A government decree in Armenia that bars pregnant women who are not residents of Yerevan from receiving free childbirth services in the capital is causing discontent in outlying regions.
In a bid to boost population numbers, the state covers the costs for childbirth services in Armenia. Seeking better facilities and medical personnel, pregnant women from the regions often travel to Yerevan to give birth. In 2012, 64 percent of the 70,648 women registered for state-provided childbirth assistance gave birth in Yerevan, according to the National Statistical Service.
The May 1 decree issued by the Ministry of Health was designed to encourage improvements at hospitals in the country’s 10 regions. Under the measure, women will only be able to obtain state-paid birthing services at hospitals in regions where they have an official address.
Health Minister Derenik Dumanian, the author of the decree, maintains that budgetary funds to improve care at public hospitals in regions will be forthcoming. The government currently pays 135,000 drams ($329) per delivery in Yerevan hospitals, and 97,000 drams ($236) at facilities in rural locations.
“One-third of the pregnant women from the regions come to Yerevan to give birth; hence, the money designated for rural hospitals is transferred to hospitals in Yerevan, leading to reduced financial resources in the regions, as well as an outflow of professionals from rural communities to Yerevan,” Dumanian told EurasiaNet.org.
Despite government assurances, some pregnant women from rural areas remain wary about the decree. Thirty-three-year-old Gohar Minasian, an expectant mother living in Abovian, 16 kilometers outside of Yerevan, fears the consequences of giving birth in her local hospital. In 2011, she noted, an Abovian anesthesiologist’s mistake led to the death of a pregnant woman from heart failure. “If this had been in the capital, under the supervision of skilled professionals, both the mother and the child would have survived,” Minasian claimed, without providing supporting details.
Under the decree, pregnant women from the regions will still be able to receive free medical care in Yerevan in emergency situations. The health ministry’s chief obstetrician-gynecologist, Razmik Abrahamian, insists that pregnant women in most of Armenia’s regions already have access to adequate care.
“If a few years ago we did not have rural maternity hospitals with modern facilities and it was understandable why they had to come to Yerevan, now six out of the 10 regions have fully equipped hospitals, but people keep coming to the capital out of habit,” Abrahamian said. “The new decree will make them at least familiarize themselves with the facilities and conditions available at their new local hospitals, and only then make a decision.”
Independent MP Edmon Marukian, who strongly opposes the decree, argues that it could end up fueling corruption. “If there are exceptions [made to the decree] for high-risk births and [women] will be sent to deliver in Yerevan, it is quite possible that women with a normal or no-risk pregnancy might bribe someone into getting permission to give birth in Yerevan,” reasoned Marukian, who represents the northern region of Lori. “Or a pregnant woman from a rural community might be in Yerevan and need to give birth, but a hospital might check her in only in exchange for money.”
Abrahamian dismissed corruption concerns, promising close supervision of the decree’s implementation. All hospitals have a ministry hotline number by which they can report attempted bribery, he added. “Let them call and everyone will be punished.”
Based on infant mortality statistics alone, the regions might appear a better choice to give birth than a hospital in Yerevan. In 2011, the latest year for which data is available, the capital recorded 118 infant deaths, the highest level in the country. But Abrahamian maintained that 70 percent of those deaths were of children born to women from the regions, where, he claimed, public knowledge of prenatal care is spotty.
Nationwide over the past decade, the number of infant deaths has declined steadily. From 2006-2012, the number of infant deaths per 1,000 live births dropped by half to 12. The maternal mortality rate also has fallen to a just a handful, compared with as many as 35 per year a decade ago.
Senior regional hospital staffers say public perceptions of medical care in the regions still lag behind the statistical evidence. For example, in Artashat, a town 29 kilometers southeast from Yerevan, the birthrate at the local hospital has fallen by 50 percent since 2008, when the state began paying for childbirth services.
“Our conditions are good, too, the medical personnel are highly professional, but we cannot compete with the hospitals in the capital equipped with the newest facilities,” said Dr. Zemfira Navasardian, head of the Artashat hospital’s obstetrics and gynecology department.
Obstetricians who earlier moved to Yerevan for work may now be tempted to return home, hospital executives said, but that process requires time. In the meantime, some Armenian women are not willing to wait. Barred from state-funded childbirth in Yerevan, Minasian, a kindergarten teacher, is saving to pay for the services herself.
Gayane Abrahamyan is a freelance reporter and editor in Yerevan.