The rising impact of civic activism on health policy: The analysis of the closure of smaller obstetric units in Estonia.

In 2017, the Estonian government performed an administrative reform with the promise to keep vital services available for people. In March 2018, the closure of two smaller obstetrics units (OU) was announced, thereby raising resistance by community members. The aim of the research is to identify public perceptions and information needs during the closure process of smaller maternity units, and examine it in the context of recently performed administrative reform. Data was collected from 226 respondents via a web-based questionnaire. To evaluate the level of information seeking activity for pregnancy- and birth-giving-related information, new aggregated index variables were constructed. For authorities and lay-people "near home" and "safety" had different meanings in the context of childbirth. Findings revealed strong correlations between perceived information availability and sufficiency (for pregnancy, birth-giving and transfer to the hospital). The subjective lack of information appeared in recognition of the start of the labour and how, when, and where to go. Respondents considered both the medical capability and personal aspects to be equally important. Considering the lack of knowledge and hesitancy among Estonians, the arguments of civic activists presented in the debate were well-grounded. To conclude, public communication must be consistent and people need clearer instructions for activities related to labour-period and security that necessary features of medical help and personal approach to be both available.

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Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.

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Declaration of Competing Interest The authors declare that they have no competing interests.