Table 1 Characteristics of the overall sample of mothers who gave birth during the COVID-19 pandemic in the WHO European Region, by factors included in the socio-ecological model (n = 26,709)

Intrapersonal factors

 Sociodemographic factors

  Maternal age

   18–24

910 (4.7)

456 (6.2)

 < 0.001

   25–30

6839 (35.3)

2586 (35.1)

0.756

   31–35

7914 (40.9)

2807 (38.1)

 < 0.001

   36–39

2901 (15.0)

1130 (15.4)

0.459

   40 or older

786 (4.1)

380 (5.2)

 < 0.001

  Parity

   Primipara

10,575 (54.7)

5189 (70.5)

 < 0.001

   Multipara

8775 (45.3)

2170 (29.5)

  Maternal education

   Junior high school or lower

945 (4.9)

518 (7.0)

 < 0.001

   High school

4313 (22.3)

1916 (26.0)

 < 0.001

   University degree

7527 (38.9)

2735 (37.2)

0.009

   Graduate degree (Master/Doctorate)

6565 (33.9)

2190 (29.8)

 < 0.001

  Payment of maternity care (insurance status)

   Non-private insurance (public/state/employer)

18,634 (96.3)

6913 (93.9)

 < 0.001

   Private insurance

467 (2.4)

208 (2.8)

0.055

   No insurance (self-paid)

249 (1.3)

238 (3.2)

 < 0.001

  Infant born in same country as mother’s origin

   Yes

17,989 (93.0)

6837 (92.9)

0.886

   No

1361 (7.0)

522 (7.1)

 Prenatal and birth factors

  Difficulty attending prenatal care

   Yes, always/Nearly always

1380 (7.1)

585 (7.9)

0.022

   Sometimes

5765 (29.8)

2322 (31.6)

0.005

   No, never/Almost never

12,205 (63.1)

4452 (60.5)

 < 0.001

  Faced barriers to access prenatal care

   Yes, always/Nearly always

1010 (5.2)

438 (6.0)

0.018

   Sometimes

4586 (23.7)

1777 (24.1)

0.444

   No, never/Almost never

13,754 (71.1)

5144 (69.9)

0.058

  Mode of birth

   Spontaneous vaginal birth

14,762 (76.3)

4547 (61.8)

 < 0.001

   Instrumental vaginal birth

1522 (7.9)

592 (8.0)

0.628

   Cesarean birth

3066 (15.8)

2220 (30.2)

 < 0.001

 Maternal ICU admission

   Yes

92 (0.5)

84 (1.1)

 < 0.001

Interpersonal factors

 Social support

  Adequate visiting hours for partner/relatives

   Excellent/good

4798 (24.8)

1418 (19.3)

 < 0.001

   Sufficient

3089 (16.0)

956 (13.0)

 < 0.001

   Insufficient/very bad

11,463 (59.2)

4985 (67.7)

 < 0.001

  Presence of companion of choice

   Yes, always/Nearly always

7879 (40.7)

2436 (33.1)

 < 0.001

   Sometimes

3309 (17.1)

1041 (14.1)

 < 0.001

   No, never/Almost never

8162 (42.2)

3882 (52.8)

 < 0.001

  HCP emotionally supportive

   Yes, always/Nearly always

14,155 (73.2)

4652 (63.2)

 < 0.001

   Sometimes

3523 (18.2)

1710 (23.2)

 < 0.001

   No, never/Almost never

1672 (8.6)

997 (13.5)

 < 0.001

  Effective communication from HCP

   Yes, always/Nearly always

14,037 (72.5)

4334 (58.9)

 < 0.001

   Sometimes

4489 (23.2)

2376 (32.3)

 < 0.001

   No, never/Almost never

824 (4.3)

649 (8.8)

 < 0.001

  Maternal involvement in healthcare decisions

   Yes, always/Nearly always

12,779 (66.0)

3914 (53.2)

 < 0.001

   Sometimes

4595 (23.7)

2129 (28.9)

 < 0.001

   No, never/Almost never

1976 (10.2)

1316 (17.9)

 < 0.001

  Treated with dignity

   Yes, always/Nearly always

15,157 (78.3)

4828 (65.6)

 < 0.001

   Sometimes

3528 (18.2)

2035 (27.7)

 < 0.001

   No, never/Almost never

665 (3.4)

496 (6.7)

 < 0.001

  Abuse (physical /verbal/emotional)

   Yes, always/Nearly always

434 (2.2)

240 (3.3)

 < 0.001

   Sometimes

2011 (10.4)

1185 (16.1)

 < 0.001

   No, never/Almost never

16,905 (87.4)

5934 (80.6)

 < 0.001

Organizational factors

 Skin-to-skin contact in the first hour after birth

  Yes

17,173 (88.7)

5657 (76.9)

 < 0.001

 Early breastfeeding

  Yes

2612 (13.5)

2465 (33.5)

 < 0.001

 Adequate breastfeeding support

  Yes

5196 (26.9)

3353 (45.6)

 < 0.001

 Rooming-in

  Full rooming-in (including night)

