Radically Transforming Policy and Culture Around Childbirth in the Former Soviet Union

A transformation in maternal and infant health care has spread throughout the countries of the former Soviet Union. Outdated, rigid, and highly medicalized methods are being replaced by modern evidence-based and integrated approaches that are more responsive to women and families, achieve better health outcomes, and reduce costs. JSI has been a key player in these advancements over a decade of dramatic change. The changes have resulted in substantial reductions in maternal death from hemorrhage and in neonatal deaths from hypothermia and birth asphyxia, while greatly reducing the reliance on abortion as birth control.

Beginning in 1999, JSI supported the governments of Russia, Ukraine, Georgia, and the five Central Asian Republics (Kazakhstan, the Kyrgyz Republic, Tajikistan, Turkmenistan, and Uzbekistan) to launch pilot projects, which were massively scaled-up, to improve maternal and infant care and reduce maternal and infant morbidity and mortality. Although there was strong government commitment to improving maternal and infant health care, there were many challenges. 

Challenges

The care provided women in the former Soviet Union was overly medicalized, with ineffective and sometimes harmful interventions used instead of evidence-based practices. Women were often hospitalized during pregnancy, received many medications and tests, and spent over a week in the hospital for delivery, with no family members allowed to visit.

Another major challenge was the critical role that policy plays in post-Soviet environments, where the presumption is that things are forbidden unless explicitly authorized by law or policy. Most health workers will not implement practices that are not officially endorsed.

How change happened

Because backing from the highest government levels was critical, JSI started with discussions with ministers of health. JSI also collaborated with the World Health Organization, which facilitated the process of convincing MOHs to try the new approaches. JSI then worked to educate in-country health providers about how clinical policy and practice has evolved in other parts of world on the basis of evidence. JSI conducted many skills-building trainings for health providers. Local data collected at project sites reinforced international evidence and was especially valuable in convincing skeptics. JSI worked with the main stakeholders on new MNCH policies, practice guidelines and clinical protocols development, and overall MNCH system strengthening.

Throughout the pilot projects, JSI worked to build understanding of and commitment to the changes underway to facilitate subsequent expansion and policy changes. JSI introduced a simulation-based method of training, and helped modernize medical records and information systems. Also, JSI employed modern social marketing and health promotion to introduce the public to the new practices, both within the project areas and beyond to help spread change more rapidly. Finally, JSI worked to ensure a systematic scale-up.

What changed

National and regional policies opened the door to more family- and client-focused approaches in participating maternity hospitals. These included:

• Partner support during labor and delivery was allowed and encouraged, leading to stronger bonding between parents and infants.
• Unnecessary restrictions, including not walking, eating, or drinking during labor, were removed.
• Unnecessary and harmful practices, including routine enemas, frequent episiotomies, and pubic shaving, have ended.
• Private, more homey birthing rooms are used for delivery when possible.
• Mothers are taught to start breastfeeding immediately after birth and babies now stay with the mother.
• Most importantly, women are now counseled on their choices rather than having health professionals making all the health decisions.