The statistics are alarming and can no longer be ignored. Birthrates dropped by 2 percent in Sofia and 27 percent in Vidin since the beginning of the year, and the total number of births for the year is expected to reach record-low levels.

Meanwhile, birthing women are not yet at the center of healthcare services as recommended by the World Health Organization and the International Federation of Obstetrics and Gynecology. This is obvious both by the 40 percent rise in planned cesarean sections, and by the disturbing stories of traumatic births that women shared with the Rodilnitsa association.

Because of this, a new project was launched in June 2015 with the goal of consolidating the efforts of NGOs working in the field and improve the services provided to mothers and their babies. The "Strategy for a Long-Term Advocacy Campaign for the Respect of Human and Civil Rights in Maternal Healthcare" is implemented by Rodilnitsa and the Parents for Parents Foundation and is funded via the 2009-2014 NGO Program in Bulgaria under the Financial Mechanism of the European Economic Area.

The activists involved in the project come from a wide range of NGOs, including Estestveno Association, Bulgarian Maternity Support Workers Association, Poppies for Mary Foundation, Friendship Foundation, Our Premature Babies Foundation, Bulgarian Helsinki Committee, Alliance of Bulgarian Midwives and Support for Breastfeeding Association.

Towards better care

The organizers from Rodilnitsa and the Parents for Parents Foundation call for accessible and respectful care that uses proven medical methods and rejects outdated and harmful practices. An ever-increasing number of mothers and families in Bulgaria seek such care and now more doctors and hospitals are ready to provide it.

"The goal of this project is to bring together all these organizations so they can participate more effectively in the decision-making processes in maternity healthcare and to assist the responsible authorities in dealing with the problems identified," said Nelly Mutafova, vice-president of Rodilnitsa.

Miglena Delcheva, manager of the Parents for Parents Foundation, believes the NGO sector is vital to improving care:

"It is important to note the positive steps that the Ministry of Health has taken - such as the investigation undertaken by Executive Agency Medical Audit in some maternity wards in the country. However, it is necessary to point out the problem areas as well - the good intentions that fail to be implemented. This is where the NGO sector comes in – it supports the Ministry of Health in the imposition of good maternity care policies based on scientific evidence and carried out with respect for mother and baby."

Lawyer Elena Ateva, a member of Human Rights in Childbirth’s board of directors, explained that in recent years, there is a global movement for respectful maternal care, which brings together experts working on the issue - parents, doctors, midwives, activists, lawyers and politicians.

She cited recent recommendations of the International Federation of Obstetrics and Gynecology, under which "every woman has the right to a positive birth experience and to dignified, compassionate care during childbirth. Every mother and every newly born baby should be protected from unnecessary interventions, practices and procedures that are not evidence-based."

Conversation starter

In addition, lawyer Daniela Fartunova of the Bulgarian Helsinki Committee said, "The Health Act provides that every woman who is pregnant, in childbirth or has already given birth has the right to services that will ensure her and her child’s optimal health and living conditions."

Despite the legislation, however, the rights of birthing women are systematically violated, because there are no real mechanisms for the protection of their rights. The mother’s informed consent or refusal is often ignored by the medical team, so the woman gives birth without being accompanied by a person close to them, and is separated from her child in the hours immediately after birth. Fartunova refered to the Charter of the universal rights of pregnant and birthing women and stressed the fact that the project will trigger a dialogue between civil society organizations and the responsible institutions.