Despite emerging evidence on safety and efficacy, most countries do not offer COVID‐19 vaccines to pregnant women even though they are at higher risk of complications from COVID‐19. We performed a web search of COVID‐19 vaccination policies for pregnant women under two categories: countries bearing a high burden of COVID‐19 cases and countries with a high burden of maternal and under‐five mortality. Of the top 20 countries affected by COVID‐19, 11 allow vaccination of pregnant women, of which two have deemed it safe to vaccinate pregnant women as a high‐risk group. In contrast, only five of the 20 countries with high under‐five mortality and maternal mortality allow vaccination of pregnant women and none of these countries has included them as part of a high‐risk group that should be vaccinated. India and Indonesia, with one‐fifth of the world's population, fall under both categories but do not include pregnant women as a priority group for COVID‐19 vaccination. To prevent COVID‐19 from further aggravating the already heavy burden of maternal and under‐five mortality, there is a strong case for including pregnant women as a high‐priority group for COVID‐19 vaccination. We recommend including COVID‐19 vaccination in routine antenatal care in all countries, particularly India and Indonesia in view of their high dual burden.

Synopsis In view of the continued threat of COVID‐19, and to synergize with routine antenatal care, COVID‐19 vaccination should become a default part of routine antenatal care with an opt‐out option.

Even though evidence for the safety and efficacy of COVID-19 vaccination in pregnancy is emerging, most countries currently do not offer COVID-19 vaccination to pregnant women, while a few leave the decision to the woman. Pregnant women are known to be at high risk of complications from COVID-19. We did a web search on policies for COVID-19 vaccination of pregnant women in two sets of countries – those bearing a high burden of COVID-19 cases globally, and a second set with a high burden of maternal and under five mortality. India and Indonesia fall in both the groups. Of the top 20 COVID-19 affected countries, six countries allow and two have in place guidelines for preferential vaccination of pregnant women. In contrast, none of the high maternal and under-five mortality burden countries have such preferential vaccination guidelines in place. For COVID-19 not to further aggravate already heavy existing burden of maternal and under five mortality, there is a strong case for inclusion of pregnant women as a high priority group for COVID-19 vaccination. We recommend including COVID-19 vaccination in the routine protocol for antenatal care in all countries, particularly India and Indonesia in view of their dual burden.

Wuhan in China was the first place to be affected by the SARS-CoV-2 infection, called COVID-19, in December 2019, quickly spreading to the rest of the world through international travelers. It was declared a pandemic by WHO on March 11, 2020. 1 Its three waves with different variants of the virus hit the world in 2020-2022 and took a huge toll on millions of lives globally. The first vaccine against COVID-19, an mRNA vaccine by Pfizer/ BioNTech, was launched in December 2020. Later, several other types of vaccines were manufactured and launched. Presently there are nine different vaccines against COVID-19 that have obtained WHO's Emergency Use Listing. 2 Two COVID-19 vaccines, Pfizer and Moderna, have received full approval from the United States Food and Drug Administration (US-FDA). 3 Vaccination against COVID-19 was initially reserved for the most vulnerable population, primarily the elderly, healthcare workers, other front-line workers, and persons with comorbidity. Pregnant and lactating women were specifically excluded from the vaccination drive due to lack of evidence on safety of the vaccine for the pregnant woman, her fetus and her breastfed baby. For ethical reasons, no clinical trials could be conducted to study the effect of

Background Despite impressive improvements in institutional births and a fall in maternal mortality, satisfaction of women with birthing experience in public health institutions is low (68%). Birth Companion is an important part of the Labour room Quality Improvement (LaQshya) programme introduced by the Government of India in 2017. Despite mandates, implementation of the concept has been unsatisfactory (9%), even though the importance of Birth Companion has increased due to enhanced risk posed by COVID-19. Little is known about awareness among health care providers on Birth Companions, perceived barriers or their suggestions. Methods We canvassed a 15-question instrument using ordinal scales on 151 health care providers comprising consultants, post graduates, residents, and nurses (response rate 69%) in the department of Obstetrics & Gynecology, Lok Nayak Hospital, Delhi, India to gauge their awareness and opinions about Birth Companions. Results Most health care providers across all categories were aware of the concept (93%), World Health Organization recommendation (83%) and Government instructions for its hospitals (68%) that every woman should be accompanied by a Birth Companion of her choice during labour. Birth Companions of choice suggested by them were the mother (70%), husband (69%). sister (46%) or nurse (43%). Most health care providers agreed that a Birth Companion should wear clean clothes (95%), be free from any communicable disease (91%), stay with the pregnant woman throughout the process of labour (74%) and should have herself gone though labour (42%). Almost all providers (95%) agreed that the presence of a Birth Companion during labour will be beneficial, as they would provide emotional support (99%), boost the confidence of the woman (98%), provide comfort measures like massage (95%), early initiation of breastfeeding (93%), reduce post-partum depression (91%), humanize labour (83%), reduce need for analgesia (70%) and increase spontaneous vaginal births (69%). Yet support for its introduction in their hospital was low (59%). Staff nurses had reservations (62%) with only 40% of those who believed Birth Companion to be beneficial approving of its introduction in their hospital. Over-crowding in labour room and privacy concerns for other women were identified as key barriers. Conclusion Even though most health care providers were aware of and convinced of multiple benefits of Birth Companion during labour, lack of adequate infrastructure in the labour room prevented them from supporting its introduction. Government should provide adequate funding to upgrade labour rooms in a way that provides privacy to the delivering women and frame guidelines and train Birth Companions to perform their role appropriately. Keywords: Birth Companion, Delivery, Respectful Maternity Care, Privacy, Health Care Providers, COVID-19