More information
Description
During the COVID-19 pandemic, measures are being introduced into maternity care in Croatia that are not based on evidence or on the recommendations of global medical organisations. This project will strengthen Roda’s watchdog capacities, to advocate for the implementation of evidence-based guidelines in maternity care. The project’s objective is to strengthen Roda’s position as a watchdog CSO in the field of women’s reproductive rights during and after the COVID-19 pandemic and to empower women to advocate for their rights in the healthcare system. The activities are: A1. Qualitative research, analysis of the situation and guidelines and preparation of thematic report, A2. Advocacy activities towards institutions in order to ensure evidence-based maternity care, A3. Result dissemination. The project contributes to the impact Strengthened advocacy/watchdog role of CSOs and other expected impacts Increased support for human rights and Increased democratic culture, civic awareness and engagement. The target groups are the Ministry of Health of Croatia, professional organisations in the field of maternity care, CSOs active in the field of women’s rights, women and the media. The Ministry of Health is slow to receive and adapt to and further communicate information on new evidence-based practices and must be regularly informed about, and used as a tool to advocate for changes in professional guidelines. Women of reproductive age will be empowered to actively participate. Alongside Roda, 15 other CSOs that are active in the field of women’s rights, but are not well-versed on these specific areas, will improve their capacity as watchdog CSOs in the area of implementing professional guidelines in maternity care during the pandemic. The Ombudswoman for Gender Equality is a project partner and will use the power of her office to advocate for these issues, which are often only considered medical issues, to also be considered through the lens of women’s human rights.
Summary of project results
The project aimed to address issues related to the introduction of non-evidence-based practices in maternity wards during the COVID-19 pandemic, which contradicted medical guidelines and negatively impacted the health and rights of women and children. Key challenges included denying women the right to have a companion during childbirth, medically unwarranted interventions such as labor induction and cesarean sections, the separation of mothers from newborns, the lack of postnatal home care, and an increased risk of reproductive violence. The project sought to strengthen Roda’s advocacy capacities, establish mechanisms for reporting irregularities, and empower women to protect their rights and dignity.
The project carried out several key activities and produced significant outputs:
Qualitative Research, Situation Analysis, and Thematic Report
- Two online surveys were conducted to gather experiences of pregnant women, new mothers, and postpartum women during the COVID-19 pandemic.
- The results of these surveys, along with an analysis of relevant guidelines, strengthened Roda’s advocacy position and that of other organizations working on women''s reproductive rights.
- A Thematic Report titled “Results of the Research by Roda – Parents in Action and the Ombudsperson for Gender Equality on the Availability of Reproductive Health Care for Women During the COVID-19 Pandemic” was published.
- The report served as a key advocacy tool and was shared with institutions, professional bodies, and international organizations such as the UN Working Group on Discrimination Against Women, UN Special Rapporteurs, and the European Parliament’s Gender Equality Committee (FEMM).
- National institutions and professional associations, including the Ministry of Health, UNICEF, and medical societies, were also informed of the findings and recommendations.
Advocacy for Evidence-Based Maternity Care
- Roda contributed to a global petition submitted by the Global Respectful Maternity Care Council (GRMCC) to the UN Working Group on Discrimination Against Women and Girls, highlighting violations of reproductive rights during crises.
- The petition addressed issues such as hospital closures, denial of informed consent, and forced separation of mothers from newborns.
- Roda leveraged its survey data to provide insights into the situation in Croatia, demonstrating systemic violations of reproductive rights.
- The Ombudsperson for Gender Equality, in coordination with Roda, sent a letter to the Ministry of Health advocating for the creation of a protocol ensuring birth companions during the pandemic.
Dissemination of Results
- Three infographics were developed based on survey findings, covering pregnancy, childbirth, and breastfeeding during the pandemic.
- A public online conference titled “Availability of Women’s Healthcare During the COVID-19 Pandemic” was held on September 24, 2020, presenting the research findings to 70+ participants, including policymakers, medical professionals, and representatives from institutions and NGOs.
- Media, professional bodies, and the public were continuously informed through social media, news articles, and Roda’s website.
- Six volunteers were actively engaged in preparing and distributing surveys and communicating with women of reproductive age.
Through these efforts, the project contributed to raising awareness, influencing policies, and advocating for improved maternity care based on scientific evidence.
