MODEL MATERNITY HOSPITAL

Region+ has written many times about the annual increase in infant mortality levels in Azerbaijan, quoting figures from the State Statistics Committee. In 2006 1,508 children died below the age of one (in 2004 1,287 and in 2005 1,321). Another key indicator of the health of the nation is maternal deaths (the number of deaths of women during pregnancy or childbirth for every 100,000 live births). In 2003 the figure was 18.5, in 2004 25.8, in 2005 28.9 and in 2006 34.2. 

The midwifery and gynaecology research institute also observes an upward trend in child mortality. Institute director Faiza Aliyeva said that child mortality in the perinatal period had increased (from 28 weeks into a pregnancy to four weeks after birth) which includes neonatal (birth plus 27 days) mortality. Perinatal mortality is formed from neonatal, when babies die within the first seven days after birth. She said that in Azerbaijan 93.9 per cent of neonatal deaths occur in the first days after birth.

A Health Ministry collegium discussed child mortality in the country in February 2008. Negative instances in many maternity hospitals were mentioned. Health Minister Oktay Siraliyev said it was essential to eliminate maternal and infant mortality and not to allow home births when the country's medical institutions had capacity. 

The Azerbaijani government is today doing its utmost to improve infant and maternal mortality in the country. Four of the nine state health programmes are devoted to protecting the health of mothers and children. Implementing these programmes is what is most important.

Childbirth European-style

An agreement was signed in April between the United Nations' Children's Fund (UNICEF) and the Norwegian company StatoilHydro on cooperation in a project to support the Azerbaijani government in reducing infant mortality and improving healthcare for mothers and children.

The project envisages introducing in four pilot maternity hospitals the latest international standards and methods in caring for newborns in order to reduce neonatal mortality.

The pilot maternity hospitals will serve as model "baby friendly hospitals", where husbands or other relatives will attend births, use of medicines will be kept to a minimum, breastfeeding will start sooner, mothers and babies will stay together and the latest recommendations on intensive care for newborns will be followed. The project is also to draw up national protocols and guidelines for the care of newborns. Medical staff who have been trained as part of the programme will continue training throughout the country.

The head of UNICEF's office in Baku, Hana Singer, said at a reception to mark the event that UNICEF works closely with big, medium-sized and small businesses across the world, building alliances to help children. "We hope that our partnership with Norwegian company StatoilHydro in Azerbaijan will promote the welfare of children in the country," Hana Singer said. "We expect our joint project to help reduce child mortality and create an atmosphere of care for mother and child in the health care system and also to inspire other representatives of the private sector to work for the sake of children."

UNICEF is hoping that cooperation on the project with the Ministry of Health will help to improve the care of newborns. The new methodology and practice in four pilot maternity hospitals will certainly help to improve health care for mothers and children. "This project must have a positive influence on the health of many families over the long term," Hana Singer said.

For his part, the head of the StatoilHydro representative office, Christian Hausken, said that the company is ready to give initial support to the project for two years and thanked UNICEF for the opportunity to get involved.

Asked about child mortality in Azerbaijan, Hana Singer said that UNICEF and the Health Ministry had different figures but the publication of the results of the Demographic Health Survey carried out in 2006 by the government with the support of UNICEF and USAID would help to clear things up. But she said that while the figures on child mortality used to make her "pessimistic", the work done in this regard in the last two years by the Health Ministry makes her optimistic.

"I understand the impatience of the media but they need to wait another month for the results to be published," the head of UNICEF in Baku said. "However, it has to be said that things are moving more quickly in this area in the other CIS countries. I would very much like to hope that work in this area in Azerbaijan would be speeded up."

Dream maternity hospital

Attempts have already been made in Azerbaijan to introduce "baby friendly hospitals" on the basis of the existing maternity establishments. Last year a similar project was launched within social action scheme Childbirth with Dignity (Dogru dogrusa dogru - DDD) of the Polish-Azerbaijani Other Space Foundation. Narmina Khebanovska, the fund's representative in Azerbaijan and the head of two social projects in the country, said the Azerbaijani Health Ministry had given every support to the project to create motherhood schools in the country. 

