of satisfaction was used by asking a question “How satisfied are you with health services?”, scored on a 5-point Likert scale. A simplified 2-item Edinburgh Postpartum Depression Scale and 2-item Generalized Anxiety Disorder scale were used to measure depressive and anxiety symptoms. Results Majority of women were very satisfied or satisfied (n = 128; 74%), while less than a third of the sample (n = 46; 26%) were dissatisfied with the received care. The prevalence of depression in the total sample was higher, compared to the prevalence of anxiety (34% versus 18%). Multivariable logistic regression showed that dissatisfaction with prenatal care was associated with older age, not attending check-ups regularly, and being employee of private company or student. Depression increased the odds of being dissatisfied by 2.6 times (95% CI 1.19∼5.79); while obstetric issues and anxiety were not associated with satisfaction. Perception of women about inadequate solution of the problem of antenatal depression was a significant predictor of dissatisfaction (AOR 6.87; 95% CI 1.81∼26.12). Conclusions Depressed women in our study were less satisfied with prenatal care. Further investigation of the perception of women about specific aspects of perinatal health services is suggested. Providing a quality, patient-centered care is needed to support pregnant women during the current pandemic. Key messages

P5 - Expectant and new fathers’ health literacy and engagement in maternity and early infant health services

Fathers’ participation in antenatal and postnatal (perinatal) health services is widely recommended, yet rarely achieved at desired levels. One barrier may be health services’ poor understanding of fathers’ health literacy. This study aimed to investigate (a) health literacy strengths and barriers, and (b) associations between health literacy and health service engagement, among expectant and new fathers, to inform the development of more father-inclusive health services. Cross-sectional study. Expectant and new fathers (infants born since 2020) were recruited in August 2021 through Prolific, an international paid online survey platform. The survey included the Health Literacy Questionnaire (HLQ) which encompasses nine conceptually distinct dimensions of health literacy, and questions about fathers’ engagement with perinatal health visits. Surveys were completed by 889 men (46.8% with pregnant partners, 53.2% with infants up to 18mnths). Respondents resided in the USA (30.9%), UK (27%), South Africa (17.5%) and other countries (24.7%). Highest HLQ scores among respondents were in Scale 9: ‘Understanding health information enough to know what to do’ (Mean 4.13, scale range 1-5) and Scale 8 ‘Ability to find good health information’ (Mean 4.05, scale range 1-5). Lowest HLQ scores were seen for Scale 3 ‘Actively managing my health’ (Mean 2.94, scale range 1-4), and Scale 1: ‘Feeling understood and supported by health care providers’ (Mean 2.96, scale range 1-4). Most fathers (81.8%) attended at least half of health visits with their partners/infants; regular attendance was associated (p<0.01) with higher scores on seven HLQ subscales. Expectant and new fathers report good basic, functional health literacy skills but face barriers to engaging actively in their healthcare. Health services should consider ways to improve their support for fathers. These data can inform tailored health information and engagement strategies for fathers, with potential long-term benefits for fathers, partners and infants.

Challenges and opportunities for perinatal health services in the COVID-19 pandemic: a qualitative study with perinatal healthcare professionals

BackgroundPerinatal healthcare professionals (PHCPs) provide essential support to all parents in the perinatal period, including young parents aged 16–24, who are at an increased risk of morbidity and mortality. Little is known about the impact of COVID-19 restrictions on the provision of perinatal services, and on perinatal healthcare professionals, caring for young parents in the UK.MethodsA UK based qualitative study using semi-structured interviews with perinatal healthcare professionals (n = 17). Data were analysed using thematic analysis.ResultsTwo themes were identified describing perinatal healthcare professionals’ perceptions of providing care to young parents during the pandemic. Perinatal healthcare professionals perceived that young parents’ needs were amplified by the pandemic and that pandemic-related changes to the service, such as the use of telemedicine to replace face-to-face interactions, did not manage to successfully mitigate the increased feelings of anxiety and isolation experienced by young parents. Concerns were raised by perinatal healthcare professionals that these changes reduced young parent’s access to vital support for themselves and their child and may contribute to exacerbating pre-existing inequalities.ConclusionsThis study provides insight into the impact of the COVID-19 pandemic on the provision of perinatal care to young parents. Perinatal mental health professionals felt these negative impacts could be overcome by using a blended approach of technology and face-to-face interactions allowing regular contact with young parents and facilitating the exchange of vital information, while maintaining access to opportunities for social interactions with other parents. Findings from this study could be used to future-proof services against further COVID-19 restrictions.

Depressive Symptoms in Fathers during the First Postpartum Year: The Influence of Severity of Preterm Birth, Parenting Stress and Partners' Depression.

Although preterm birth constitutes a risk factor for postpartum depressive symptomatology, perinatal depression (PND) has not been investigated extensively in fathers of very low (VLBW) and extremely low birth weight (ELBW) infants. This study explored paternal depression levels at 3, 9, and 12 months of infant corrected age, investigating also the predictive role played by the severity of prematurity, maternal and paternal PND levels, and parenting stress. We recruited 153 fathers of 33 ELBW, 42 VLBW, and 78 full-term (FT) infants, respectively. Depression was investigated by the Edinburgh Postnatal Depression Scale (EPDS) and distress by the Parenting Stress Index-Short Form-PSI-SF (Total and subscales: Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child). ELBW fathers showed a significant decrease (improvement) in EPDS, total PSI-SF, and Parental Distress mean scores after 3 months. Paternal EPDS scores at 12 months were significantly predicted by VLBW and FT infants’ birth weight categories, fathers’ EPDS scores at 3 and 9 months, Parent–Child Dysfunctional Interaction subscale at 3 months, and Difficult Child subscale at 9 months. This study strengthens the relevance of including early routine screening and parenting support for fathers in perinatal health services, with particular attention to fathers who might be more vulnerable to mental health difficulties due to severely preterm birth.