As Russia grapples with its demographic crisis, the government has identified improving healthcare at state maternity clinics as a key priority.

Officials insist there have been some successes, of course - but without extra funding and a more modern attitude towards childbirth, experts fear that help will be too long in coming.

The government has pledged to spend 1.6 trillion roubles by 2016 on improving the birth rate, and last year 1.79 million babies were born in the country. Since 2006 the birth rate has increased by 23 per cent, Deputy Prime Minister Alexander Zhukov reported last week, while in the last five years infant mortality among newborn babies fell by 32 per cent, and deaths of women in childbirth have fallen by 13.4 per cent.

As part of the improvements, some 20 modern prenatal centres will open in Russia this year, and up to 460 billion roubles will be spent from the federal budget on regional healthcare programmes, most of which is to be spent on children’s healthcare. But Zhukov acknowledged that big problems still lie ahead.

“Two-thirds of Russian maternity clinics need refurbishment and retraining of medical staff,” Zhukov told a National Forum on Children’s Healthcare last month. 

Going abroad

With confidence still lacking in maternity care, many wealthy and middle-class Russians still head abroad to give birth in Western clinics, as the quality of service at local maternity hospitals lags far behind maternity hospitals abroad, critics say. 

A key problem is the bribe culture in many maternity clinics, which is so widespread that Russian women are used to the fact that to get better service, it’s often necessary to bribe doctors and nurses.

And women say that, apart from a paid birth plan with a separate hospital room and improved service, the basics of maternity healthcare haven’t changed much since Soviet times.

Changing attitudes

However it’s now possible to get Western-style healthcare service in Russia. Ten years ago a healthcare programme called the Maternal and Child Health project (Мать и дитя) was launched jointly with USAID in two areas and later spread to 20 Russian regions. 

The programme includes training on how to give a woman psychological support without interfering in the process. Also she can have relatives and a partner near her during childbirth.

The traditional Russian methods of assisting in childbirth, where a woman is told what to do and is treated almost like she was on a factory-style conveyer belt, are slowly being replaced with a more modern attitude, experts say. 

“Gone are the days when mother and child were kept separately and a husband could only communicate with his partner by shouting through the hospital’s windows. This Maternal and Child Health Project allows a more comfortable more and homely attitude,” said Anna Karpushkina, deputy general director at Institute for Family Health.  

The town of Cherepovets in northern Russia was the first to join the innovative programme. At the outset the novelty was not welcomed by women patients, but after several months the maternity clinics which introduced the new approach won over admirers.

“We have changed the traditional Russian approach to the service of assisting in a child’s delivery. Now we don’t dictate to a woman what to do but give her full support,” said German Myasnov, chief doctor at a Cherepovets maternity clinic.

Funding reforms

Myasnov’s clinic at Cherepovets is benefiting from treating more women due to a system of funding clinics per number of births, which was introduced in 2007. Since then state funding all is paid to a maternity hospital for each client, and a woman is free to decide which one to choose. 

Antenatal clinics get a total of 3,000 roubles for each patient, while maternity clinics receive 6,000 roubles.

This “makes maternity clinics improve the quality of care and we can now see more rivalry for clients,” said Karpushkina.  

Help from USAID

Benefits can be seen from the expanding cooperation between Russia’s Health and Social Development and USAID, which is one focus of the Health Working Group in the Russia-US Bilateral Presidential Commission. 

USAID currently supports five maternity healthcare projects throughout Russia, including in the Urals, North Caucasus and Central Federal districts.

“While the overall situation in the country is improving, many regional maternity facilities do not have the resources to provide the same level of care as some of Russia's state-of-the-art maternity hospitals,” said William Slater, Director of Health Department at USAID in Russia. “USAID-supported programs are aimed at decreasing maternal and infant mortality, a decrease in abortions, and improved clinical practices at the regional level.” 

In another initiative due to start later this year, a partnership of US and Russian healthcare organisations will set up a free messaging service, “Text4baby” to provide mothers and mums-to-be with healthcare information. The scheme will be subsidised by Russian mobile operators

Home births?

Some women are so deeply discontented with current conditions at maternity clinics that they opt to give birth somewhere else, including at home. The Institute for Family Health strongly advises against this, saying it seriously endangers the health of both mother and child. And, without medical help available on the spot, any problems with the delivery could be far more dangerous - particularly given the slow ambulance response times common in Russia.

But those warnings did not stop Anastasia Melentyeva, a mother of two, giving birth to both her children at home to avoid a noisy and unpleasant atmosphere and rude service at a Russian maternity house, she said.

“My husband and I decided that I would give birth at home because we think this process is very intimate, and for a woman it causes too much stress to stay away from home,” said Melentyeva.

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