Wednesday, October 1, 2014

The development of early maternal health policies in Finland

Note: This post was created to supplement a different post on the Finnish welfare state. For clarity, a long blockquote I wanted to include in that post is instead published here.

The book Birth by Design details several countries' transition to a healthcare system in which childbirth occurs in a hospital, instead of in a family's own home. Lacking hospital infrastructure, impoverished Finland had an additional, intermediary step. Before transitioning to birth in hospitals, the Finnish government expended significant effort to provide professional birth attendant services for in-home births. The the innovative strategies to that ultimately overcame the many difficulties of this process make this decades-long event a classic example of social policy design:

In 1927 all rural municipalities were required to hire a trained midwife to assist in [all] home births yet by the late 1930's almost half of all home births were assisted by lay midwifes or relatives. The law of municipal midwives was intended to lower maternal mortality by abolishing lay birth attendance. The trained municipal midwives were salaried but were to cover a part of their salary with fees from their nonpoor customers. Women in many remote areas, however, resisted trained assistance [despite it being provided for free] because the traditional lay birth attendants had a respected mystical and religious role in the rural communities. At the end of the 1930's, prenatal care was, by decree, included in municipal midwives' work, and its impact was profound, raising mothers' prenatal care rates from 11 percent in 1939 to 95 percent in 1950 (Pitkanen 1960). This development was promoted by a 1944 law that made the organization of free prenatal care for all an obligation for municipalities and a 1949 decree that made the maternity benefit (given in the form of baby clothing and accessories for birth or one-time monetary payment) available to all women, but tied it to early attendance in prenatal care. Women who did not begin prenatal care before the end of the fourth month of pregnancy could lose their benefit...
See the original post for much more on the development of this social welfare policy.

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