Bulgaria’s state healthcare system is struggling to support pregnant women who lack health insurance, according to a report from the Bulgarian National Audit Office. The country has one of the smallest preventive health budgets in the European Union, making it difficult to assist its most vulnerable citizens.
Approximately one million working-age individuals, or about 25% of the population, do not pay health insurance. This group primarily includes people from the large Roma minority, informal sector workers, and those permanently out of the labor market.
The National Audit Office’s report highlights that many pregnant women in Bulgaria have not had any check-ups during their pregnancies. Additionally, they have not utilized the resources available through the state program. The report attributes this lack of participation to low education levels, poor health and social status, ineffective information campaigns, and inadequate outreach to help pregnant women access state medical care.
Only 40% of uninsured pregnant women have taken advantage of the state-funded medical check-up program. This percentage dropped to 37% in 2022.
New Healthcare Measures
Starting January 1, 2023, the state will cover up to four preventive check-ups per year for uninsured pregnant women. They will also have the right to hospital care for high-risk pregnancies, up to twice a year. However, funding for advanced examinations and consultations to detect congenital anomalies in uninsured pregnant women is not being fully utilized.
A study by researchers at the National Statistical Institute, published in August 2024, reveals significant disparities in life expectancy among different ethnic groups in Bulgaria. Ethnic Bulgarians live an average of six years longer than Roma individuals, who represent about 10% of the population. Bulgarian women have an average life expectancy of 78.6 years, compared to 76.9 years for Turkish women and just 71 years for Roma women.
In 2021, a Eurostat study ranked Bulgaria as one of the EU countries that invests the least of its GDP in health prevention, at only 0.28%. Slovakia ranked last at 0.12%, with a similar proportion of Roma in its population.
Lack of Awareness and Education
The audit report criticizes the state for not funding effective education and awareness campaigns. Such initiatives are crucial for informing the population, especially in rural areas and among vulnerable groups, about health promotion and the benefits of available programs. Improved awareness could help reduce maternal and infant mortality rates.
Maternal and Infant Health Concerns
Bulgaria’s maternal and child health indicators remain below the EU average. Although infant mortality rates dropped by 4.6% from 2010 to 2022, the country still reported 3.3 deaths per 1,000 live births in 2022—the highest rate in the EU, trailing only Romania and Slovakia.
Data from the National Health Insurance Fund for 2023 show that many Bulgarians skip preventive check-ups, despite them being mandatory for insured citizens. Only 41% of people over 18 attended a preventive check-up last year, a slight increase from 36% in 2021.
While health check-ups are legally required, there are currently no penalties for those who choose not to participate.
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