SARAJEVO — Magdalena gave birth to two children at the same state-run hospital in Sarajevo, and both times the 38-year-old gave the doctor envelopes.
Inside was the equivalent of 150 euros ($170). Even though state-run health care should have covered all the costs, Magdalena, who requested that her last name not be used and did not want to specify which hospital she received treatment in, handed over the cash, as she put it, “to ensure better treatment during childbirth.”
According to Magdalena, the physician told her the money wasn’t necessary, but took it anyway.
The cash, however, seemed to do the trick.
“The doctor was present at both births, not the midwife. I am also grateful to have received full anesthesia for suturing,” Magdalena recounted recently to RFE/RL’s Balkan Service.
“After the children were born, [the doctor] brought me his cell phone to call my family. They treated me differently from other mothers. I don’t feel sorry for what I did, and I would do it again,” Magdalena added unapologetically, saying she is not alone.
According to Magdalena, such payments, or bribes, are normal in Bosnia — a form of extra insurance to ensure better care.
And at least one survey backs her up.
Some 1 million euros in bribes were given in maternity wards in Bosnia-Herzegovina last year, according to a survey by Baby Steps, an NGO in Bosnia battling to end to “corruption in childbirth.”
The survey of 2,713 mothers from across the entire country found that 50 percent had given money or a gift to medical staff. The average payment was the equivalent of 70 euros.
The survey indicates widespread corruption at maternity wards across Bosnia, with every other birth tarred by it, said Amila Tatarevic, president of Baby Steps.
Staff at some maternity wards actually made it clear that such payments should be made, while in other cases families handed over the envelopes without such suggestions, fearful from the stories and rumors they had heard if they didn’t, Tatarevic explained to RFE/RL.
The results of the survey were shared with Health Ministry officials at the national and regional levels, as well as with maternity wards, Tatarevic said, adding that the response was less than overwhelming.
“We received a few answers [from officials], most stating that there have been no reports of corruption in the last 10 years. So, we have 15,000 births linked with corruption, and there are absolutely no reports of that. That in itself tells us just how big a problem we have,” Tatarevic continued.
Overall, corruption, if not rampant, is very prevalent across Bosnia. With a score of 35, the country is a significant decliner in the region, dropping seven points since 2012 in Transparency International’s CPI 2020 index on global corruption.
RFE/RL contacted the Dr. Abdulah Nakas General Hospital in Sarajevo to inquire about possible bribery in its maternity ward. The hospital said it had no such reports, but added it was taking measures to prevent it.
“An anti-corruption team has been formed at the hospital. Anti-corruption material has been placed at eight locations in the hospital, together with forms for reporting corruption, and detailed instructions on how and to whom to report corruption in the hospital,” the hospital said in its response to RFE/RL.
The Srbija Hospital, located in East Sarajevo in Republika Srpska, the Serb-dominated entity in Bosnia-Herzegovina, said patients had not complained about bribery in its maternity department.
“Therefore, there was no need to take any steps. In cases of corruption, the Srbija Hospital will take all necessary steps to launch disciplinary proceedings,” the hospital told RFE/RL.Everyone is expecting that envelope. We live where we live, and we need to be aware of that.”
While not addressing the claims of corruption, some health officials did note a uniform system for reporting corruption was adopted in October when directors of health centers gathered.
Research by the Baby Steps NGO shows that many mothers in Bosnia are so traumatized during their first childbirth that they are put off having more children.
Vesna, who didn’t want her last name to be used, gave birth to three children at the same maternity hospital in Sarajevo as Magdalena. After experiencing what she described as a “traumatic experience” with her first child, she made sure to pay bribes for the next two.
“The only time I didn’t give money to the doctors, I got into trouble. When a doctor is scheduled to deliver your child, they need to be [bribed] in advance. I didn’t know that and I think I suffered for not handing over money. It was a disaster,” Vesna, 38, recounted to RFE/RL.
“I was not told why I was going into induced labor and what medications they were using. I was terrified. The doctor came in a few times during childbirth and in the end sutured me without any anesthetic,” Vesna continued.
For her next two births, Vesna decided to pay the doctor and nurse attending to her the equivalent of 200 euros.I was not told why I was going into induced labor and what medications they were using. I was terrified. The doctor came in a few times during childbirth and in the end sutured me without any anesthetic.”
On average, people in Bosnia pay the equivalent of 60 euros a month for state-run health insurance. That’s no small amount for most people. The average monthly gross salary amounts to the equivalent of 500 euros.
Like the other mothers who spoke to RFE/RL, 32-year-old Sanja from East Sarajevo, who didn’t want to give her last name or specify the name of the hospital, also handed over an envelope to medical staff when she gave birth four years ago.
Technically, it was her husband, Sanja noted, who did the giving. The amount was the equivalent of 100 euros, paid to the doctor attending to her.
“Everyone is expecting that envelope. We live where we live, and we need to be aware of that. The doctor who managed my pregnancy was not on duty at the time. I paid because I wanted her to birth my baby. She wasn’t scheduled that day, but she came in and was there for my birth. She didn’t ask, but I think that goes without saying because otherwise she wouldn’t have come in,” Sanja explained.
Senad Saric, a specialist in gynecology and reproductive medicine, has worked for years at a hospital in Mostar, a city in southern Bosnia. Saric is currently working in a private practice and says he has never witnessed corruption in a maternity ward firsthand, although he admits the practice is ubiquitous in the Balkan country.
“I’ve worked for years and not once have taken [money]. That is, however, not always the case here. There is a custom to symbolically honor, but it is a trifle, and here in Mostar it has never been widespread,” Saric explained. “As for the maternity hospital in Sarajevo, I know that there are rumors about paying for a caesarean section and other things. That is incomprehensible to me. Whoever does that should be held criminally responsible,” Saric said.I’ve worked for years and not once have taken [money]. That is, however, not always the case here. There is a custom to symbolically honor, but it is a trifle, and here in Mostar it has never been widespread.”
The Bosnian Health Ministry did not respond to requests for comment from RFE/RL on the allegations of bribery in maternity wards.
The experience of giving birth three times in state-run hospitals prompted Amira Cerimagic to have her fourth child at home, definitely not the norm in Bosnia.
“It is undefined in Bosnia. That is, [home births] are this gray area. I went through the formal process to ask hospitals for this possibility, but I knew ahead of time that [my request] would be rejected. It is not forbidden, but you can’t find medical staff, nor is that option available,” Cerimagic, now a volunteer at Baby Steps, explained. “I finally did give birth at home, and the midwife — that is, the man, ‘baban,’ as I call him — was from the European Union and lives in Slovenia.”
Frustrated with her ordeal to have the right to give birth at home, Cerimagic appealed to the Bosnian Constitutional Court, claiming her human rights had been violated.
After the country’s highest court rejected her case, Cerimagic turned to the Strasbourg-based European Court of Human Rights. That request is now being considered.
Meanwhile, Baby Steps has launched an online petition “for childbirth without fear and ‘additional’ costs.” It said thousands have signed already.
The NGO says all mothers deserve professional and dedicated staff and a dignified birth without “additional costs.”
“Corruption threatens basic human rights because it creates inequality in the treatment of mothers,” Baby Steps said. “Accepting bribes is a crime that should be recognized, discouraged, and sanctioned.”