The state of obstetric care system in the Russian Federation from the perspective of identifying reserves for reducing infant mortality within the current medical and demographic context
Kotova E.G., Papanova E.K.
Objective: To explore opportunities and propose measures to improve obstetric care in the context of the decreasing number of births and a slowing decline in infant mortality.
Materials and methods: The data source for the number of births at level 3 maternity facilities in the Russian Federation and its regions during 2012–2024 is the Federal Statistical Report No. 32 “Information on medical care for pregnant women, women in labor, and women who have just given birth”. The distribution of registered infant deaths by causes of death in 2024 is presented according to the data of the Federal Register of Medical Death Certificates of Unified State Information System in Healthcare. The bed occupancy rate of perinatal centers (independent legal entities) was calculated using the Federal Statistical Report No. 47 “Information on the network and activities of medical facilities”.
Results: The article presents a review of studies conducted by the Russian and foreign researchers on the impact of measures for improving the routing of pregnant women and the centralization of births in large maternity hospitals on infant and perinatal mortality rate in high-income countries with low infant mortality rate. It also assesses the state of the tiered obstetric care system, including the concentration of births at level 3 hospitals in the Russian Federation and its regions. Key opportunities have been identified to further reduce the indicator by improving the organization of obstetric care. The importance of appropriate routing of pregnant women and adequate resource allocation for improving the quality of medical care is emphasized.
Conclusion: In the Russian Federation, there has been a decrease in the number of births at perinatal centers and a reduction in bed occupancy. This suggests that it may be possible to increase the concentration of births, including preterm ones, in level 3 obstetric hospitals without additional resources. Key resources for reducing infant mortality in the context of declining birth rates include increasing the concentration of high-risk pregnancies and women in labour with premature births in level 3 perinatal centers. These measures will contribute to a decrease in the number of infant deaths, including those caused by specific conditions that arise during the perinatal stage.
Authors’ contributions: Kotova E.G. – developing the concept of the study, the discussion of the concept, writing the text, editing the article; Papanova E.K. – the discussion of the concept, data collecting and processing, writing and editing the text. All the authors have approved the final version of the article.
Conflicts of interest: The authors declare that there is no conflict of interest.
Funding: The study was not sponsored.
For citation: Kotova E.G., Papanova E.K. The state of obstetric care system in the Russian Federation from the perspective of identifying reserves for reducing infant mortality within the current medical and demographic context.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2026; (2): 5-15 (in Russian)
https://dx.doi.org/10.18565/aig.2025.383
Keywords
infant mortality
obstetric medical care
level 3 maternity hospitals
routing of pregnant women
centralization of childbirth
References
- Андреев Е.М. Неравенство в младенческой смертности среди населения современной России. Вопросы статистики. 2020; 27(2): 48-62. [Andreev E.M. Inequality in infant mortality among population of modern Russia. Voprosy statistiki. 2020; 27(2): 48-62 (in Russian)]. https://dx.doi.org/10.34023/2313-6383-2020-27-2-48-62
- Nolte E., McKee M. Measuring the health of nations: analysis of mortality amenable to health care. BMJ. 2003; 327(7424); 1129. https://dx.doi.org/10.1136/bmj.327.7424.1129
- Баранов А.А., Альбицкий В.Ю., Намазова-Баранова Л.С. Смертность детского населения в России: состояние, проблемы и задачи профилактики. Вопросы современной педиатрии. 2020; 19(2): 96-106. [Baranov A.A., Albitskiy V.Yu., Namazova-Baranova L.S. Child mortality in Russia: situation, challenges and prevention aims. Current pediatrics. 2020; 19(2): 96-106 (in Russian)]. https://dx.doi.org/10.15690/vsp.v19i2.2102
- Макаренцева А.О. Достижения перинатальной реформы и резервы дальнейшего сокращения младенческой смертности в России. Демографическое обозрение. 2023; 10(3): 62-81. [Makarentseva A.O. Achievements of perinatal reform and the capacity for further reduction of infant mortality in Russia. Demographic review. 2023; 10(3): 62-81 (in Russian)]. https://dx.doi.org/10.17323/demreview.v10i3.17970
- Poets Ch.F., Bartels D.B., Wallwiener D. [Patient volume and facilities measurements as quality indicators of peri- and neonatal care: a review of data from the last 4 years]. Z. Geburtshilfe Neonatol. 2004; 208(6): 220-5. [Article in German]. https://dx.doi.org/10.1055/s-2004-835868
- Sudo A., Kuroda Y. The impact of centralization of obstetric care resources in Japan on the perinatal mortality rate. ISRN Obstet. Gynecol. 2013; 2013: 709616. https://dx.doi.org/10.1155/2013/709616
