BIRTHING PAINS: FEE ON BABY DELIVERY REMAINS AN ISSUE OF CONTROVERSY IN ARMENIA
- When Adrine Gatrjyan, 24, learned of her pregnancy she decided she would deliver her baby in a non-state hospital. She chose the Shengavit Medical Center, one of Yerevan’s six private maternity hospitals. (There are also 4 state hospitals.)“I knew that Armenian women pay for the delivery anyway regardless the status of hospital. I thought it is better to deliver in a hospital where money is paid officially, not to the doctor but to the cash desk. I wanted to pay and quit, because I wanted to have comfort and avoid panhandling from the medical personnel,” she says.
Adrine paid 157,000 ($470) for the delivery in the hospital where she says she found no comfort, nor did she avoid demands of separate payment from hospital personnel.
“I was very disappointed with the hospital and medical personnel. The personnel were rude and treated women as if we are guilty for our pain in labor. I was in a ward along with the two other women and in all with our babies there were 6 of us in one ward.”
“After the delivery, when I fed the baby I urgently needed some rest and asked the nurse to take care of my baby. She asked me for 2,000 drams ($6). I was shocked and said that my husband had already paid the required amount. But she said the payment was for delivery not for the care of baby.”
Adrine unwillingly remembers her delivery and environment in the hospital. However a few months after the delivery she learned something that made her even more confused. She learned that the delivery in Armenia as well as medical examination of women during pregnancy should not be charged even in non-state hospitals, because the expenses are covered by the government within the state order.
Adrine’s baby girl Lidia is three months old now and Adrine says she is planning some time later to have a second child. But already now she is concerned with the hospital for the second baby.
“In all I paid over $650 for the visits to doctors during the pregnancy, blood tests and delivery and as a result I got no adequate service for the money I paid. I wonder how women who do not pay for the delivery are treated. I do not believe there is any delivery in Armenia without money. And I do not think there will be a woman in labor who would dare to tell a doctor that she would not pay him because she knows the law.”
The law on medical assistance to women envisaging free of charge delivery was passed in 2005. However, the law aiming to stimulate the birth rate in Armenia did not have the slightest effect in maternity hospitals, where as before the law, the well-entrenched system of illegal payments is largely applied.
The solvent Armenian families, even those who are aware of law generally do not object to pay gynecologists, considering it not as bribe but rather as guarantee of successful deliveries or merely out of gratitude. The average amount of around $300 is distributed among the doctors, nurses, and chief doctor of the hospital.
Still for many families the fee for delivery (minimal $200-250) is unaffordable; especially taking into account the other expenses they have to make for the child (clothes, cot, baby carriage, etc.).
It is widely known that in some cases insolvent women have been neglected by doctors who did not provide the elementary assistance during the delivery.
The officials however provide the official comment, which is based on the state strategy of promoting birth rate in Armenia and in reality has nothing to do with the situation in the hospitals.
Ruslana Gevorgyan, the deputy health minister says if the ministry learned that women are asked money, or that a pregnant woman was refused to be accepted into hospital, or she was refused assistance in delivery, the ministry immediately will quit subsidizing that hospital.
Gevorgyan says that the health minister recently met with chairpersons of maternity hospitals and made it clear that if the illegal practice of taking bribes is not stopped the hospitals would be punished.
Gevorgyan says even though now in Armenia there are non-state hospitals, the delivery there should also be free of charge.
“If doctors want their hospitals to be private and take money from clients let them refuse the governmental financing. The maternity non-state hospitals can charge mothers for additional services, like providing a day-round nurse, VIP ward, nutrition and other services. But not for the delivery.”
The doctors in Armenian maternity hospitals strictly reject the accusations of their refusal in assistance in delivery. Instead they claim that the governmental subsidy is hardly enough to cover a part of the hospitals expenses.
A doctor at the Erebouni Medical Center who understandably prefers not to be identified, said the salary or gynecologist which ranges from 40,000 to 70,000 ($120-210) is merely enough to sustain and taking into account the responsible work of doctors there is left no choice than taking money.
“Just imagine- the gynecologist can be called to the hospital right after he arrived home in the morning. He goes to assist the delivery, then another delivery then more. Sometimes we do not sleep for 3-4 nights. In all civil countries the state order is called the service which is adequately paid. The subsidies we get from the government hardly cover half of the delivery expenses. It is really hard to imagine how at current situation doctors can survive.”
The officials also realize that only with the threats of refusing subsidies they can not suppress the practice of taking bribes for delivery. To encourage doctors to work transparent the health minister Harutyun Kushkyan (he was appointed minister after the May parliamentary elections) has promised that from the next year the government will double the subsidy to the maternity hospitals.
Now the subsidy for one delivery makes 48,000 dram ($145). The minister also promised that they would introduce a new system of wages for doctors, when along with their regular wage the doctors will get $30 per delivery.
Still the promises of the minister do not encourage doctors.
“Why has Kushkyan decided to oppose the ‘shadow business’ in hospitals now, when he is a minister, but not when he was among us?” says the other doctor, referring to the time when Kushkyan was a chief of Erebouni Medical Center, another private hospital.
“The doubled subsidy will not improve the situation, and the doctor would always prefer to have $100-150 in hand rather than promised $30 per delivery.”
Some gynecologists say that the best way for solving the problem is depriving the non-state hospitals from subsidies and distributing the amount among the state hospitals.
Annually there are some 38,000 children born in Armenia, while daily from 30-40 children are born in 10 Yerevan hospitals.
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