Maternity Care in Armenia is Postcode Lottery

Women in Armenia are alarmed by new rules that deny them access to free maternity services in the capital Yerevan if they happen to come from anywhere else.

Many expectant mothers opt to have their babies in the capital as they do not have much faith in local health provision.

From March, they can still do so, but they must pay private-sector charges in the state hospitals. Only registered residents of Yerevan will be given free birth care there.

The decision stems from a health ministry meeting in November, where minister Derenik Dumanyan discussed the nationwide situation with provincial health chiefs.

“Henceforth, obstetric services will be provided on a regional basis, meaning that a woman giving birth can choose the institution… solely based on her place of residence,” Dumanyan said at a press conference afterwards. “A resident of a [particular] region will give birth in that region, and a resident of Yerevan will give birth in Yerevan.”

Ministry officials say the decision was taken to prevent too many women coming to the capital to give birth, thus overburdening maternity services there and skewing expenditure. Official statistics indicate that nearly two-thirds of all births in Armenia last year were in Yerevan, even though the city accounts for one-third of the country’s population.

“Thanks to these measures, we can make sure that the funds the state assigns for medical care reach the places they’re intended for,” Karine Saribekyan, head of the mother and child department at the health ministry, said.

Pregnant women like Armine Asatryan are horrified. Now expecting her third child, Asatryan has lived in Yerevan for the last ten years, but will be barred from free maternity care in the city because she is still formally registered as a resident of Gegharkunik region.

“There’s a high level of infant mortality in the regions. Apart from that, you can’t have all the tests done in regional hospitals,” she said. “They need to raise all the hospitals to the standard of those in Yerevan, and only then reform the system.”

With her only other choice being to go back to her home region to have the baby, she has decided to pay the fees at a Yerevan hospital.

Ara Babloyan, who chairs the parliamentary committee on health commission, says it is no longer true that hospitals outside Yerevan are worse, as the government has made major investments in improving them.

“Localising the obstetric care system will save people extra costs. We are doing this so that people don’t come to Yerevan and spend money for nothing,” he said. “A few years ago, we didn’t have regional birth centres with modern equipment, so we can understand why people preferred to seek more professional treatment. But now we need to make sure that births take place at the local hospitals, since we have all the equipment and specialists that are needed.”

Armenia currently has 62 maternity units, 11 of them in Yerevan. Under reforms adopted in 2009-10, medical centres in Ijevan, Hrazdan, Armavir, Ararat, Ashtarak and Goris were given new equipment. The same reforms also provided pay increases to encourage medical staff not to move to the capital.

Some of the pregnant women contacted by IWPR expressed little faith in the reforms, since the doctors in local hospitals remained the same as before.

“If there were qualified specialists in the regions, then believe me, not a single pregnant woman would go to give birth in Yerevan,” said one expectant mother.

Arpi Harutyunyan is a reporter for Armnews television in Armenia.