- Merlo J., Gerdtham U.G., Eckerlund I., Håkansson S., Otterblad-Olausson P., Pakkanen M. et al. Hospital level of care and neonatal mortality in low- and high-risk deliveries: reassessing the question in Sweden by multilevel analysis. Med. Care. 2005; 43(11): 1092-100. https://dx.doi.org/10.1097/01.mlr.0000182484.14608.b9
- Heller G., Richardson D.K., Schnell R., Misselwitz B., Künzel W., Schmidt S. Are we regionalized enough? Early-neonatal deaths in low-risk births by the size of delivery units in Hesse, Germany 1990-1999. Int. J. Epidemiol. 2002; 31(5): 1061-8. https://dx.doi.org/10.1093/ije/31.5.1061
- Moster D., Lie R.T., Markestad T. Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units. BJOG. 2001; 108(9): 904-9. https://dx.doi.org/10.1111/j.1471-0528.2001.00207.x
- Grytten J., Monkerud L., Skau I., Sørensen R. Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality. Health Serv. Res. 2014; 49(4): 1184-204. https://dx.doi.org/10.1111/1475-6773.12153
- Kweon S.Y., Lee S.M. Conceptualized framework for levels of obstetric care. Obstet. Gynecol. Sci. 2018; 61(3): 289-97. https://dx.doi.org/10.5468/ogs.2018.61.3.289
- Handley S.C., Passarella M., Herrick H.M., Interrante J.D., Lorch S.A., Kozhimannil K.B. et al. Birth volume and geographic distribution of US hospitals with obstetric services from 2010 to 2018. JAMA Netw. Open. 2021; 4(10): e2125373. https://dx.doi.org/10.1001/jamanetworkopen.2021.25373
- Redshaw M., Rowe R., Schroeder L., Puddicombe D., Macfarlane A., Newburn M. et al. Mapping maternity care: the configuration of maternity care in England. Birthplace in England research programme. Final report part 3. NIHR Service Delivery and Organisation programme. London; 2011. 58 p. Available at: https://www.npeu.ox.ac.uk/assets/downloads/birthplace/Birthplace_Report_3_-_the_configuration_of_maternity_care.pdf
- Iida M., Horiuchi S., Porter S.E. The relationship between women-centred care and women's birth experiences: a comparison between birth centres, clinics, and hospitals in Japan, Midwifery. 2012; 28(4): 398-405. https://dx.doi.org/10.1016/j.midw.2011.07.002
- Kuitunen I. Delivery unit volume and neonatal mortality - A nationwide register study in Finland from 2008 to 2023. Eur. J. Pediatr. 2025; 184(5): 293. https://dx.doi.org/10.1007/s00431-025-06133-5
- Holowko N., Ladfors L.V., Örtqvist A.K., Ahlberg M., Stephansson O. Hospital obstetric volume and maternal outcomes: Does hospital size matter? Acta Obstet. Gynecol. Scand. 2025; 104(1): 55-67. https://dx.doi.org/10.1111/aogs.14980
- Zeitlin J., Mohangoo A.D., Delnord M., eds. European Perinatal Health Report: Health and care of pregnant women and babies in Europe in 2010. Paris: INSERM/Euro-Peristat; 2013. 252 p. Available at: https://www.europeristat.com/wp-content/uploads/2012/06/Peristat-2013-V2.pdf
- Satoh S., Itakura A., Ikeda T., Kurasawa K., Nakai A. The Perinatal Committee report: review of the progress of obstetric healthcare in Japan. J. Obstet. Gynaecol. Res. 2025; 51(7): e16354. https://dx.doi.org/10.1111/jog.16354
- Aoshima K., Kawaguchi H., Kawahara K. Neonatal mortality rate reduction by improving geographic accessibility to perinatal care centers in Japan. J. Med. Dent. Sci. 2011; 58(2): 29-40.
- Горев В.В., Михеева А.А. Маршрутизация беременных как один из путей снижения младенческой смертности. Здоровье мегаполиса. 2021; 2(3): 17-23. [Gorev V.V., Mikheeva A.A. Routing of pregnant women as one of the ways to reduce infant mortality. City Healthcare. 2021; 2(3): 17-23 (in Russian)]. https://dx.doi.org/10.47619/2713-2617.zm.2021.v2i3;17-23
- Мурашко М.А. Современные аспекты оказания акушерской помощи в регионе с низкой плотностью населения. Сыктывкар: Изд. Коми научного центра УрО РАН; 2005. 120 с. [Murashko M.A. Modern aspects of providing obstetric care in a region with low population density. Syktyvkar: Publishing house of the Komi Scientific Center of the Ural Branch of the Russian Academy of Sciences, 2005. 120 p. (in Russian)].
- Мурашко М.А. Опыт организации регионального перинатального центра в структуре акушерской и неонатальной помощи на примере Республики Коми. Российский вестник акушера-гинеколога. 2005; 5(6): 22-9. [Murashko M.A. Experience of organizing a regional perinatal center in the structure of obstetric and neonatal care on the example of the Komi Republic. Russian Bulletin of Obstetrician-Gynecologist. 2005; 5(6): 22-9 (in Russian)].
- Мурашко М.А., Котова Е.Г. Региональные аспекты акушерской помощи. Акушерство и гинекология. 2007; 5: 81-5. [Murashko M.A., Kotova E.G. Regional aspects of obstetric care. Obstetrics and Gynecology. 2007; (5): 81-5 (in Russian)].
Received 24.12.2025
Accepted 05.01.2026
About the Authors
Evgeniya G. Kotova, PhD (Medicine), Deputy Minister of Health of the Russian Federation, 127994, Russia, Moscow, Rakhmanovsky per., 3,https://orcid.org/0009-0005-2025-3157
Elena K. Papanova, PhD (Sociology), Head of the Department of Demographic Analysis and Reproductive Health, Russian Research Institute of Health,
127254, Russia, Moscow, Dobrolubov str., 11, e.papanova@mednet.ru, https://orcid.org/0000-0002-3288-4926
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