Obstetrics and neonatal care in small islands

Abstract

The promotion of a healthy pregnancy and safe childbirth is a major goal of most, if not all, health care systems. The WHO states that all women should have access to basic maternity care during pregnancy and delivery. Malta and Gozo have been monitored continuously thanks to the National Obstetric Information System and its predecessor projects. The data for a ten year period (1999-2008) was analysed for Malta and Gozo. The data was also analysed to compare with data collected from other similarly populated islands or states such as Gibraltar, Liechtenstein, the Shetland Islands and the Faroe Islands. The number of deliveries, island to island transfer, primiparous and multiparous rates, assisted and non-assisted deliveries, delivery complications and mortality rates of over 40,000 births were calculated for the Maltese Islands. The trends showed a gradual drop in birth rates in all islands with a stable and low complication rate. Primiparous births are becoming more common with the average age of the mothers slowly increasing possibly due to socioeconomic shifts. The numbers of single mothers is increasing drastically with a gradual decrease in births to married mothers mirroring this change. Assisted deliveries are becoming more and more common with the rates of caesarean deliveries increasing drastically over the past decade with no increase in maternal mortality. Malta and Gozo are both experiencing lower birth rates with the latter experiencing the lower rates. The socio-demographics of the maternal population are changing with more unmarried and older mothers giving birth to fewer children. The healthcare centres available in Gozo require an investigation into possible reforms. Data is needed to ensure that the most effective strategies for safe motherhood are integrated into essential service packages. Obstetric care in Gozo is comparable with that of other small island communities with similar populations and health systems.