16,814 (86.9)

5507 (74.8)

 < 0.001

  Mostly rooming-in

1752 (9.1)

1321 (17.9)

 < 0.001

  Mostly/always in healthy infant nursery

784 (4.0)

531 (7.2)

 < 0.001

 Allowed to stay with infant as long as wished

  Yes

861 (4.4)

600 (8.2)

 < 0.001

 HCP type present at birth

  Midwife

17,481 (90.3)

6172 (83.9)

 < 0.001

  Nurse

7067 (36.5)

2920 (39.7)

 < 0.001

  Student (before graduation)

2835 (14.7)

923 (12.5)

 < 0.001

  Obstetrics post-graduate registrar/resident

3149 (16.3)

1454 (19.8)

 < 0.001

  Obstetrics physician

10,150 (52.5)

4557 (61.9)

 < 0.001

  I don’t know

1774 (9.2)

943 (12.8)

 < 0.001

  Other

2277 (11.8)

758 (10.3)

0.001

 Adequate number of HCP given the workload

  Excellent/good

8884 (45.9)

2724 (37.0)

 < 0.001

  Sufficient

6915 (35.7)

2765 (37.6)

0.005

  Insufficient/very bad

3551 (18.4)

1870 (25.4)

 < 0.001

 Adequate assistance from HCP

  Yes, always/Nearly always

13,864 (71.6)

4520 (61.4)

 < 0.001

  Sometimes

4274 (22.1)

2063 (28.0)

 < 0.001

  No, never/Almost never

1212 (6.3)

776 (10.5)

 < 0.001

 HCP professionalism

  Excellent/good

12,931 (66.8)

3818 (51.9)

 < 0.001

  Sufficient

5542 (28.6)

2850 (38.7)

 < 0.001

  Insufficient/very bad

877 (4.5)

691 (9.4)

 < 0.001

 Immediate attention by HCP when needed

  Yes, always/Nearly always

14,036 (72.5)

4415 (60.0)

 < 0.001

  Sometimes

4433 (22.9)

2264 (30.8)

 < 0.001

  No, never/Almost never

881 (4.6)

680 (9.2)

 < 0.001

 Privacy protected by HCP

  Yes, always/Nearly always

15,374 (79.5)

5364 (72.9)

 < 0.001

  Sometimes

2707 (14.0)

1270 (17.3)

 < 0.001

  No, never/Almost never

1269 (6.6)

725 (9.9)

 < 0.001

 Type of birth facility

  Public

17,912 (92.6)

6608 (89.8)

 < 0.001

  Private

1438 (7.4)

751 (10.2)

 Adequate number of women per room

  Excellent/good

13,492 (69.7)

4790 (65.1)

 < 0.001

  Sufficient

4318 (22.3)

1858 (25.2)

 < 0.001

  Insufficient/very bad

1540 (8.0)

711 (9.7)

 < 0.001

 Comfort of facility room

  Good/excellent

9988 (51.6)

3139 (42.7)

 < 0.001

  Sufficient

7857 (40.6)

3318 (45.1)

 < 0.001

  Insufficient/very bad

1505 (7.8)

902 (12.3)

 < 0.001

 Room cleaning

  Excellent/good

13,034 (67.4)

4434 (60.3)

 < 0.001

  Sufficient

5277 (27.3)

2224 (30.2)

 < 0.001

  Insufficient/very bad

1039 (5.4)

701 (9.5)

 < 0.001

Community and society factors

 Timing

  Birth before June 23, 2020

5221 (37.0)

1889 (25.7)

0.031

  Birth from June 23, 2020

14,129 (73.0)

5470 (74.3)

 Country of infant’s birth

  Bosnia and Herzegovina

227 (1.2)

132 (1.8)

 < 0.001

  Croatia

836 (4.3)

719 (9.8)

 < 0.001

  France

649 (3.4)

397 (5.4)

 < 0.001

  Germany

687 (3.6)

216 (2.9)

0.013

  Italy

4109 (21.2)

1662 (22.6)

0.017

  Latvia

1186 (6.1)

442 (6.0)

0.707

  Lithuania

682 (3.5)

167 (2.3)

 < 0.001

  Luxemburg

292 (1.5)

106 (1.4)

0.679

  Norway

2178 (11.3)

509 (6.9)

 < 0.001

  Poland

1152 (6.0)

280 (3.8)

 < 0.001

  Portugal

1372 (7.1)

387 (5.3)

 < 0.001

  Romania

413 (2.1)

436 (5.9)

 < 0.001

  Serbia

466 (2.4)

272 (3.7)

 < 0.001

  Slovenia

1212 (6.3)

604 (8.2)

 < 0.001

  Spain

231 (1.2)

52 (0.7)

0.001

  Sweden

2966 (15.3)

823 (11.2)

 < 0.001

  Switzerland

692 (3.6)

155 (2.1)

 < 0.001

 Country’s percent of facilities ever BFHI designated

  Not Reported or 0–49%

11,465 (59.3)

4300 (58.4)

0.224

  50–100%

7885 (40.7)

3059 (41.6)