International maternal health indicators and middle-income countries: Russia

BMJ 2005; 331 doi: http://dx.doi.org/10.1136/bmj.331.7515.510 (Published 1 September 2005)
Cite this as: BMJ 2005;331:510

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  1. Justin O Parkhurst, lecturer (justin.parkhurst@lshtm.ac.uk)1,
  2. Kirill Danischevski, lecturer2,
  3. Dina Balabanova, lecturer1
  1. 1 Health Systems Development Programme, London School of Hygiene and Tropical Medicine, London WC1E 7HT
  2. 2 Moscow Medical Academy, Ferganski Prospect 14-3-55, Moscow 109507, Russian Federation
  1. Correspondence to: J O Parkhurst

    Maternal health outcomes for the countries of the former Soviet Union are poorer than for the rest of Europe. Russia in particular is a problem. What measures are suitable for guiding the country's policy on improving this area of health care?

    Introduction

    Maternal mortality is a key indicator of a country's progress in improving health, forming the basis for one of the United Nations' millennium development goals. It is an area where, despite substantial gains in the post-war period, the countries of the former Soviet Union have made only limited progress since gaining their independence in the early 1990s. Yet a failure to reduce maternal mortality does not indicate what action is needed for improvement. Interest is focusing on other measures, many of which examine the provision of the various elements of delivery of care.1 2 But in the post-Soviet context, how useful are these process indicators in guiding policy development?

    Background

    Russia's overall maternal mortality ratio was estimated to be 34 deaths per 100 000 live births in 2002. This is significantly higher than the ratio in western Europe, where ratios of 10 or lower are common.3 4 This figure is also higher than in the other former communist countries of central and eastern Europe.4 Yet, despite the international focus on maternal mortality as one of the millennium development goals, little analysis has been done on what action is needed in the former Soviet Union to tackle this problem, still less on the quality of services provided, or the access to care by different groups in the population.

    This paper reviews the maternal health situation in Russia, looking at commonly used measures of maternal care. We draw on a range of information sources (table 1), as well as using primary data collection in one Russian oblast (an administrative …

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