DDD's aim is to carry out reforms in the obstetrics system, making use of European, in particular Polish, experience in this sphere, Narmina Khebanovska said. Schools of childbirth and motherhood will be set up on the basis of the maternity hospitals and women's medical centres and will provide lactation advice and information about the importance of active births. "The situation in the obstetrics system in Azerbaijan and recommendations of the World Health Organization and UNICEF were the reason for the DDD campaign. The project is based on successful experience in similar programmes in Poland. Childbirth with Dignity is a public campaign which has used the potential of thousands of women."

The organizers of the initiative, who were just a few dozen people, managed to create a mechanism through the mass media which women could use to change the situation in the country. The action was successful thanks not only to the organizers - the foundation's working group - but also to thousands of women who shared their experience in questionnaires and letters. Many doctors and midwives responded to them and this led to beneficial changes for women in maternity hospitals. Family birth appeared - in the presence of loved ones - and hospitals opened to visitors. Most important, in the first year of the project in Poland the figures for mother and infant mortality fell considerably.

The DDD action uses public opinion, that is, the media and general public, to influence conditions in maternity hospitals and the attitude of staff towards mothers and their families and to find out what has to be changed.

Khebanovska said that similar schools operated in the Soviet period on the basis of the maternity hospitals. "They just need to be revived and this is not such an expensive project, although donors are of course necessary. What's most important is that society take an interest in the process," Narmina Khebanovska said.

The head of a working group of the Other Space Foundation, Sahla Ismayilova, said that research entitled Transformations in the Region had been carried out as part of the project together with the WARD organization, the Women's Association for Rational Development, in Azerbaijan. 

"We took as our goal reducing the level of mother and infant mortality in Azerbaijan. Every pregnant woman should receive general natal care and have access to it; she should be aware of her rights and insist that they be kept," Sahla Ismayilova said. The project also aimed to make the health services take account of the demands of women and their families, to base medical practice on the results of scientific research and to put the proposals of the World Health Organization into practice in maternity hospitals. The research revealed that laws passed in Azerbaijan only partially ensure the rights of mothers and children as recommended by the WHO. "There is practically no free care which should be provided for pregnant women and mothers. The cost of giving birth in the capital varies from $400 to $1,200, not to mention the cost of medicines and care from a doctor and midwife. This is the result of the low salaries of medical personnel. Interestingly there is no list of the rights of the patient in Azerbaijani maternity establishments. These lists are displayed in almost every European hospital for use by patients and medical staff alike. Our maternity hospitals are closed institutions. Relatives are not allowed to attend a birth."

The quality of natal care depends on the financial situation of the patient, for example, if she is able to pay for painkillers during childbirth, etc. In most cases doctors do not inform mothers and their relatives about how the birth will be conducted, what medicines will be used and do not ask permission for a variety of procedures. All this is a consequence of the lack of a statement of rights of patients in maternity hospitals and wards which would provide information on rights and responsibilities. They do not exist in our country and often mothers do not know their rights or how to act in a given situation.

UNICEF has been carrying out its Action on Breastfeeding programme for more than 10 years. Most of the country's maternity hospitals have joined the UNICEF Baby Friendly Hospitals initiative. Thanks to this initiative, mothers and newborns have been kept together in recent years in health care institutions. However, according to UNICEF statistics only one in 10 babies up to the age of three months are fed exclusively with mother's milk. At the same time the law on Feeding Babies and Young Children obliges medical institutions, regardless of ownership, to inform pregnant women and mothers about the importance of breastfeeding. This is not always done everywhere. As a rule, a baby is first fed two hours after birth at best although the principle of skin on skin is already applied but most likely only symbolically. Straight after birth a baby is taken away for examination.

Azerbaijan has not yet taken on any obligations on obstetrics before international organizations (WHO, UNICEF, UN). Not one recommendation of the WHO, UN Population Fund and UNICEF on obstetrics has yet been legally formulated, but UNICEF's representative in Azerbaijan hopes that this will happen in the near future.