Reductions in government healthcare spending in the European Union (EU) are associated with increased maternal mortality rates, suggests a new paper published today (10 December) in BJOG: An International Journal of Obstetrics and Gynecology (BJOG). However, if skilled birth attendants are in place, the association disappears, highlighting the potential importance of maternal care, finds the research.
The study looks at the association between reductions in government healthcare spending (GHS) and maternal mortality across the European Union (EU) over a 30 year period from 1981 to 2010.
Maternal mortality is defined as the death of a woman during pregnancy, childbirth, or within 42 days of delivery from direct obstetric causes. GHS is the total expenditure on health care by a government measured as a percentage of gross domestic product (GDP).
This study used data on maternal mortality from the World Health Organization (WHO) database. Data were available for 24 EU countries, a population of 419 million people (2010).
The study found that for every 1% decrease in government healthcare spending, EU countries experienced an average 10.6% annual increase in maternal mortality. This association also remained significant for 1 year after the spending cut.
Moreover, the study found that the association remained significant after accounting for economic, infrastructure and hospital resource controls, in addition to out-of-pocket expenditure, private health spending and the total fertility rate. However, when accounting for the percentage of births attended by skilled health professionals, defined as people trained to give the necessary supervision, care and advice to women during pregnancy, labor and the postpartum period, the effect is no longer significant.
Professor Thomas Zeltner, University of Bern, Switzerland, Special Envoy for Financing to the Director General of the World Health Organization and co-author of the paper said:
"With reduced government spending in this area in times of austerity, policy makers need to be aware of the consequences of the budget cuts. If cost-reductions are matched by sufficient increases in efficiency, quality of care may remain.
"Our results suggest that reductions in government healthcare spending are associated with increased maternal mortality rates in the EU. This may occur due to a variety of reasons such as reductions in the number of births attended by skilled health professionals."
John Thorp, BJOG Deputy-Editor-in-Chief, said:
"This paper covers a large amount of time and is one of the only studies to look at this.
"It is clear that skilled attendants such as doctors, midwives and nurses who have been adequately trained to manage uncomplicated as well as complicated pregnancies, childbirth and the postnatal period are crucial to maximizing safety and survival of women and their infants."
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BJOG: An International Journal of Obstetrics and Gynecology is owned by the Royal College of Obstetricians and Gynecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynecology worldwide.
Maruthappu M, Ng KYB, Williams C, Atun R, Agrawal P, Zeltner T. The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study. BJOG 2014; DOI: 10.1111/1471-0528.13205.