Researched by Katelynn Takács

Maternal health outcomes vary greatly among countries, shaped by governmental policies, healthcare access, and societal norms. A closer look at Belarus and Azerbaijan, two former Soviet countries, reveals striking differences in maternal mortality rates and the factors that influence them. This comparison offers critical insights for improving maternal health in regions facing similar challenges.

Belarus: A Model of Maternal Health Progress

In 2020, Belarus reported a maternal mortality rate of 1 death per 100,000 live births, ranking first globally among 186 countries, according to the CIA World Factbook. This achievement is remarkable, considering Belarus’s history of higher maternal mortality under Soviet rule, which saw rates as high as 32 deaths per 100,000 live births. The Belarusian government’s multifaceted, proactive approach has driven this success, setting an example for other nations aiming to improve maternal health outcomes.

Key Components of Belarus’s Success

1. Multileveled Perinatal Care System: Since 2005, Belarus’s Ministry of Health has implemented a “Multileveled Perinatal Care System.” This approach, backed by national leaders, expanded rural gynecological care and employed over 2,700 obstetricians across the country. The system prioritizes maternal care at various levels, concentrating specialized services in designated centers for high-risk cases, while low-risk pregnancies receive at-home monitoring and support.
2. Incentives for Early Prenatal Care: To encourage early engagement with healthcare, Belarus introduced a financial allowance for pregnant women who see a physician between weeks 1 and 12 of pregnancy. This incentive reportedly increased first-trimester prenatal visits by 93.5%, supporting early detection of pregnancy complications and promoting timely intervention.
3. Enhanced Prenatal Services: Belarus has expanded baseline prenatal care to include three mandatory screenings throughout pregnancy, each tailored to address specific risks. This targeted approach allows healthcare providers to customize care plans based on each patient’s needs, leading to improved outcomes.
4. Family-Friendly Policies: Belarus supports mothers with paid maternity leave ranging from 126 to 140 days and encourages fathers’ involvement during delivery. Many labor and delivery units are designed to accommodate family presence, recognizing the importance of a supportive environment for childbirth.
5. Investment in Training and Equipment: Belarus has made significant investments in healthcare infrastructure. Specialized medical devices like ultrasound machines are strategically allocated to high-risk centers, and healthcare providers undergo continual training to ensure they remain up-to-date with best practices in maternal care.

The result of these comprehensive measures is that over 98% of Belarusian women now have access to free, high-quality prenatal care. This access, combined with targeted programs and incentives, has drastically reduced maternal mortality, providing a model of what is possible with coordinated government support and investment in maternal healthcare.

Azerbaijan: Struggling with Persistent Challenges

In contrast, Azerbaijan reported a maternal mortality rate of 41 deaths per 100,000 live births in 2020, ranking 102nd globally. While Azerbaijan has made strides in healthcare, several social, economic, and structural challenges continue to impede progress in reducing maternal mortality.

Factors Contributing to Azerbaijan’s Higher Maternal Mortality Rate

1. Adolescent Pregnancy and Early Marriages: Approximately 13% of girls aged 15–19 in Azerbaijan are married, and the adolescent birth rate remains high, with 40 births per 1,000 young women in this age group as of 2022. Early marriage and teenage pregnancies are significant risk factors, often resulting in inadequate maternal care and higher maternal mortality rates. These trends reflect gender inequality and highlight the need for systemic changes to empower young women.
2. Socioeconomic Barriers to Healthcare Access: Although maternal services are technically free, socio-economic disparities restrict access for lower-income women, who are more likely to give birth outside of healthcare facilities. Wealthier individuals have access to higher-quality facilities, while those from lower-income backgrounds face limited choices, often delivering without professional support.
3. Lack of Comprehensive Sex Education: Limited sex education in Azerbaijan has been linked to lower usage of prenatal and perinatal services. Studies suggest that increased awareness and educational campaigns could encourage better healthcare utilization among pregnant women, particularly in rural areas.
4. Complications Related to Abortion: Azerbaijan has a high rate of abortion-related complications, contributing to maternal mortality. While abortion services are accessible, the quality of care and follow-up is inconsistent, leading to health risks that could be mitigated with better post-abortion support and contraception education.
5. Inadequate Program Implementation and Resource Allocation: Government programs like the “State Programme on Improvement of Maternal and Child Health” (2014–2020) and the “Action Plan to Prevent Gender-Biased Sex Selection” have been deemed insufficient by the European Committee of Social Rights. Challenges include limited public spending and issues with healthcare accessibility, particularly in terms of ensuring timely care.

Learning from Belarus: Recommendations for Azerbaijan

Belarus’s approach provides valuable insights that Azerbaijan could adapt to its context. Below are some actionable recommendations:

1. Strengthen Prenatal Incentives and Access: Introduce financial incentives for early prenatal visits and increase rural healthcare access to ensure timely prenatal screenings. Widespread campaigns could be employed to promote these services, improving healthcare outcomes, especially in underserved areas.
2. Enhance Educational Campaigns: Implement comprehensive sex education and public health campaigns to raise awareness about the importance of prenatal care. Promoting accessible, accurate information could empower women to seek timely healthcare, lowering mortality risks.
3. Invest in Healthcare Infrastructure: Allocate resources to high-risk maternity facilities and ensure quality equipment is available nationwide. Targeted funding for maternal health can support lower-income populations who currently lack adequate healthcare options.
4. Focus on Addressing Gender Inequality: Adopt policies that discourage early marriage and adolescent pregnancy, aligning with international standards on women’s rights and health. By creating a supportive legal framework, Azerbaijan can begin to address the societal factors that exacerbate maternal mortality.
5. Monitor and Improve Existing Programs: Evaluate and revise programs like the State Programme on Maternal Health to enhance efficiency and effectiveness. Investing in data-driven improvements can optimize resource allocation, ensuring that public spending on maternal health produces measurable results.

Conclusion: Bridging the Maternal Health Gap

The maternal health achievements in Belarus demonstrate what a proactive, well-funded government strategy can accomplish. Azerbaijan, facing unique social and economic barriers, can draw from Belarus’s successes to create targeted, impactful maternal health policies. By adapting elements of Belarus’s model—such as incentivizing early prenatal care, implementing educational campaigns, and addressing infrastructure gaps—Azerbaijan has the potential to improve maternal health outcomes substantially.

Improving maternal health requires not only healthcare investment but also a commitment to empowering women and addressing systemic inequalities. Belarus’s example provides hope and direction, proving that change is possible, even in countries with limited resources. Azerbaijan, along with other nations in similar situations, stands to benefit from these insights, creating a brighter future for mothers and children across borders.