What do we know about the state of maternal health in Russia? Report on the situation analysis

OBJECTIVES AND METHODS
This paper provides an overview of the existing knowledge and gaps in knowledge of reproductive and maternal health care in the Russian Federation. It is one of a series of country reports being undertaken within the framework of the United Kingdom Department for International Development’s (DFID) Health Systems Development Programme (HSD). The HSD programme has identified maternal health as one means by which it can evaluate the response of health systems to the needs of the poor (a probe condition). During the first year of this programme, similar analyses have also been undertaken in three other partner countries (South Africa, Bangladesh, and Uganda). These situational analyses will be followed by further primary research in each country by partners in the HSD programme. This review on Russia was conducted between December 2001 and March 2002. This review aimed to assess the current state of knowledge on reproductive care in Russia by means of an overview of existing literature on the subject, including grey literature, with a focus on maternal and perinatal mortality, abortion, and barriers to services, especially for vulnerable groups. In addition to the current state of knowledge, the review identifies needs for further research. We expect that some of these will be developed within the programme’s research plan for 2002-2003. The overview sought to identify the scope and focus of existing research conducted by international agencies, Russian academic departments, and individual researchers. While the usual electronic search methods were used, much of the relevant material was less easily accessible than is often the case in health services research. Much published Russian research on public health fails to meet western standards for systematic presentation of information and is not easily available internationally (Tkatchenko et al, 2000). Consequently, snowball sampling was used, beginning with key informants, to identify institutions active in the field. The process was continued until saturation (i.e. when no more sources were emerging). Telephone enquiries, informal interviews and meetings seeking to establish activities in the area of maternal health were then undertaken (especially recent research). In the process, useful contacts were established with key actors. Sources were extremely diverse - including background papers, project documentation, consultancy reports, and specific studies commissioned by international agencies - yet there was very little material found in the international scientific literature. Russian studies have been difficult to find due to poor dissemination, both within Russia and internationally. PhD theses and other unpublished material were identified. There are several extensive surveys and qualitative studies that have been conducted in this field in Russia, but in most cases analysis is limited to immediate needs of the funding agency, thus narrowing the scope of analysis. Research on socio-economic determinants of maternal health and access to care in the former Soviet Union (FSU) was not published before 1990, precluding comparisons. Study design and data validity is often difficult to judge due to lack of uniform standards and limited use of effective peer review. The review so far has identified considerable gaps in understanding maternal health and maternal health services even after a decade of transition in Russia. The vast majority of work focuses on reproductive health issues. Research initiated by international agencies predominates as national research funding in Russia fell throughout the 1990s following successive economic shocks. We are aware that this review is only a first step in mapping the maternal health situation in Russia. The issues identified in the report are not an exhaustive list, and further questions will be raised in the course of future HSD research. On 14 March 2002, a workshop was organised in Moscow to provide a forum for discussion of maternal health issues among interested stakeholders and to seek support for further research in 2002-3. This permitted confirmation of the remaining gaps in knowledge and thus identification of key research questions.

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