4. Reduce child mortality
is indicative for the overall social and economic state of any society and goes far beyond issues of healthcare and medical care. From 2001 to 2006 infant (under-one) mortality in Bulgaria significantly decreased from 14.4/1,000 live births to 9.2/1,000. Under-five mortality also decreased from 16.7/1,000 in 2001 to 11.0/1,000 in 2007.
If that annual reduction rate of 5 to 6% is sustained, Bulgaria will be able to achieve its planned targets by 2015. Progress against the other two targets is significantly slower.
Perinatal mortality has declined marginally from 12.3/ 1,000 in 2001 to 11.0/1,000 in 2007, whereas underweight births show no substantial dynamics over the past 6 years (8.8% in 2007 compared with 8.6% in 2001).
The trend of decreasing child mortality in the country results more from Bulgaria’s overall social and economic development than from specific progress in the healthcare system. With few exceptions, child mortality in the 28 districts does not directly depend on the status of healthcare services represented in the number of beds, obstetricians and other factors. The proportion of GDP allocations for healthcare and medical care has been increasing every year. However, the healthcare system is still under-funded.
In 2005, healthcare appropriations in Bulgaria accounted for 4.3% of GDP against 6.65% in Europe (2003) and 8.81% in EU countries (2003). The difference is even more dramatic in absolute terms. In the same years per capita GDP was USD 3,443 in Bulgaria, USD 20,776 in Europe and USD 24,743 in EU countries.
Local deficiencies in recording perinatal mortality cannot be ignored in the context of still high child mortality in Bulgaria. Bulgarian demographic practice does not follow the criteria for „giving birth“ and „abortion“ recommended by the World Health Organization.
Many countries restrain from the full adoption of these criteria, but in Bulgaria they have been completely altered, which significantly distorts demographic data. Recording births and abortions under a uniform methodology with other EU countries will lead to even greater and more negative aberrations of perinatal mortality indicators in Bulgaria.
Lagging dynamics in the effort to address perinatal mortality and underweight births require decisive measures for improving the quality of obstetric and gynecological aid.
Overall data give reason to believe that by 2015 Bulgaria will achieve at least two of its child mortality targets – under-five mortality down to 9.5 per 1,000 live births and total infant (under-one) mortality down to 7 per 1,000 live births. If the current rate of improvement is sustained, even better results can be expected for these indicators.
