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Women’s reproductive and maternal health care in Finland
– Reported, January 19, 2012
Good maternal and child care practices are contributing to low infant mortality rates in Finland. Health of a woman is followed up throughout pregnancy and follow-up visits after it with the newborn at the Maternity Health Care Clinics, and the new baby is similarly an object of physical, mental, and social observations by nurse and physician at the Well-Baby Clinics several times during the first year and at six or twelve-month intervals thereafter. Vaccinations are also provided and over 90% of the parents agree to have their children vaccinated.
Maternal health care was organized in 1944 and the law stipulated that one midwife should be available for an area of 5000 inhabitants and one for each 5000 inhabitants in a city (e.g. Turku has 16 visitation sites). The existence of midwives is a strong one and cited in feminist literature, with education of midwives since the 17th century.A pregnant woman living in Finland has the right to maternity and parental allowances when pregnancy has lasted at least 154 days and the potential mother has made the first visit to a maternal health care or personal physician before the end of the fourth month of pregnancy.The family allowance may be obtained as a package or as money (760 mk in 1999) and is per child so that having twins will bring two allowances, etc. Application for this allowance is to
be made two months prior to the estimated birth.
The maternity/parental leave is 263 days long, Sundays not included in the counting (105 for mother alone as maternity leave allowance, 158 for mother or father as parent, parent leave allowance). The maternity leave allowance is based on the existing or previous salary as is later parental allowance. Maternity allowance needs to be applied for two months prior to child birth.
Father is allowed paternity leave 12 days off paid immediately after the birth of the baby and 6 additional days off sometime during the mother’s maternity or parental leave. A father may also use the 158 days of parental leave instead of the mother using it. The allowance is determined in both cases by the existing or previous salary. If mother and/or father is not employed, the amount of the allowance is 60 mk/day. Following the birth of the child, a child living in Finland will be paid child allowance which is 535 mk/month for the first child and increases stepwise for the other children. While the allowances paid to parents are taxable
income, child allowance is tax-free and cannot be used to deduct payments. The parents need to have lived in Finland for 180 days prior to child birth in order to claim the needed allowances, and the father must be living with the mother in order to claim the paternity
allowance. There are no days of living restrictions for the child.
About 99% of the mothers attend the maternal health care, and there is a recommendation for 13-16 maternity health care visits with an uncomplicated first pregnancy and 9-12 visits in subsequent pregnancies, including two post-partum visits (Screening and collaboration in maternity care 1996). The City of Turku which is different in maternal health care from the rest of the country in that gynecologists are a part of it had about 17 visits per pregnancy in the 1980’s (Rautava 1985). While about 4 physician visits take place in normal circumstances elsewhere in the country and the rest are with public health nurses, women in Turku are referred to hospital physicians in problem issues only . Medical tests are mapped out for each week of pregnancy and visits with the physicians are reported to the woman’s own maternity health care center.
Sihvo and Koponen (1998) investigated how well the offerings of the health care services corresponded with the reproductive health care needs of the clients. A questionnaire was mailed to 3000 women (74% response rate) and 400 men (53% response rate). Almost all
women had visited a physician because of contraception at least once. The services were considered satisfactory, and no major shortcomings were found. The counseling at the maternal health care centers was requested to be changed and brought up-to-date. More
information was desired on fertility.Parenthood is considered among one of the greatest challenges in adult life, and education
should be offered so that one gains the most of it, referring to issues stated in the law of patient status and rights: integrating personal culture and language for all, minority groups included.
The average length of stay at a Finnish hospital during pregnancy and childbirth are 3.9 days.In Turku in 1996, most births (62%) were to women 25-35 years of age. Practically all of these mothers (97.3%) were Finnish citizens, 64.2% were married, 23.6% reported living in a marriage-like relationship without being married. Over 60% had none or one previous child.During the pregnancy, 77% of the women had reported having visited maternal health care 9-19 times, and 95% had had a routine check-up at the hospital out-patient clinic.
The thought that Finland should increase its population (Salmi 1995) is challenged by those who contribute to it, namely women. Education is considered one of the most effective birth control devices, and it is truly working well in Finland.Prevalence of contraceptive use among fertile Finnish women is high; it has been suggested that more than two-thirds of those 22 to 46 years of age use a condom or another method.The intrauterine device (IUD) was studied using a stratified random sample of 18-44 -year old women in the province around the capital of Finland in 1987-88. There was a high prevalence 77% for the use of this contraceptive. In all, 71% of those responsing to the survey considered it a good method of birth control.
There is no cheap, easy and quick way to detect ovarian cancer, the fourth common malignancy among Finnish women in 1995 (Engblom 1999). It is the leading gynecological cause of death among women. About 600 new cases are found annually, and often too late as
ovarian cancer does not have clear symptoms in early stages. Auranen (1996) studied familial occurrence of ovarian cancer and discovered that siblings have a 3.7 times higher risk.
Laine (1998) discovered that Finnish students displayed emotional loneliness of the three alternatives (global, emotional, social) without an apparent explanation to it. “We have company for social interaction but not true friends”, she suggested (Laine 1999, personal
communication with permission). To break out of a shell will require a set of positive things at the same time when to have positive things to happen will suppose activity. A kind person in between might help things along.
Old age and female gender are traditionally associated with a low frequency of sexual intercourse (Kivelä 1996) but it must be remembered that a sexual intercourse is only one form of sexual interaction, and the presence of a male partner is necessary in it. In those instances when a sexual partner was present, the reasons for a lack of intercourse included poor health and partner’s impotence (Kivelä 1996). When only a third of the women are married and have a potentially constant partner, it is expected that sexual needs in other cases may need to be satisfied in other ways than through sexual intercourse. There are also women who are willing to share a partner as they wish no longer to be married themselves. Understandably, a number of women also prefer the company of women for sexual purposes. A more important indicator than sexual intercourse may be the lack of desire reported by three of four women over 60 years of age or older. Kivelä (1996) reported that the older the woman was the less desire she felt. Estrogen replacement therapy can help those women to whom it is an acceptable method.
Finnish women appear to use hormone therapy less than five years (Topo 1997). The issue is still controversial as most physicians appear to consider this therapy self-evident and many women not necessarily so . A grass roots group of women has been meeting for years to discuss this issue .There is a physiological issue in maturity as it may take a longer time of caress for an older woman to reach orgasm, the orgasm may be shorter in duration and intensity, and the ability to achieve multiple orgasms may be reduced with age (Kivelä 1988). An issue worth mentioning is that with time, the sameness of caresses may lead to boredom and thus reduce sexual activity between partners. Hardly any researcher recognizes the fact that it may not feel worthwhile to attempt sexual satisfaction in relationships which are doomed to failure. The chances granted men to marry a younger partner are also not easily available to women, and even masturbation may be more difficult to allow for an older woman than for the male counterpart.
Credits:Dr. Ansa Ojanlatva,Dept. of Public Health University of Turku 20520 Turku 52 Finland
More information at:http://www.gesundheit-nds.de/ewhnet/Country_Reports/Finland.PDF
– WF Team