Background COVID-19 affected adverse birth and pregnancy outcomes (ABPOs) both directly through infection risks, and indirectly through lockdown restrictions which affected socio-environmental determinants of ABPOs, such as access to healthcare, social support, and lifestyle. Periods of lockdown were associated with increased rates of maternal depression, and decreased rates of premature birth. The impact of lockdowns was unequal between advantaged and disadvantaged subgroups and needs to be explored at an individual level so strategies and structures can be developed to reduce ABPOs and inequalities in the future.

Aim To explore the underlying mechanisms and enduring impact of lockdowns on ABPOs and perinatal experiences in England, through semi-structured interviews with individuals who were pregnant or gave birth during lockdowns.

Methods This study recruited individuals who were pregnant or gave birth in England during periods of lockdown restrictions in 2020-2021. Recruitment was network-based and used a combination of public and patient involvement & engagement (PPIE) groups, community centers, and maternity charities and organizations, to recruit and purposively select a diverse sample of participants. Semi-structured interviews were conducted via video-conferencing software with translators for non-English speaking participants. Interviews were recorded, transcribed, and reviewed for accuracy. Transcripts underwent Grounded Theory Analysis using the constant comparative method in NVivo. Themes will be co-produced with PPIE members, and in the theorization of themes, Feminist and Inter-phenomenological lenses will be used.

Results 38 participants each took part in 1 hour-long semi-structured interviews. Participants included a variety of backgrounds, ABPOs, and experiences from across England. Thematic analysis is almost complete, with the validation of themes currently underway. The final stages of thematic co-production and theorization are set to be completed in April - May of 2024. Themes that are emerging from the data indicate lockdowns have an enduring impact on maternal health and experiences of birth and pregnancy. These can be described in three core areas: 1) limited and inconsistent access to quality maternity and perinatal mental health services, 2) maternal mental illness and formations of maternal identity in the context of unaddressed trauma, and 3) access to social support and management of childcare in changing workplace environments and policies.

Our findings outline the mechanisms through which lockdowns impacted and continue to impact maternal experiences and ABPOs. They demonstrate that an umbrella lockdown approach has unequal consequences for ABPOs, and targeted policies and tailored support structures are warranted to achieve and sustain equity in perinatal experiences long-term.