Azerbaijan's Painful Births

On paper, mothers like Gulnara Mekhtieva have the same rights to maternity care as other Azerbaijani women. Yet the reality of being poor and not having the right connections, made her birth experience a nightmare and left her with a sick child.

Poor medical standards, pervasive corruption and growing demand for its services has thrown the country's maternity care sector into crisis and contributed to its unusually high infant mortality rate.

Gulnara case was all too typical. A low-paid and hard-working waitress in a bar, the 29-year-old went into Maternity Home No. 6 "from the street", in other words without any prior agreement with a doctor.

She was put into a ward with women suffering from pregnancy problems. "The doctor on night duty, who received me, left me alone and said as she went that I should call her, when things became absolutely intolerable," she said. When Gulnara asked the midwife for medicines, she was quietly told that some of them had run out, while others were not available at all.

Most Azerbaijani maternity homes do not use anaesthetics. "I was so weak from pain that I could not follow the doctor's orders," said Gulnara. "I turned into an incoherent animal, who was going numb from pain and could only scream desperately."

Gulnara's daughter was born with asphyxia, caused by lack of oxygen, and suffered an eight cm bruise on her head. The doctor wrote in his report that the child was a "forceps delivery". Gulnara challenges this, "I did not lose consciousness and definitely remember that they did not use a forceps during the birth."

According to Azerbaijan's last census, 108,310 children were born in the country in 1999, fuelling a rapid rise in the country's young population. However, in the same year, according to the United Nations Development Programme, the country's infant mortality rate was an alarming 35 cases per 1,000 births - almost twice as high as the comparable figures for its neighbours Georgia and Russia and almost six times more than in the United Kingdom.

The country's several hundred thousand refugees and internally displaced persons, housed in camps and hostels, are especially vulnerable. The health ministry says that all refugee parents have exactly the same rights as other Azerbaijanis and are also entitled to use the medical centres in their camps.

The women go to consulting sessions and are taken to regional hospitals when the time comes to give birth, said Mubariz Agayev, an official with the State Refugees Committee.

However, according to Khada Rajabova, chairwoman of the parliamentary commission on social policy, many refugee mothers are forced to give birth in their tents, with the help only of inexperienced local midwives. The problem is that many unemployed refugee fathers simply do not have the money to hire a car and pay off expensive doctors.

One such father, Gyulbala Mamedov, said that his wife had already given birth to two children in their camp outside the town of Sabirabad in terrible conditions. "I have no money to pay for her delivery in hospital," he said. "The doctors refuse to receive us. They say that there are no places, but it's clear that it's all a matter of money."

Money is a factor after birth as well. In Azerbaijan's maternity homes it's customary for the mother to start breast-feeding only on the third day. Until then the infant is given artificial food, with many hospital staff demanding a bribe to allow breast-feeding to begin

Mothers also complain of the Azerbaijani tradition according to which the member of staff who's first to tell the mother that the umbilical cord has gone dry must be paid immediately and as much as possible. Some doctors cut the umbilical cord just so as to wrest the money away from the next shift on duty, with the result that, especially in summer, many infants receive a festering wound.

With every day in hospital, the informal costs mount up. "Both of the children's doctors had to be paid ten to fifteen dollars a day for normal care of a newborn child," said Yekaterina Osipova, who gave birth in a maternity hospital in Baku's Khatain district. "Clean nappies cost more. And we paid the midwife on duty and the nurse the same amount every day."

The maternity hospitals are so expensive that women try to get discharged from them as quickly as possible, even if it hurts the health of mother and newborn child. For the doctors, extended stays are profitable - and so to be discharged from hospital mothers have to "buy" permission from the ward doctor and paediatrician at the cost of 25-30 US dollars. Yekaterina Osipova's delivery cost a total of 500 dollars.

If there are complications with the birth, the sums increase still more. A doctor in one of Baku's maternity hospitals, who asked to remain anonymous, said that a birth by caesarean section cost between 500 and 1,000 dollars. "One fifth of this sum goes to the anaesthetist and the rest is shared by the doctor, the nurse and the midwife," he said.

The high costs involved do not, unfortunately, guarantee good healthcare. Yekaterina Osipova witnessed one tragic case in her hospital. "A child died when it was lying under a drip, because of the paediatrician on duty," she said. "It happened because the doctor was criminally irresponsible and fell asleep in the next room. In the morning they found the child was dead. If there had been a doctor there, he could have saved it."

The reports of corruption in maternity homes can be explained by the fact that their staff do not receive their salaries on time and, when they do, they are worth a mere 40-50 dollars a month. In Azerbaijan this is only enough to buy bread and travel on public transport.

However, ministry of health officials strongly deny allegations of bribe taking. According to Mamed Ismailov, one of the managers of the Republican Gynaecology and Midwifery Hospital, "Maternity homes have their problems, just like other state institutions and there is nothing wrong with parents bringing some essential medicines in with them." Rejecting the corruption claims, he said, "Young mothers and fathers simply want to 'thank' the medical staff that took part in the birth."

Lia Bairamova and Zaur Mamedov are reporters with Zerkalo newspaper in Baku.