The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Introduction:IUDs are safe, effective, and used worldwide to prevent unintended pregnancy. However, uptake in Haiti is low. There are limited data on IUD choice and experience in low resource settings; anecdotal reports from providers in Haiti have suggested that Haitian women are unlikely to choose to use or be satisfied with the IUD. The objective of this study is to explore the perceptions of a cohort of IUD users in Mirebalais, Haiti.Methods:In June and July 2015, an IRB-approved mixed methods study of women over age eighteen with hormonal or copper IUDs inserted at Hôpital Universitaire de Mirebalais (HUM) was performed in Mirebalais, Haiti.Results:Twenty-one eligible women participated, out of 58 women identified as eligible. Most women (81%) reported using the copper IUD; most (86%) had used the IUD for 6 months or more. Over half were under 30 years old (62%) and most had completed primary school or less (76%). Almost all (91%) reported prior pregnancies; 65% did not desire more children. The majority of participants were satisfied with the IUD, with 70% being very satisfied and 25% somewhat satisfied. Most women (71%) reported no very bothersome side effects, and would recommend the IUD to others (86%). Qualitative data highlighted positive perceptions of the IUD among users, as well as misperceptions and lack of knowledge regarding the IUD among members of their communities.Conclusion/Implications:Understanding of culture-specific perceptions is critical in addressing barriers to IUD uptake. Our findings indicate that IUDs can be an acceptable contraceptive method for women in Haiti, and suggest the possibility that increased access to the IUD may lead to increased acceptance of this method.

To address the gap in the uptake of long-acting contraception (LAC) methods among high-risk postpartum women who fail to return for a family planning method at HôpitalUniversitaire de Mirebalais in the Central Plateau Department of Haiti, contraceptive implant trainings were held for providers on the Labour and Delivery, Post-Partum and Internal Medicine inpatient wards.A very high maternal mortality rate affects large numbers of women in Haiti; however, contraceptive use can reduce maternal mortality significantly. A quality improvement strategy to offer LAC methods to immediate postpartum women at a University Hospital in rural Haiti was initiated in March 2016. This new strategy produced an average improvement from 5% to 32% of women delivering at the hospital, accepting a long-acting method (including bilateral tubal ligations) by the end of the project and which has proved sustainable at an average of 20% to date.

over a 5 year period following the implementation of a comprehensive robotics training program.METHODS: A review of hysterectomies done at a large teaching hospital and a smaller, community hospital in the same health system over a 5 year period was performed to determine how many hysterectomies were performed using an open, laparoscopic, or vaginal approach. The study included 5175 women, and was evaluated after the implementation of a comprehensive teaching, training, mentoring and proctoring program at each hospital. Laparoscopic procedures included TLH and LSCH, as well as RATLH and RASCH. Vaginal Hysterectomies included TVH and LAVH cases.

BackgroundFollowing the first COVID-19 peak in 2020, came the seasonal childbirth peak at Hôpital Universitaire de Mirebalais (HUM). This peak is associated with overcrowding on the labour and delivery (L&D) ward. Lack of sufficient bed-space for sick neonates in the neonatal ICU at HUM, has led to overcrowding and lengthy stays of sick newborns on L&D. These conditions contribute to the subsequent lack of bed-space for newly postpartum mothers and potentially decreases quality of care for both new mothers and neonates.MethodsA Maternity Task Force was created by hospital leadership to address these urgent needs. The team’s objective was to eliminate mothers and newborns laying on the floor in L&D. The Six-Sigma/DMAIC quality improvement methodology was used as the problem was urgent, demanded rapid results and centred around the process of patient flow in the institution. Process flow chart and Ishikawa diagrams were used to identify the root causes of the issues.ResultsAn average of 22% of postpartum women did not have a bed preintervention and 0% of postpartum women were laying on the floor post intervention. An average of 33% of newborns received paediatric care on the maternity ward pre-intervention compared with an average of 17% postintervention. The team did not achieve its objective for this second indicator, which was to have less than 10% of sick newborns on the maternity ward receiving paediatric care.ConclusionHUM hospital leadership took the vital decision to form the Maternity Task Force to make changes, which consequently led to a sustainable positive and lasting impact on the lives of new mothers and their babies at the institution. The objective of 0 postpartum mothers and newborns on the ground was achieved and fewer newborns receive intensive paediatric care on the maternity ward as a result of our interventions.