BACKGROUND:
Monitorization of the quality of maternal and neonatal care (QMNC) in Portugal is relevant, a country that is facing systemic challenges within the National Health Service in the last year, affecting particularly the obstetric and pediatric services.

OBJECTIVES:
Compare women's perspectives on the QMNC around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal.

METHODS:
Women participating in the cross-sectional IMAgiNE EURO study completed an online structured questionnaire with four domains of QMNC: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region.

RESULTS:
Among the 1,845 participants, one in three (33.7%) had a cesarean birth. Several indicators reflected good-quality care, including low rates of missed early breastfeeding (8.0%), limited absence of rooming-in (7.7%), and minimal reports of informal payments (0.7%). Staff professionalism (94.6%), and the comfort and equipment of birthing rooms (95.2%) is highly rated. Still, important challenges and regional differences were evident in several aspects. Among those who labored, rates of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in the Center. The use of fundal pressure varied widely—from 34.8% (Lisbon) to 66.7% (Center). Episiotomy was performed in 39.3% (range 31.8% North – 59.8% Center) of non-instrumental vaginal births. One in four women (26.1%) reported not receiving adequate breastfeeding assistance (range 19.4% Algarve - 31.5% Lisbon). At discharge, 22.1% of babies were not exclusively breastfed (range 19.5% Lisbon - 28.2% Algarve).

CONCLUSIONS:
Urgent actions are needed to reduce inequities and promote women's rights and respectful care around the time of childbirth.

KEY MESSAGE:
Improving and harmonizing QMNC and reducing inequities across regions in Portugal is relevant Data collection (including three-minute presentation competition)