Bulgaria is an interesting case study into the effects of State level investment into health care. Until the 1990’s maternal mortality rates were dropping. Bulgaria was affected by the fall of communism and the end of the Cold War which brought rapid political and market reforms to Bulgaria and many other Eastern Bloc countries.

Bulgarian_mother_childDuring the 1990’s maternal mortality rates increased from 10.4 deaths per 100,000 live births to 21.2 in 1992. These rates have fluctuated up and down over the last decade, but have been on a downward trajectory for the last decade as increased attention has been focused on reducing maternal mortality. Part of the reason for the increase and decrease in any given year is the disparity between urban and rural rates and the more restricted access to health care services in rural areas. Additionally, generally decreasing birth rates also account for some of the decline.

“Until 1991, there was a tendency towards a decrease in maternal mortality rates. For example, in 1991 the rate was 10.4 per 100,000 live births compared to 25 in 1986. In 1992, it rose to 21.2, and it again decreased in 1993 to 14.1 ((CEDAW 1994 art 119)). Although, as a whole, there is a tendency towards decrease of maternal mortality in Bulgaria, it remains high in comparison with Western European countries. Basic reasons for this are complications related to pregnancy, birth and the after-birth period; bleeding; and abortions. Last but not least, unfavourable living or working conditions, unbalanced nutrition, as well as unsatisfactory preventive activity by women’s health centres should be stressed.” It can be assumed that the government has not made huge strides in preventing maternal mortality, considering the rate is so much higher than other European nations1.

 
Bulgaria has reached it’s UN Millennial Development goal. Currently there are 11 deaths per 100,00 live births2, which is an improvement on the goal of being under 12 deaths by 20153. The World Bank rates the country even lower at only 6 deaths per 100,000 live births4.
 
With continued investment Bulgaria will easily reach parity with other European countries. This pattern should serve as a caution. Twice in Bulgaria’s recent history lower investments into maternal health stalled or reversed these gains. This occurred in the transition to democracy and capitalism, but it also happen in 2006-7 when the rates stalled again5. Thankfully various agencies with the government continued to pressure for continued access to services. Bulgaria should read as a cautionary tale for those who believe rates will improve on their own, or once set in motion will not need continued monitoring to insure proper attention is given to this important investment. 

  1. UNDP 
  2. World Health Organization, World Health Statistics, Part III, Global Health Indicators, Published 2012, Accessed 1 June 2012 
  3. UNDP 
  4. The World Bank, World Development Report: Gender Equality and Development, The World Bank, Washington, D.C., 2011, 17 September 2012) 384, 385  
  5. Bulgaria National Government, 2011 Bulgaria CEDAW, January 2011, 12 April 2013 

  1. UNDP 

  2. World Health Organization, World Health Statistics, Part III, Global Health Indicators, Published 2012, Accessed 1 June 2012 

  3. UNDP 

  4. The World Bank, World Development Report: Gender Equality and Development, The World Bank, Washington, D.C., 2011, 17 September 2012) 384, 385  

  5. Bulgaria National Government, 2011 Bulgaria CEDAW, January 2011, 12 April 2013