There are two major social determinants of health that affect the pregnancy care of women in Croatia, and those are socioeconomic status and gender inequality.
Poverty, along with a lack of quality medical care, is directly correlated with socioeconomic status, for the mothers who obtain adequate resources during labor, such as the use of anesthetics, are socially [pre]determined (Marmot). There are not enough properly trained anesthesiologists in Croatia to administer anesthetics to every mother preparing to give birth. Instead, many doctors will resort to unorthodox methods of pregnancy care that have been declared violent and trauma-inducing. “Poor circumstances during pregnancy can lead to less than optimal fetal development via a chain that may include deficiencies in nutrition during pregnancy, maternal stress, a greater likelihood of maternal smoking and misuse of drugs and alcohol, insufficient exercise and inadequate prenatal care” (Wilkinson). A low socioeconomic status can spark a chain reaction that’s results negatively impact both mother and newborn.
Gender inequality is, unfortunately, a catalyst in Croatia’s social issue of violent pregnancy care, for men cannot give birth, so only women are able to share their experiences. Roda, or Parents in Action, has been working closely with survivors to advocate for a change within the ministry of health. They have received over four hundred letters from women who could attest to traumatic events that occurred during their pregnancy care (Violent Treatment During Childbirth: Croatian Women Speak Out). With no response still from the ministry, Roda decided to take matters of the affair into the hands of the UN. Three complaints were made in regard to obstetric violence in Croatia: special rapporteur for violence against women, special rapporteur for the right of health, and a working group on the issue of discrimination against women in law and in practice (Drandić). There has yet to be a formal investigation; however, more media and news outlets are covering the story.
“For public health professionals to use the political arena effectively, they must not only have a basic understanding of how politics works but also know what the impact of politics on population health has been in the recent past” (Mackenbach). With realistic expectations, one would note the third complaint, a working group on the issue of discrimination against women in law and practice, and understand that not many women in Croatia have the power to make political changes. This is another example of gender inequality but from a higher-up socioeconomic position. The Croatian Health Minister, Milan Kujundzic, has yet to make any policy changes after being frequently criticized for numerous mistakes, and the omissions of those mistakes, made by the healthcare system, and yet he remains in his position (Violent Treatment During Childbirth: Croatian Women Speak Out). The ministry said they would lead inspections of medical care facilities, but have not published any results or any kind of evidence of the supposed inspections. Instead, victim-blaming has become the most popular response for leaders in some of the most important Croatian healthcare institutions and professional organizations (Drandić). These two social determinants of health, socioeconomic status and gender inequality, have left women feeling scared and helpless, and could potentially affect the entire population of Croatia by women no longer wanting to give birth in these violently, unchanging conditions.
References
Drandić, D. (2018). Complaints sent to UN Bodies on Obstetric Violence in Croatia. Roda. Retrieved from http://www.roda.hr/en/reports/complaints-sent-to-un-bodies-on-obstetric-violence-in-croatia.html
Mackenbach, J. P., (2014). Political Determinants of Health. European Journal of Public Health. Retrieved from https://drive.google.com/file/d/1Ta6F0CX9dCURi9VW_-Bcc1HEIB-fhlmK/view
Marmot, M. (2005). Social Determinants of Health Inequalities. Public Health. Retrieved from https://drive.google.com/file/d/1bct-CtOGaE-NCBdQUDE11L9x1n4Riotk/view
Violent Treatment During Childbirth: Croatian Women Speak Out. (2018). Healthy Newborn Network. Retrieved from https://www.healthynewbornnetwork.org/blog/violent-treatment-during-childbirth-croatian-women-speak-out/
Wilkinson, R. & Marmot, M. (2003). Social Determinants of Health: The Solid Facts. World Health Organization. Retrieved from https://drive.google.com/file/d/1ubK2nSOuNnZS9X5vvt7C7rwqQq370tnh/view