Country: Croatia
Health Topic: Pregnancy Care
The World Health Organization declared Croatia as having a relatively low birth rate at 9.3/1,000, a total fertility rate of 1.5 per woman fifteen to forty-nine years old, a moderate death rate at 12.0/1,000, and a life expectancy at birth of seventy-six years for both sexes (Urelija). These four sociodemographic characteristics suggest that there are currently more deaths occurring than there are deliveries. Croatia has a unique, universal healthcare system that specifically allows all pregnant women, regardless of their insurance or residence status, to receive free prenatal care. Patients who have received this care, however free it may be, have spoken out about undergoing unnecessary dangers and even encountering obstetric violence in the process.
“According to the World Health Organization, countries with a c-section rate higher than fifteen percent put women’s lives at risk” (Morris). Croatia, with a c-section rate of seventeen per 100,000 live births, is, unfortunately, one of those countries. Also, many pregnancy-related procedures that take place have reportedly refused the use of any anesthetic. These procedures include biopsies, medically-assisted fertility, curettage, the sewing repairs of tears after vaginal childbirth, and episiotomies (Twigg). Instead, the use of force and/or restraint during such invasive procedures are commonly reflected in patient testimonies. Survivors of obstetric violence have joined with Roda, Parents in Action, to create a campaign to advocate for this important health issue called #BreakTheSilence, which is similar to both the #MeToo and #TimesUp movements.
From a cultural standpoint, this kind of violence against women is not something that is considered new. A history of inequality towards Croatian women has been evident for centuries. The concept of feminism is up and coming though, as more and more women are starting to share their stories and join together in mutual protest. If multiple patients are experiencing the same mistreatment during their pregnancy care at different facilities, the culture of the entire institution is problematic. With recent media coverage shedding even more light on the subject, the Croatian Health Ministry has promised to send health inspectors to any hospital mentioned by survivors (Vladisavljevic). Hopefully, these results come with new, innovative solutions or renderings to the current system and offer free violence and trauma counseling to all those previously affected.
From a public health standpoint, such gaps in progress show pathways for potential improvement. “There’s a whole lot more that needs to be done in that area” (Lecture 4.1). Faculty and clinician education about violence and trauma should be deemed mandatory. If the intentions of public health are to provide benefits to the majority of people, and every single person is born via a woman, women should be equally represented in the healthcare system. Compliance with the Respectful Maternity Care Charter should be upheld as well (Vladisavljevic). Moving forward, all patients in the Croatian healthcare system should be both informed and given the opportunity to properly grant consent before any medical procedure takes place. Also, forms of anesthetic should be available for intense procedures upon advancing technologies. If there is a lack of technicians qualified to administer such pain-relief, other medical professionals should be trained to fill-in that position.
References
Morris, T. (2016). Cut It Out: The C-Section Epidemic in America. New York, NY: New York University Press.
Twigg, K. (2019, January 11). Croatian Women Challenge Brutal Pregnancy ‘Care’. Retrieved from https://www.bbc.com/news/world-europe-46803178.
Urelija Rodin, Boris Filipović-Grčić, Josip Đelmiš, et al., “Perinatal Health Statistics as the Basis for Perinatal Quality Assessment in Croatia,” BioMed Research International, vol. 2015, Article ID 537318, 9 pages, 2015. https://doi.org/10.1155/2015/537318.
Vladisavljevic, A. (2018, November 08). Violent Treatment During Childbirth: Croatian Women Speak Out. Retrieved from https://www.healthynewbornnetwork.org/blog/violent-treatment-during-childbirth-croatian-women-speak-out/.