Travel restrictions35

Lack of ambulances27 30

Quarantine and travel restrictions33 35

Insufficient staffing (absenteeism, abandonment, transfer and/or death related to EVD)21 23 24 27 30–32 36

Unqualified, traditional HCWs3 30 31 33–35

Facility closures, reduced hours3 22–24 27 28 34 35

Waiting time increased with EVD testing23 27 29 32

Resource diversion and scarcity3 20 23 24 26 28 30 31 35 36

EVD screening difficulties23 28 32

Exclusion of pregnant women from services27 31 34

MHS reduced, suspended, discontinued or unavailable13 23 24 26–31 34 35

Late or no referral27

HCW fear of EVD3 20 24–31 35 36

Absent, insufficient or delayed training on EVD and infection control3 20 24–26 30 31 35

Clinical guidelines absent, unclear, impractical29

Lapse of support to traditional birth attendants and community health workers for MHS referrals35

Rumours regarding EVD and the intentions of HCWs and other EVD responders3 24–30 32 35 36

Informal fees31

Shift from public to private facilities due to fear of EVD in the public sector3

Rumours that MHS are no longer free27

Staff mistrust of pregnant women27

Worsened interpersonal skills among HCWs31

Community fear and/or mistrust of facility-based HCWs and health facilities3 24–28 30–36

Preference for/increased traditional, community-based care3 30 31 33–35

Stigmatisation of HCWs, pregnant women and EVD20 24 29 31 33

No touch policy27 31 35