Miteniece Elina, Pavlova Milena, Rechel Bernd, Kabakchieva Margarita, Zuza Irina, Radu Ilinca, Groot Wim
Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK.
Birth. 2023 Mar;50(1):205-214. doi: 10.1111/birt.12693. Epub 2022 Nov 21.
Eastern European health system indicators (e.g., number of health workers and care coverage) suggest well-resourced maternity care systems, but maternal health outcomes compare poorly with those in Western Europe. Often, poor maternal health outcomes are linked to inequities in accessing adequate maternal care. This study investigates access-related barriers (availability, appropriateness, affordability, approachability, and acceptability) to maternity care in Romania, Bulgaria, and Moldova.
This cross-country study (n = 7345) is based on an online survey where women who received maternity care and gave birth in 2015-2018 in Bulgaria (n = 4951), Romania (n = 2018), and Moldova (n = 376) provided information on their experiences with the care received. We used regression analysis to identify factors associated with accessing maternity care across the three countries.
Results show high rates of cesarean births (CB) and a low number of antenatal and postnatal care visits. Informal payments and use of personal connections are common practices. Formal and informal out-of-pocket payments create a financial burden for women with health complications. Women who had health complications, those who gave birth by cesarean, and women who gave birth in a public facility and had fewer antenatal check-ups, were more likely to describe facing access-related barriers.
This study identifies several barriers to high-quality maternity care in Romania, Bulgaria and Moldova. More attention should be paid to the appropriateness of care provided to women with complicated pregnancies, to those who have CBs, to women who give birth in public facilities, and to those who receive fewer antenatal care visits.
东欧的卫生系统指标（如卫生工作者数量和医疗覆盖范围）表明其孕产妇保健系统资源充足，但孕产妇健康结果与西欧相比却较差。通常，孕产妇健康结果不佳与获得充分孕产妇保健服务方面的不平等有关。本研究调查了罗马尼亚、保加利亚和摩尔多瓦在获得孕产妇保健服务方面存在的相关障碍（可及性、适宜性、可负担性、可接近性和可接受性）。
这项跨国研究（n = 7345）基于一项在线调查，2015 - 2018年在保加利亚（n = 4951）、罗马尼亚（n = 2018）和摩尔多瓦（n = 376）接受孕产妇保健服务并分娩的女性提供了她们接受保健服务经历的相关信息。我们使用回归分析来确定这三个国家中与获得孕产妇保健服务相关的因素。
结果显示剖宫产率较高，产前和产后检查次数较少。非正式付费和利用私人关系是常见做法。正式和非正式的自付费用给有健康并发症的女性造成了经济负担。有健康并发症的女性、剖宫产分娩的女性、在公共机构分娩且产前检查较少的女性，更有可能表示面临与获得服务相关的障碍。
本研究确定了罗马尼亚、保加利亚和摩尔多瓦在高质量孕产妇保健服务方面存在的若干障碍。应更加关注为患有复杂妊娠的女性、剖宫产女性、在公共机构分娩的女性以及产前检查较少的女性提供的保健服务的适宜性。
