Funding agency: UNICEF
The American University of Armenia (AUA) Center for Health Services Research and Development (CHSR) conducted this study with support from UNICEF and the Ministry of Health (MOH) to identify whether there are problems in classification of late abortions, stillbirths and live births as well as in registration and reporting of stillbirths and early neonatal deaths in Armenia. The research applied different methods including review of existing legislative and sub-legislative frameworks related to classification of newborns as livebirth or stillbirth, and registration of birth and death cases; analysis of the statistics on livebirths, stillbirths and neonatal deaths reported by health facilities and Civil Status Acts Registration Bodies (CSARB); assessment of the knowledge of health care providers on the WHO ICD 10th definitions of livebirth, stillbirth, and perinatal period; and qualitative study through focus group discussions (FGD) and in-depth interviews (IDI) among different groups of stakeholders to identify their perceptions and practices on the subject. The factors that contribute to misreporting of some portion of late abortions and neonatal deaths as stillbirths include providers’ attitude of prioritizing some signs of livebirth over others, their efforts to avoid showing high neonatal mortality rates, their avoidance of different problems related to neonatal death cases, and, most importantly, the pressure from the maternity hospital heads on them and the hospital’s financial motivation to get additional funding in the scope of Obstetric Care State Certificate Program through misreporting some portion of late abortions as stillbirths.
Based on the study findings and suggestions provided by the study participants, the research team developed a set of recommendations that include improving technological capacities of neonatal units and women consultations, introducing controlling mechanisms in maternity hospitals to address the issue of misreporting, finding ways to eliminate financial incentives leading to misreporting, paying equal attention to stillbirth and neonatal mortality rates, increasing the knowledge of providers on the new definitions and their practical implications, extending the package of diagnostic tests for pregnant women and for conducting more specific pathological tests under the State Order, strengthening pathological services and their connections with providers, and simplifying the procedure for receiving child birth allowance.
Further case-based investigation/audit is recommended to identify the exact reasons for the observed moderate discrepancies between the numbers of livebirth, stillbirth, and neonatal death available from the vital statistics registry and health services reporting. The team is currently working on a manuscript for publication.