Health Policy and Planning Advance Access originally published online on February 21, 2006
Health Policy and Planning 2006 21(3):195-205; doi:10.1093/heapol/czl001
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Delivering babies in a time of transition in Tula, Russia
1School of Public Health and Health Management, Moscow Sechenow Medical Academy, Moscow, Russia and 2London School of Hygiene and Tropical Medicine, London, UK
Correspondence: Dina Balabanova, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK, Tel: + 44207 927 2929 Fax: + 44207 637 5391, E-mail: dina.balabanova{at}lshtm.ac.uk
Objective: To investigate the provision of maternal services in the Tula region of Russia, with an emphasis on variations in practice.
Method: The study was set in Tula Oblast. Data sources included an obstetric information database detailing all Tula deliveries in 2000 (n = 11 123) and structured interviews with the heads of maternity facilities and hospital maternity departments.
Results: Caesarean-section rates varied from 3.3–37%; episiotomy from 9–80%; and amniocentesis from 0–51%. As fertility rates fell since the 1980s, increasing numbers of women were hospitalized for ‘pathological pregnancy’ in an attempt to preserve infrastructure.
Conclusion: Over-medicalization arises in a system typified by excess capacity and large numbers of specialists. Some practice variations were correlated with characteristics of mothers, but others derive from systems structures such as equipment availability. Improvements in practice will require addressing these structural elements and steering the clinical culture towards evidence-based medicine, rather than simply writing new decrees.
Key Words: maternal health services, physician's practice patterns, practice guidelines, Russia
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  K. Danishevski, M. Mckee, F. Sassi, and V. Maltcev The decision to perform Caesarean section in Russia Int. J. Qual. Health Care, April 1, 2008; 20(2): 88 - 94. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. M. Marx, R. A. Atun, W. Jakubowiak, M. Mckee, and R. J. Coker Reform of tuberculosis control and DOTS within Russian public health systems: an ecological study Eur J Public Health, February 1, 2007; 17(1): 98 - 103. [Abstract] [Full Text] [PDF]
|
|