When the maternity wards of Põlva and Valga hospitals were closed five years ago, the number of births in the nearby South Estonia Hospital in Võru went up to over 500 in 2021. However, it dropped again in what is now the only hospital with a maternity ward in Southeast Estonia, to 450 children in 2022, whereas there have been around 100 fewer births still this year, said Agnes Aart, chief of medicine for the South Estonia Hospital.

"We can perhaps set 300 annual births as the critical limit in terms of when maintaining a maternity ward becomes unreasonable from the hospital's point of view, and from where it becomes very difficult to ensure high-quality childbirth and postnatal care."

But Aart added that any such decision needs to be carefully weighed as it affects the general availability of healthcare in the region.

"Unfortunately, closing maternity wards would also see the disappearance of gynecologists. It is on-call work and 24-hour shifts that allow us to keep specialists in the area – we often also lose access to out-patient obstetrical care and appointments," Aart said.

There are currently 12 hospitals in Estonia offering childbirth care, while all of them have been seeing fewer births in recent years, said Heli Paluste, head of the healthcare network for the Ministry of Social Affairs.

"Fewer than 300 babies were delivered in the Järva County, Kuressaare, Viljandi and Narva hospitals in 2022. These are the starkest examples of small hospitals seeing fewer births. Their managers and owners have some thinking to do in terms of how to maintain and develop these services in a way to ensure enough staff and make sure the hospital can cope financially," Paluste said.

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