Neoliberal Policy Impact on Health Care Provision for Parents of Very Preterm Infants in Portugal: A Mixed-Method Approach

  • Julia Nadine Doetsch
  • Sandra Marques
  • Ricardo Almendra
  • Raquel Teixeira
  • Elsa Lorthe
  • Henrique Barros
Keywords: Health Care, Parents, Preterm, Maternal health, Neoliberal policy, Mixed-Method, Policy analysis, Portugal.


Background. The Troika bailout programme under neoliberal policy, comprising health care reforms and austerity measures for the National Health System (NHS), was implemented by the Portuguese Government (2011-2014) to economize non-essential health care costs. In the post-era of neoliberal policy implementation, we aimed to evaluate its perceived impact on maternal health care provision for mothers giving birth to very preterm infants (VPT) in Porto and Lisbon, Portugal.

Method. A mixed-method approach of policy and qualitative analyses was used. The Bacchi (2012) “WPR-approach” on policy analysis was applied to the “Programa Nacional de Saúde Materna e Infantil” (2006). Qualitative data was collected between April-July 2018 comprising: i) 4 Focus Groups with 11 parents and 6 health care professionals (HCP); ii) 8 in-depth interviews with policy makers and HCP; iii) 6 Video Stories encompassing 14 videos and 5 debriefing interviews with parents. Parents of the EPICE-PT cohort and HCP involved in maternal care were selected according to their response rate (email and phone) and recruited until the saturation point was achieved. A content analysis on qualitative data was performed using Nvivo2011 software. Retrieved data from policy and quality analysis was categorized into the WHO ”Conceptual framework for action on the social determinants of health” (Solar & Irwin, 2010).

Results. The policy analysis highlighted the need of specific and tailored care for VPT infants in policy regulations and detected an inadequacy of guidelines on postnatal care. Qualitative data disclosed inadequate provision of maternal health care. Main detected barriers were the lack of: i) preventive measures and initiatives; ii) adequate prenatal follow-up; iii) communication between doctor and patient; iv) pre- and postnatal psychological support. Maternal health care provision in public hospitals was evaluated to be unsatisfactory (e.g. overcrowded rooms, overworked staff). Privatization measures were found to be associated with complicating provision of healthcare services for mothers of VPT infants due to i) increased working hours; ii) decentralization of health facilities and; iii) cuts in: healthcare staff, salary, benefits, and health care resources and investment.

Conclusion. Neoliberal policy with privatization, budget cuts, and health care reforms, was found to have impacted health care provision for parents with VPT infants in Portugal. Stronger emphasis should be laid on prenatal care by providing psychological support for parents and their families, information guidelines, increased communication, and intensive pre-and postnatal follow-up care. The authors recommend specific tailored national policies for parents with VPT infants and enhancement of home support for the family.