Maternal trouble: why babies die in maternity hospitals
After the tragedy in Novokuznetsk, where nine newborns died during the New Year holidays, the rest of the maternity hospitals in the region were also checked. In recent years, huge amounts of money and government efforts have been invested in the development of the perinatal care system, and this has borne fruit — infant mortality has halved between 2015 and 2023. However, problems remain, and they are largely related to the low birth rate. Because of this, on the one hand, it is necessary to reduce small maternity wards that have remained unclaimed for a long time, on the other hand, the enlargement of maternity hospitals increases the risks of infection. For more information about the situation in Russian maternity hospitals, see the Izvestia article.
Infection despite the SanPiN
In Novokuznetsk, nine newborns died in maternity hospital No. 1 in early January. The information was confirmed by the Ministry of Health of the region. The Investigative Committee has opened a criminal case under articles on causing death by negligence and negligence, the chief physician has been temporarily suspended, Rospotrebnadzor and Roszdravnadzor are conducting their own checks. The exact reasons have not yet been named, but the maternity hospital was quarantined due to exceeding the threshold for respiratory infection.
Also, all maternity hospitals and perinatal centers in Kuzbass will be unscheduled.
Tatyana Butskaya, first deputy chairman of the State Duma Committee on Family Protection, Fatherhood, Motherhood and Childhood, stressed that only after the investigation it will be possible to say exactly what the causes of the tragedy are. However, she believes it could be an infection.
— Where did this infection come from? What norms were violated? After all, all the laws and SanPiN have been written, and they all require strict implementation," she told Izvestia. — I am sure that all maternity hospitals and perinatal centers, without waiting for the decisions of higher authorities, will conduct an internal audit today and will do everything to ensure that their medical institutions remain the safest place before the birth of a child.
The Ministry of Health of the Russian Federation informed Izvestia that a group of specialists from the National Research Medical Center of Obstetrics, Gynecology and Perinatology was sent to the Kemerovo Region for verification. Kulakov and St. Petersburg Pediatric University.
How many newborns die in Russia
The tragedy occurred despite statistics according to which the situation with newborn mortality has improved significantly in recent years.
It is better to look at the situation in maternity hospitals through the prism of the perinatal mortality rate — it takes into account both stillbirths and deaths of children in the first seven days of life. It follows from the collection "Healthcare in Russia 2025" that 4,720 children died in 2015 at the age of seven days. This is 2.43 per thousand births. In 2020, the figure dropped to 2,179 (1.56 per thousand births). In 2023 — up to 1560 (coefficient — 1.23).
Infant mortality (that is, between the ages of birth and one year) has also decreased significantly: from 12.6 thousand in 2015 to 5.3 thousand in 2023. Moreover, among its causes, infectious and parasitic diseases occupy only the fifth place. In 2023, 256 babies died as a result, compared to 484 in 2015. More often, children die from "certain conditions that occur in the perinatal period," that is, just in the first seven days — 2,464 children in 2023. This category includes intrauterine hypoxia, asphyxia during childbirth, birth injuries, as well as a number of disorders in the fetus and newborn, in particular hemorrhagic disorders.
As of 2022, according to Rosstat statistics, the highest infant mortality rate was in Chukotka — 15.8 per 1,000 live births. Although in absolute terms, this is one of the lowest rates — only eight children died there. The top ten "anti-leaders" also included the Republic of Altai, the Orel Region, the Republic of Dagestan, the Primorsky Territory, the Tver, Ryazan, Kurgan Regions, the Kamchatka Territory and the Chechen Republic. The Kemerovo region is in 11th place in this sad ranking with a coefficient of 5.8. The leaders had a coefficient of 3.1–3.5 deaths per thousand live births.
Back in 2020, Doctor of Medical Sciences, Professor of the Russian National Research Center named after Academician B. V. Petrovsky Valery Albitsky stated in his work that the reduction in infant mortality in the 21st century was the result of the implementation of the national Health project, as well as the overall strengthening of the material and technical base of maternity and childhood medical organizations, the development of perinatal centers, the appearance of high-tech equipment in hospitals, intensive care beds for newborns, etc.
Yan Vlasov, co-chairman of the All-Russian Union of Patients, also emphasizes that a significant role in this "was played by the creation of a network of perinatal centers, where personnel, technologies and modern care protocols are concentrated."
— This shows that systemic investments and proper organization of the service really save lives. But the tragedy in Novokuznetsk should be the reason for a substantive conversation about what solutions are needed today: from the modernization of maternity hospitals and the restoration of human resources to strengthening epidemiological control," the Izvestia interlocutor emphasized.
The Ministry of Health emphasized that in Russia, infant mortality has been decreasing annually over the past few years, with positive dynamics recorded in all regions of the country. With the current infant mortality rate (3.6%), Russia belongs to the group of countries with the lowest values in the world.
"The availability of medical care for pregnant women, women in labor, and women in labor is ensured through a three—tier obstetric service," the ministry explained to Izvestia.
Vladimir Klimov, Chief freelance obstetrics specialist at the Russian Ministry of Health, noted that 141 third—level medical organizations in the country provide perinatal care - these are institutions that can provide medical care to women and newborns in the most difficult clinical situations.
