Reducing Stillbirth: Interview with Georgia’s MoH Health Department Head

During a sermon at the beginning of July 2015, Georgian Patriarch Ilia II stressed the issue of mother-child care and claimed that the number of stillbirths has increased in Georgia. The Patriarch thanked Health Minister Sergeenko for his support but also requested him to pay more attention to the issue. Wanting to find out more, Georgia Today met Marina Darakhvelidze, Head of the Health Department at the Ministry of Labor, Health and Social Affairs of Georgia.

Q: Ms Darakhvelidze, during one of his recent sermons, the Patriarch preached about the increased number of stillbirth cases in Georgia. Just how severe is the problem?

A: Stillbirth is one of the most problematic issues of maternal and child health, linked to the quality of perinatal care in medical facilities. Since 2013, the Ministry has been working on a maternal and child death warning system which enables us to take each case of death for periodic analysis of the structure and cause.

Yet based on current statistics, child mortality rates have actually reduced. In particular, Georgia has been able to reach the 4th Goal of Millennium Development, as, in 2014, infant mortality was 9.5% while under-five child mortality rate 10.9% (out of 1000 lives).

According to the 2012 record, the ratio of stillbirths was 11.9 but in 2013 it was 10.6, so we see a significant reduction. The 2014 record shows the same figures as 2013. As for 2015, the stillbirth ratio, based on the first half of 2015, was 10.0 - again very reduced compared to the previous years’ first six months data. As it was 10.3% in 2013 and 11.5% in 2014, it means that stillbirth has so far decreased by 13% in 2015.

Despite this progress, the ministry believes that a lot is still to be done in this direction.

Q: Is stillbirth more common in the capital or in the regions?

A: The vast majority of cases of childbirth (about 99%) were observed in medical facilities and, based on the available data, we can say that 52% of cases of fetal mortality of 2015 have been observed in Tbilisi medical clinics, and the remaining 48% in the regions, though we should consider the fact that the referrals of complicated cases from the regions are dealt with in Tbilisi hospitals.

Q: Who is responsible for the deaths of unborn children: the mother or the doctor?

A: There may be many reasons behind fetal death, which may be related to the quality of care provided at a medical institution and to the heath and awareness of the woman carrying the child.

Averting or mitigating pregnancy-related risk factors is possible if both the adequate medical assistance and the correct awareness of expectant mothers is present. Expectant mothers should bear in mind several factors that have a direct impact on their pregnancy. In such cases, the proper planning of pregnancy and the proper management of pregnancy significantly diminishes the chances of negative outcomes.

The dynamics in the past years reveals that the number of mothers registering with medical facilities in the first 13 weeks of pregnancy (antenatal visits) has increased. However, according to the statistics in recent years, the number of women showing up for all four mandatory antenatal visits is quite low, at 84 percent. Since a number of risk factors related to pregnancy and childbirth are identified by the second and subsequent visits, we may conclude that expectant mothers are unknowingly facing high risks and they may develop a range of problems related to pregnancy, childbirth, and postpartum recovery. Notably, abstaining from antenatal visits may be due to such factors as women’s insufficient awareness about the importance of these visits and/or poor medical services at women’s consultative medicine centers.

In addition, equally important are behavioral risk factors, such as smoking, alcohol and drug abuse, which pose a serious threat to pregnant women.

Q: How does the Ministry of Health (MoH) intend to prevent said facts? Is there an action plan?

A: The health of mothers and children is the most important issue in any country, and relevant indicators define the effectiveness of the healthcare system. This is exactly why, since 2013, the　Maternal and　Child Health Coordinating Council has been operating at the MoH, made up of employees of the ministry’s structures, representatives of international organizations and professional associations, and leading experts in the field. The Council is chaired by the Minister. The structure and reasons for maternal and child death are periodically analyzed at the meetings of the Coordinating Council, and the opinions and recommendations of experts define interventions implemented by the Ministry in order to ensure better healthcare for mothers and children.

As a result of the work of the Council, the issues of caesarian ( C ) sections and the artificial termination of pregnancy have been regulated. In particular, C-section guidelines and protocol were developed, strictly defining a list of cases requiring a C-section. A package of regulatory mechanisms for abortion was also developed, practically regulating all previously unsolved issues related to abortion.

Based on the analysis of cases reviewed by the　Maternal and　Child Health Coordinating Council and taking into account international experience, the regionalization of perinatal services has already begun in Georgia, stemming from the concept for the regionalization of maternal and child healthcare services developed by USAID/JSI. The regionalization of perinatal services seeks to provide pregnant women, mothers, and newborn children with access to quality, safe, and timely care before, during, and after childbirth. This process is based on defining the levels of perinatal services, and it ensures the identification of functional ties between different levels, which, in case of complications, is the foundation of a timely and adequate referral of patients to a relevant facility. It is a very complicated and dynamic process, the proper planning and implementation of which makes rapid and radical changes to the existing situation and allows for a decrease in the number of maternal and child fatalities.

Meri Taliashvili