ObjectivesThe 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).DesignThis is a cross-sectional study using data collected on a survey of 599 households in Lubumbashi, DRC, using stratified random sampling.ParticipantsWe included 604 women (15–49 years) who were pregnant between March 2020 and May 2021.Outcome measuresA 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.ResultsOne-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; p<0.001) and positive attitude towards the COVID-19 vaccination (aOR=1.9; p=0.04). Reasons for not seeking maternal care included lack of money and avoiding COVID-19 vaccination.ConclusionDuring 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.

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.