The implementation of the project involved a diverse range of stakeholders, including:
Women – pregnant women, mothers, and those with experience in the healthcare system during the COVID-19 pandemic,
The Ministry of Health of the Republic of Croatia,
Professional societies such as the Croatian Society of Gynecologists and Obstetricians, the Croatian Society of Perinatologists,
Directors and heads of gynecology departments in Croatian maternity hospitals,
The Croatian Medical Chamber, the Croatian Chamber of Midwives, the Croatian Chamber of Nurses,
Associations in Croatia advocating for women''s rights,
International institutions focused on protecting women''s reproductive rights,
Members of the National Committee for Breastfeeding at the Ministry of Health,
The National Committee for Medically Assisted Reproduction,
The media.
These stakeholders were engaged in various phases of the project, including the creation, distribution, and analysis of two surveys (one on women''s healthcare during the COVID-19 pandemic and another on women''s experiences with medically assisted reproduction during the pandemic), dissemination of survey results, and analysis of national and international professional guidelines. The project also focused on advocating for evidence-based maternal care, raising awareness about the importance of accessible healthcare for women and newborns during the pandemic, and ensuring the adoption of best practices aligned with current professional guidelines.
The impact of engaging these stakeholders is reflected in the strengthened advocacy position of organizations working in the field of women''s reproductive health during and after the COVID-19 pandemic. The data collected through surveys and guideline reviews serve as a powerful advocacy tool that will be used long after the project ends, especially given the continued relevance of the data to the ongoing epidemiological situation.
Key outcomes and impacts:
The survey results were presented at an online conference to all key stakeholders and made permanently available online for other actors to use in their advocacy activities.
The project led to increased civic engagement, as more women actively reported irregularities related to disproportionate pandemic measures affecting their reproductive health. The surveys were completed by 1,485 women, nearly three times the expected 500 responses.
The project generated significant interest from diverse stakeholders, particularly professionals, who actively participated in the online conference where research results were presented.
Media interest in reporting on this aspect of healthcare was another clear impact. While the pressure on institutions and policymakers, as well as public awareness, is difficult to measure in a short time, the media’s role was undeniable. During the project, three press releases were issued, and the project was covered 23 times in various media outlets, including national TV networks, online portals, radio stations, and local media.
The project''s long-term impact on professional societies and the international community is expected to become evident over time as international institutions release reports on women''s reproductive rights during the pandemic.
Unexpected positive impacts:
Although Roda has extensive experience in organizing professional conferences, it became evident that these events primarily attract female professionals, mainly midwives and community nurses, with very few physicians attending. Due to the hierarchical structure in the healthcare sector, doctors often refuse to participate in events organized by associations, particularly when midwives and community nurses are present. However, the online conference format proved highly effective in increasing the participation of doctors from across Croatia. The virtual format allowed them to join anonymously and without needing to travel or miss work. As a result, a broader range of stakeholders participated in the final presentation of research findings on women''s healthcare access during the pandemic.
One significant moment was the participation of Dr. Gordan Zlopaša from the Department of Perinatal Medicine at the Clinic for Women’s Diseases and Obstetrics, University Hospital Center Zagreb. During the conference, he openly admitted for the first time that the statement made by the President of the Croatian Society of Gynecologists, Dr. Ante Ćorušić, claiming that all COVID-19 suspected or confirmed patients would give birth via cesarean section, was incorrect. Previously, Dr. Zlopaša had supported Dr. Ćorušić in the media. His public acknowledgment of this mistake during the conference was a major step forward, demonstrating progress following official complaints from the Ombudswoman and Roda on the issue.
The research analysis confirmed previous assumptions about practices that contradict professional guidelines, as evidenced by the survey results and guideline analysis.
Another unexpected positive outcome was the revelation of new issues in women''s reproductive healthcare that Roda had not previously focused on, such as the decreasing availability of public healthcare services for women under the Croatian Health Insurance Fund (HZZO) and the increasing trust in private healthcare. This finding highlights a significant issue, particularly given the declining number of gynecologists working within the public healthcare system in both urban and rural areas. This is a crucial insight that underscores the need for stronger advocacy efforts to address gaps in women''s healthcare.
The significantly higher number of survey responses allowed for a more comprehensive understanding of women''s healthcare access during the pandemic.
Another positive impact was the substantial participation of vulnerable groups, indicating their interest in addressing these issues and their willingness to engage in advocacy. The surveys included responses from women in rural areas, women of lower socioeconomic status, women with disabilities, and members of the LGBTQ+ community, among others. While this participation was not entirely unexpected—given that the survey was distributed to LGBTQ+ organizations, disability advocacy groups, the Ombudsperson for People with Disabilities, and Roma organizations—it confirmed the importance of further engaging these communities in advocacy efforts.
Finally, the project benefited from an exceptional collaboration with the Ombudswoman for Gender Equality and her team. While this partnership was not unexpected, its positive impact was significant, particularly in raising the visibility of her work and ensuring greater public awareness of these critical issues.