Maternal health education and infant care preparedness in Bulgaria: high coverage, limited content

Background

Infant mortality in Bulgaria remains above the EU average, despite high coverage of maternal health services. This suggests that potential shortcomings lie in the quality and content of perinatal support. This study examines maternal preparedness for infant care and assesses the extent to which the health system provides meaningful educational support before and after childbirth

Methods

A survey was conducted in 2023 among 249 mothers of children under one year in Bulgaria. Data were collected with a structured 30-item questionnaire covering maternal counseling and support through prenatal care, childbirth, and infant care. Maternal preparedness and knowledge were assessed using Likert-scale and categorical items. Data were analyzed with descriptive statistics and chi-square tests to examine associations between maternal preparedness and exposure to health services.

Results

While 97% of mothers attended prenatal consultations, 75.9% (95% CI: 70.1–81.1%) reported no counselling on newborn care. Advice was focused on delivery, with limited guidance on feeding, hygiene, and daily infant care. At discharge, 30% (95% CI: 25–36%) reported insufficient instructions. Postnatal support was inconsistent, with no home visits for 14% (95% CI: 10–18%) of newborns. Only 25% (95% CI: 20–31%) felt well prepared for infant care. Non-medical sources were more frequently used than professional advice. Lower-educated mothers more often reported no counselling (27.3% vs 9.9%; χ²=12.7, p = 0.002), indicating socio-demographic differences in antenatal support.

Conclusions

High coverage of maternal health services in Bulgaria is not matched by adequate educational support. This results in suboptimal preparedness for infant care and a reliance on informal information sources, even among higher-educated mothers. These findings point to systemic gaps in the quality and continuity of maternal education, highlighting the need for structured interventions across the perinatal period

Key messages

• High utilisation of maternal services does not guarantee adequate preparеdness for infant care.

• Missed educational opportunities across the continuum of care shift responsibility to families and may reinforce health inequalities.