Bulgaria’s State Health System Failing Pregnant and Vulnerable Women
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Loading... - LAOISE HOGAN
- 01 Nov 2024
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Bulgaria's state healthcare system is facing significant challenges in providing adequate care for pregnant women, particularly those who cannot afford health insurance. A recent report by the Bulgarian National Audit Office highlights the inefficiencies within the healthcare system, which is struggling to reach its most vulnerable citizens, including a substantial portion of the population that remains uninsured.
With one of the smallest preventive health budgets in the European Union, Bulgaria's healthcare system is ill-equipped to address the needs of nearly one million working-age citizens—approximately 25% of the population—who do not pay for health insurance. This group primarily includes individuals from the large Roma minority, informal sector workers, and those permanently excluded from the labor market.
The report specifically notes that many pregnant women in Bulgaria have not received any prenatal check-ups, missing out on the benefits of state programs designed to support maternal and child health. The reasons for this lack of engagement are multifaceted, including low levels of education, poor health and social status, ineffective information campaigns, and insufficient outreach efforts to guide pregnant women toward available medical care.
Alarmingly, only 40% of uninsured pregnant women have utilized the state-funded medical check-up program, and this figure has continued to decline, dropping to 37% in 2022. This trend raises serious concerns about the accessibility and effectiveness of healthcare services for vulnerable populations.
Recent Policy Changes and Their Impact
Starting January 1, 2023, the Bulgarian state announced that it would cover up to four preventive check-ups per year for uninsured pregnant women and allow hospitalization for high-risk pregnancies up to twice a year. However, the financial resources allocated for high-tech examinations and consultations aimed at early detection of congenital anomalies in uninsured pregnant women are not being fully utilized. This underutilization further exacerbates the challenges faced by pregnant women in accessing necessary healthcare services.
Ethnic Disparities in Health Outcomes
A study published by the National Statistical Institute in August 2024 reveals stark disparities in life expectancy among different ethnic groups in Bulgaria. Ethnic Bulgarians live, on average, six years longer than Roma individuals, who make up about 10% of the population. Bulgarian women have an average life expectancy of 78.6 years, while women from the Turkish ethnic group live an average of 76.9 years, and Roma women have a life expectancy of just 71 years. These disparities highlight the urgent need for targeted health interventions and policies to address the specific needs of marginalized communities.
Insufficient Investment in Preventive Health
According to a Eurostat study from 2021, Bulgaria spends only 0.28% of its GDP on health prevention, one of the lowest rates in the EU. This lack of investment is particularly detrimental to vulnerable populations, as the state has not allocated sufficient funds for effective education and awareness campaigns. These campaigns are crucial for informing the public—especially in rural areas and among vulnerable groups—about health promotion and the benefits of available programs aimed at improving maternal and child health.
Maternal and Infant Mortality Rates
Bulgaria's maternal and child health indicators remain below the EU average. Although infant mortality rates decreased by 4.6% from 2010 to 2022, the country still recorded 3.3 deaths per 1,000 live births in 2022, making it one of the EU countries with the highest infant mortality rates, trailing behind Romania and Slovakia. The National Health Insurance Fund's data for 2023 indicates that many Bulgarians are skipping preventive check-ups, despite them being compulsory for insured citizens. Only 41% of individuals over 18 attended a preventive check-up last year, a slight increase from 36% in 2021. While health check-ups are mandated by law, there are no penalties for those who choose not to participate.
The findings from the Bulgarian National Audit Office underscore the urgent need for reforms in the state healthcare system to better serve pregnant women and vulnerable populations. Addressing the barriers to access, increasing investment in preventive health, and implementing effective outreach and education campaigns are critical steps toward improving maternal and child health outcomes in Bulgaria. Without these changes, the disparities in health access and outcomes are likely to persist, further entrenching inequalities within the healthcare system.
