Gaps, demands and fragmentation – exploring the marketisation of Finnish maternity care

BACKGROUND: Public maternity services are considered a source of pride in Finland. They comprise of publicly funded community-based clinics that are free at the point of delivery. The services play an important role in the care of the pregnant parent and the monitoring of foetal growth and development. However, maternity services have not been immune to the strains faced by public services, such as funding cuts and staff shortages. Over recent years, an increasing number of private providers have begun to offer maternity care. These include large healthcare companies and small midwife-led services. The aim of this study is to better understand various developments fuelling the maternity service market in a country that offers free maternity care. This study provides new insights from the perspective of professionals providing private services. I ask: what needs are private providers attempting to respond to and how? Additionally, I explore the role of private services in creating new demands and how the expanding market may contribute to the fragmentation of maternity care. METHODS: The materials consist of individual interviews with health professionals (n = 20) conducted during the spring of 2023 and analysed using thematic analysis. RESULTS AND CONCLUSIONS: Preliminary findings suggest that private providers are attempting to respond to needs that are currently neglected by the public sector. These include a gaps in specialist care, emotional care and care quality. Hence, those with disposable income are able to purchase services and products that are not available in the public sector. The existence of this market also contributes to the growing demand for laboratory tests, screening and ultrasounds without medical indication. Expectant parents use private and public services in various combinations, but a lack of formal collaboration between different service providers can lead to fragmented care if health information is not shared between professionals. KEY MESSAGES: • Finnish maternity services are expanding and diversifying as increasing number of private providers begin to offer pregnancy care. • Private services attempt to respond to expectant parents’ wishes. However, market expansion can also contribute to the increased demand for screening and the fragmentation of care.