Utilisation of services along the continuum of maternal healthcare during the COVID-19 pandemic in Lubumbashi, DRC: findings from a cross-sectional household survey of women

Abstract Introduction: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 and accompanying mitigation measures 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, and explores factors associated with use of the full continuum.Methods:This is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi using stratified random sampling. We included 604 women (15-49 years) who were pregnant between March 2020-May 2021. 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:Of the women who gave birth during the COVID-19 pandemic, 61% had ANC 4+ consultations, most had a skilled birth attendant (97%), and more than half (55%) had a PNC check for themselves and the newborn. One-third (36%) of women completed the continuum of maternal healthcare. Factors significantly associated with completing the continuum included higher education (aOR=2.6; p-value<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p-value=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.Conclusion:During the COVID-19 pandemic, maternal healthcare seeking behaviours were shaped by vaccine hesitancy and care unaffordability in Lubumbashi. By disproportionately affecting women and vulnerable populations, the pandemic could exacerbate pre-existing structural barriers to maternal healthcare utilisation. Addressing the high cost of maternal healthcare and vaccine hesitancy appear essential to avoid deepening pre-existing socio-economic inequalities.