Journal of Preventive Medicine

Introduction
Prenatal care is the most effective factor in improving pregnancy outcomes and ensuring children’s health in the future. Providing prenatal care is more cost-effective than any intervention to reduce maternal mortality and morbidity and prevent premature birth and low birth weight. Mothers who are satisfied with prenatal care have been shown to have better pregnancies. Since the immune system is partially suppressed during pregnancy, pregnant women are more vulnerable to viral infections and complications of COVID-19. Therefore, COVID-19 has serious consequences for pregnant women. Iran’s Ministry of Health recommended a temporary reduction in the number of visits for prenatal care during the pandemic; to compensate for this decrease, it was replaced by telephone follow-up. Therefore, health care providers are required to follow up pregnant mothers by telephone during the time set for the face-to-face follow-up. Considering that during the pandemic, no study was conducted on the quality of perceived prenatal care in Iran, this study aims to investigate the quality of these services in Bandar Abbas city.

Methods
This is a descriptive analytical study that was conducted in Bandar Abbas, south of Iran from August 2021 to February 2022. Participants were 400 pregnant women (third month of pregnancy) referred to health centers and received pregnancy care services by phone or in person at least 3 times and had health records. Sampling was done by a quota sampling method; the samples were selected from 7 urban health centers proportional to the size of population. The data collection tools were a sociodemographic form, Heaman’s Quality of Prenatal Care Questionnaire (QPCQ), and a prenatal care delivery checklist. Data analysis was done in SPSS v. 21 software. The variables were described using descriptive statistics. Multivariable linear regression analysis with Backward method was used to determine the predictors of the quality of perceived prenatal care.

Results
The mean age of pregnant women was 28.1±5.9 years. Weight measurement was the most frequent service provided to them (96.8%), while the domestic violence screening (35%) was the least provided service. 

Discussion
The results of this study showed that more than half of the pregnant women did not have any phone calls from the health centers and they had a great intention to have in-person prenatal care visits. Not taking the Ministry of Health’s decision seriously by the health center staff and women’s lack of trust in telephone follow-ups and online services are its possible reasons. Less than 10% of women received routine care completely. More than half of them had not received oral and dental health education, domestic violence screening, smoking/alcohol/drug use screening, and sexual health education. Some of the possible reasons for low quality prenatal care are the existence of restrictions during the pandemic, the fear of infection with COVID-19, and low human and financial resources. Many health care workers in Iran, who are responsible for providing prenatal care services to pregnant mothers, were responsible for general vaccination against COVID-19; their workload increased during the pandemic which can lead to reduced prenatal care quality. Among the five prenatal service quality subscales, women obtained the lowest score in the “approachability” subscale and the highest score in the “information sharing” subscale. The approachability subscale is complementary to the respectability subscale; it addresses relationships between the caregiver and the pregnant woman. Fear of COVID-19 infection is related to a decrease in full presentation of prenatal care services. 
In addition, the fear of this disease may force health workers to refuse to provide services to pregnant mothers. In our study, low educational level and history of infertility were the predictors of perceived prenatal care quality. Women with a low literacy level usually have a low economic class and are unable to receive services from private health centers. The inability to compare the services provided by governmental and private health centers can be one of the possible reasons for higher perception of prenatal care quality. Women who had a history of infertility perceived the quality of services as low. The high sensitivity of these women and not receiving proper feedback can be the possible reasons. Since a considerable percentage of pregnant women from the middle- and low-economic classes rely on the services provided by government health centers, the high quality of prenatal care services in these centers is very important and vital. Decision makers in the health sector should make serious efforts to improve the infrastructure of online prenatal care services, training and optimal monitoring of health care providers to provide quality prenatal care services.

Ethical Considerations

Compliance with ethical guidelines
This study is taken from the approved research project of Tabriz University of Medical Sciences (Code: IR.TBZMED.REC.1400.228).

Funding
This study was done with the financial support of Tabriz University of Medical Sciences.

Authors' contributions
Sampling, preparing the original version of the article: Mari Goudarzi; Article review: Esmat Mehrabi; Sampling supervision, assistance in statistical analysis: Siddiqa Abedini; Study design: Niloofar Sattarzadeh Jahdi; Designing the study, revising and revising the article, analyzing the data and extracting the results: Sevil Hakimi.

Conflicts of interest
The authors declared no conflict of interest.

Acknowledgements
The authors appreciate the cooperation of the health center personnel of Bandar Abbas city and the mothers who participated in this research.
 

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