According to him, the national Family project is currently re—equipping perinatal centers and obstetric hospitals, creating and expanding a network of women's clinics, "especially in rural areas."
Is the enlargement of maternity hospitals to blame
Yan Vlasov believes that such tragic situations most often turn out to be the result of decisions on "thoughtless optimization of the bed stock and space," as well as a chronic shortage of medical personnel, primarily middle—level and specialized specialists.
Indeed, in the past few years, there have been repeated reports of the closure of maternity wards and entire maternity hospitals in different regions of the country.
The Ministry of Health told Izvestia that they had "repeatedly denied information about the closure of maternity hospitals."
— Today, there is no closure, but on the contrary, the opening of new perinatal centers and obstetric hospitals as part of multidisciplinary hospitals, for example, a city perinatal center based on the 7th city hospital has been opened in Kazan, and a perinatal center based on a clinic in Kommunarka has been opened in Moscow, — said Vladimir Klimov. — The number of newly introduced obstetric hospitals in the country will only increase, and specialized care will be provided at a higher level.
However, the statistics published in the collection "Healthcare in Russia 2025" confirm the negative trend: if in 2015 there were 69.4 thousand beds in various medical institutions for pregnant women, women in labor and women in labor in the country, then in 2024 there were only 48.2 thousand — the number is consistently decreasing. Moreover, the decrease occurs both in absolute terms and per 10,000 women aged 15-49 years — from 19.4 in 2015 to 14.2 in 2024.
It reflects statistics and problems with the number of medical staff. If the number of obstetricians and gynecologists from 2015 to 2024 remains at 5.4 per 10,000 women, then the number of midwives (this is already the average medical staff) has sharply decreased — from 57.3 thousand to 47.7 thousand (7.3 and 6.1 per 10,000 women, respectively).
Medical workers interviewed at the request of Izvestia, who are members of the closed professional community Doctors of the Russian Federation, indicated that the enlargement of maternity hospitals — when small maternity hospitals are closed and all women in labor are redirected to regional or large district centers — can also contribute to the spread of infections.
"The fewer births there are in the hospital, the fewer cases of nosocomial infection and the more attention each patient receives. The larger the hospital, the more problems there are. With a heavy load on the hospital, the number of nosocomial infections will increase. And what will they do when it is necessary to close this large maternity hospital for prevention, where to send patients?" wrote one of the interviewed doctors.
Yan Vlasov also points out that the spread of nosocomial infections is facilitated by outdated material and technical facilities and buildings that do not meet modern sanitary requirements, as well as a shortage of epidemiologists and infection control specialists.
— The structure of medical care-related infections (ISMS) most often includes pneumonia, postoperative infections, purulent-septic complications in maternity hospitals and newborns, as well as airborne infections. All this suggests the need to review approaches to the organization of inpatient care, infection safety and staffing," he said.
A necessary measure
However, the closure of small maternity hospitals is recognized as a necessary measure by the doctors themselves. One of the members of the Doctors of the Russian Federation community spoke about the closure of the maternity hospital when the number of births dropped to 30 per year. All this time, the staff of the shift on duty came to work, in fact, "to eat, sleep and wash." At the same time, there was no anesthesiologist in this hospital, which excludes the possibility of a cesarean section.
— The nearest maternity hospital is 100 km away on asphalt. In another CRH, the maternity hospital was closed even earlier — it's a 20-30-minute drive to the two nearest city maternity hospitals on good asphalt. This is the right decision — a midwife who delivers four to five babies a year is not serious," the source told Izvestia.
Another medical worker said that in his region, of the five maternity hospitals in the regional center and 18 in the districts, two remained in the regional center and one in the district. It was impossible to find funds for the maintenance of institutions without an adequate workload, medical staff could not receive normal salaries, and skills were seriously declining.
Tatiana Butskaya emphasizes that the enlargement of maternity hospitals is precisely related to this: a small maternity hospital in which one birth takes place in 10 days is "a very dangerous story."
But there are no simple solutions to this problem, experts and doctors emphasize. Sergey Rybalchenko, Chairman of the Public Chamber's commission on demography, protection of family, children and traditional family values, notes that childbirth, of course, requires qualified and technological assistance, but at the same time it should take place as close as possible to the place of residence. The current situation with maternity hospitals complicates logistics for the family.
"This requires a set of solutions to support families, especially families where several children are being raised and a third and subsequent child is being born," he believes.
Sergey Rybalchenko notes that one of the additional factors worth paying attention to here is the size of the birth certificate (a document providing free medical care to a woman in labor, which is issued at a women's clinic). Since 2007, its size has changed only once, increasing by one thousand rubles. Now it is 12 thousand rubles, but taking into account inflation for this period it should be at least 33 thousand rubles.
— The birth certificate allows for flexibility and variability in the financing of prenatal care, childbirth and postpartum care for women, — said Sergey Rybalchenko. — We have repeatedly raised this issue, and we believe that it should be resolved. This could serve to develop the entire system, including private clinics, and enable a woman to choose a place where childbirth can take place.
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