Nestling against his mother’s breast, barely two hours old, the infant was happy and contented. Only his mother, Ziyoda Karimova, could have been happier. “This is my third child,” she told us. “All three have been born here and the staff are great.”
Mother and child were lying in a well-lit and equipped birthing room at the Republican Centre for Obstetrics and Gynaecology, Tashkent. With its modern birthing methods and state-of-the-art equipment, the centre offers the highest quality of maternal health care currently available in Uzbekistan. With her mother-in-law and the midwife Khurshida Musaeva in attendance, the care that Ms. Karimova has received has been a world away from the techniques that were practiced during the Soviet era.
With almost thirty years’ experience at the hospital, Khurshida has witnessed the remarkable transformation.
“Before the nationwide introduction of international standards of maternal care, babies used to be separated from their mothers as soon as they were born,” she explained. “Then they would only be breast-fed on a strict regime of three hour intervals.” Khurshida hopes that pregnancy will one day be treated as a normal phase of life rather than an illness, and that the level of facilities available at her hospital will be available to all women in Uzbekistan.
This may be a distant goal, but it is one that the government, with the support of the United Nations Population Fund (UNFPA), wants to see realized. While nearly all deliveries in Uzbekistan occur in a maternity hospital with the support of a midwife, a discrepancy remains between the services available in rural and urban regions.
Of the average 265 obstetric complications that occur in Uzbekistan each day, 170 take place in rural areas. The occurrence of maternal death also follows the same trend.
The Government hopes to change this worrisome situation through the introduction of health care reform. About a decade ago, the Ministry of Health with the support of UN agencies including the UNFPA, introduced a new delivery framework. In this framework, smaller delivery units were replaced with single well equipped child delivery complexes for each district. Regional Perinatal Hospitals offering child delivery and prenatal care services were also established.
Normal deliveries are carried out at a district and urban level, while complicated pregnancies are referred to regional level facilities.
The Deputy Minister of Health Dr. Asomiddin Kamilov has said that big improvements have been made in the last decade. “The figures speak for themselves,” he said. “In the 90’s we had a maternal mortality ratio of 65 per 100,000 live births. Now it is about 20 and we are working towards further improvements.”
In Uzbekistan, midwives play a critical role in delivering antenatal care for pregnant women and in assisting physicians during the delivery process. There are currently 24,000 midwives in the country, playing a vital role in further improving quality of care.
Problems still persist despite these advances, including gaps in the training of midwives and a problematic lack of funding. The roles and responsibilities of midwives have not been clearly defined in recent reforms.
The UNFPA has supported the Uzbekistan Government’s improvements in the field of reproductive health, and has been ready to offer further assistance by means of promoting best practices and providing international expertise.
