The World Health Organization (WHO) considers respectful maternity care (RMC) to be based on the principles of universal human rights [1]. The WHO define RMC as “care organised for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth” [1]. In the United Kingdom (UK), the National Health Service (NHS) England Better Births maternity review emphasises the need for both safety and personalisation in maternity and neonatal care [2]. Safe care is more than good perinatal outcomes: it also includes the importance of women having choices and making decisions based around their personal circumstances, values, social norms, and needs [2].

The coronavirus (COVID-19) pandemic has impacted health care capacity worldwide, including maternity and neonatal care. At the beginning of the pandemic, there was uncertainty about the effect of COVID-19 infections on perinatal health outcomes, and actions were taken to protect pregnant women and babies [3, 4]. Changes in maternity care provision were made to reduce infection rates and to protect maternity and neonatal care capacity [5]. These changes included switching to online and telephone consultations, limiting birth partner companionship, and ensuring extra hygiene precautions during breastfeeding for COVID-19 positive mothers [5]. While it can be considered acceptable to limit some rights to contribute to security, safety, and emergency resource management [6], some of the changes have raised fierce opposition [7]. Complaints have been made about restrictions in women’s birth choices, and about women being alone during labour or while attending potentially highly sensitive appointments (i.e. anomaly scans). For some, this has been seen as a direct violation of women’s rights [8].

The UK and the Netherlands (NL) are European countries with similar social structures and norms, comparable maternity care systems, and, by population size, experienced similar numbers of COVID-19 infections. In principle, therefore, they should not differ drastically in the way they balance human rights in the areas of safety and personalisation in maternity care [9]. However, key differences in maternity and neonatal services organisation have been noted, particularly in terms of rules about companionship during labour and birth, and accessibility to community maternity care provision [5].

This paper reports on the findings from a multi-method study that was undertaken to compare the UK and Dutch COVID-19 maternity and neonatal care responses. We considered that an understanding of why and how similarities and differences occurred in similar health and social contexts could help inform how to optimise maternity and neonatal care in future, both in normal circumstances, and during future crises. Therefore, our research question was: how and why did maternity and neonatal care policies adapt to the COVID-19 pandemic in the UK and the NL?