Maternal mobility and infant mortality in Greece: a regional analysis

The paper is an attempt to analyse the pattern of cross-boundary flows to maternity clinics. The question is whether the expectations of expectant mothers who often travel long distances in order to give birth can be (i) explained by the lack of adequate levels of care in the out-flow areas, and (ii) justified in terms of birth outcomes. Infant mortality is used as a measure of the effectiveness of medical care. The results show that maternal mobility is indeed the result of inadequate provision of services. However, regional variations in infant mortality do not relate to availability of medical care. Mortality rates among infants born in the areas with net outflow of births are lower than the national average, while better-equipped areas experience higher infant mortality rates. Moreover, expectant mothers that move to Athens and Salonica (the main receiving areas) from the net outflow areas seem to face worst survival chances for their babies than those who stay. The nature of data does not permit control for risk factors and obstetric histories. However, it is argued that the sheer scale of maternal mobility and infant mortality differentials revealed in the paper imply that the possibility that moving itself significantly increases the risk of infant mortality should be looked at more carefully. The paper recommends the introduction of health policy initiatives in provincial Greece, aimed at increasing availability, improving standards and restoring public confidence to locally available medical services. The standards of care in maternity clinics should also be subject to audit mechanisms. It is finally necessary that maternal mobility is confined to cases for which good medical reasons exist.