Improve maternal health

Where we are?

 picture by Apolonija Lucic: The warm embrance of my mother (from the 2004 children's competition on MDGs in Croatia)

In Croatia, maternal mortality has been low for years, and it comes down exclusively to exceptions. Maternal deaths include all women who died during pregnancy, childbirth or 42 days after childbirth, regardless of whether the cause of death is connected with the pregnancy or delivery.

All women in the Republic of Croatia are entitled to free delivery in a healthcare institution, regardless of whether they have health insurance; more than 99.9% of deliveries take place at a healthcare institution, with rare exceptions, such as giving birth at home or on the way to the maternity hospital.

In the last ten years, more than 30% of women who died in pregnancy, childbirth or during puerperium died from reasons that are indirectly related to the birth (various chronic and malign diseases).

The share of women of fertile age who died out of the total number of women who died is low (approximately 3% of all women who died), and the rate is somewhat above 70/100,000 women of fertile age. The most common causes of mortality are tumours, then injuries and circulatory system diseases. Hence, healthcare's attention should be focused on prevention of these causes of ailments and mortality. Certain preventive measures are conducted through national screening programmes (for breast cancer) and others are available to every woman through healthcare system measures from obligatory insurance.

National Programme for Early Breast Cancer Detection envisaged in the 2006 – 2012 National Health Care Strategy has been implemented for three years and the number of women examined annually has been gradually increasing (in 2008, 57% came to the examination after receiving an invitation). It is expected that the results of these screenings will have an influence on reducing the occurrence of advanced breast cancer types and subsequent women's mortality. Owing to the screenings, in the past three years, 1,400 cases of breast cancer were detected and confirmed. Annual breast cancer incidence is approximately 2,500/100,000 women, out of which 800 – 900 die (approximately 40/100,000 per year). Further prevention of breast cancer, through the system of obligatory health insurance, includes the procurement of a sufficient number of mammogram machines and their local distribution according to needs.

The order of the main causes of death of population in Croatia, according to individual diagnostic entities has not changed in the last five years. The most common cause of death is ischemic heart disease (20%), followed by cerebrovascular diseases (15%), heart failure (6%), bronchial and lung cancer (5%) and, finally, colorectal cancer (4%). Represented among the ten most common causes of death from digestive diseases are chronic liver disease, fibrosis and cirrhosis. The most prominent in the respiratory disease group are bronchitis, emphysema and asthma.

At the moment, maternal mortality is kept at a low level owing to the existing mechanisms of antenatal, natal and postnatal care defined by protection standards, i.e. Programme of Health Protection Measures. Prevention programmes and programmes aimed at a reduction in the number of deaths caused by injuries still have not been developed on the national level, and there are a few programmes aimed at prevention of specific causes of death (e.g. traffic accidents). Therefore, it is necessary to develop a multidisciplinary approach regarding such programmes, bearing in mind the specific cause of death.

In addition, prevention of and suppressing of certain most common causes of death of fertile age women has been carried out through different health education methods (lectures and actions organised on the occasion of World Health Day, specific educational programmes in local communities).