countries, the WHO definition was introduced long before the lifting of the ‘Iron Curtain’, and after 1994, when Poland adopted the WHO definition, Bulgaria was the only European country outside of the CIS where the Soviet definition persisted.4 Table 3 shows, however, that in several CIS countries, the Soviet definition was still recently in use. Indeed, in those CIS countries where the definition of live birth was changed during the 1990s to move towards the WHO definition, it was done in a rather limited way. In Russia for example, a decree titled “On shifting to WHO definition of live birth and foetal death” (see Appendix II) was issued in 1992 by the Ministry of Health and Goskomstat. This defines as live birth a birth that shows any sign of life at any gestational age. However, the same document states that registration with the Civil Acts Register (ZAGS – Zapis ob Actah Grazhdanskogo Sostoyania), used in the calculation of official infant mortality statistics, shall be done only for the following: • live births and stillbirths with birthweights of 1000 grams or more (or, if birthweight is unknown, length of 35 cm or more and period of gestation of 28 weeks and more) • all infants with birthweight between 500 and 999 grams who survive 168 hours (7 days). Thus, infants weighing less than 1000 grams who die within seven days, even though they are considered live born, are supposed to be registered only in medical documentation of the health facility where birth and subsequent death have taken place, but not in the civil register. Therefore they are not counted in official statistics.5 4 In Bulgaria, a variation of the Soviet definition applies: infants who weigh less than 1,000 grams are counted as miscarriages if they survive less than seven days; length and gestational age are not taken into account. In addition, all life signs, rather than just breathing, are seen as valid signs of life. 5 Indeed it has been suggested that little may be done to keep infants with a birthweight of under 1,000g alive. A recent item in a Moscow newspaper reads: ‘Aleksandr Baranov, director of the Russian Academy of Medical Sciences Center for Children's Health, said that the low quality of health care in Russia has caused the infant mortality rate to grow "continuously." Further, he said the Duma must pass the draft law "On the Security of the Health of Children in the Russian Federation" to protect premature babies. In Russia, children born weighing less than one kilogram are not registered in the Civil Registrar's Office unless they live more than 7 full days. Until a child in that weight category is seven days old, he or she is not eligible to receive expensive intensive care treatment.’ (“Doctor Lobbies for Lower Infant Mortality Rate” Vechernyaya Moskva 17 October 2003). 8 Table 3: Definitions of live birth in CIS countries (Autumn 2003) Legal instrument Registration in medical documents Civil Acts registration Belarus Decree of Ministry of Health and State Statistical Committee (1993) Georgia Decree of Ministry of Labour, Health and Social Affairs, Ministry of Justice and Committee of Social Economic Information (1993) Live birth: birth of product of conception, with birth weight greater than 500 grams (or length of 25 cm or more or born after 22 or more weeks of gestation) that breathes or shows any other evidence of life. Stillbirth: Birth of a baby showing no sign of life who weighs at least 500 grams at birth (or has a length of 25 cm or more or born after 22 or more weeks of gestation) Armenia Decree Ministry of Health (1994) Kyrgyzstan Instruction of Ministry of Health (2002) Moldova Decree of Ministry of Health and State Department on Statistics (1995) Russia* Decree of Ministry of Health and Goskomstat, (1992) Ukraine Decree of Ministry of Health (1996) Live birth: birth of product of conception, with birth weight greater than 500 grams that breathes or shows any other evidence of life. Stillbirth: Birth of a baby showing no sign of life who weighs at least 500 grams at birth. All live and still births with birth weight greater than 1000 grams (or with length of 35 cm or more, or born after 28 weeks of gestation) All newborns weighing 500-999 grams if they survive 168 hours after birth (7 days) Azerbaijan Soviet definition still in use for both medical and civil acts registration. Decrees soon to be issued for the adoption of WHO definition of live birth Kazakhstan Soviet definition still in use for both medical and civil acts registration. WHO definition of live birth definition is used in two pilot regions (Almatinskaya oblast and Almaty city) Tajikistan Soviet definition still in use for both medical and civil acts registration. Transition to WHO definition of live birth being discussed. Uzbekistan Soviet definition still in use for both medical and civil acts registration. WHO definition of live birth is being used in one pilot oblast Turkmenistan Soviet definition still in use for both medical and civil acts registration. Date for transition to WHO definition of live birth has not been set * According to Information Note of MOH of Russia (2002) “On statistical counting of infant born before 28 weeks of gestation and with birth weight of 1000 gram and more surviving perinatal period (168 hours)”, any termination of pregnancy before 28 weeks of gestation are completed is classified as an abortion regardless of outcome. Thus, if child is born before 28 weeks of gestation are