Finland enjoys a high international reputation for its maternity and child care facilities. The Finnish maternity and child care system is unique in the world, reaching 99 percent of all families residing in Finland. It dates back to the 1920’s when pediatrics professor Arvo Ylppö initiated the first maternity clinics. After the Second World War special legislation was passed to establish free-of-charge municipal maternity care for all pregnant women. The underlying thought of the legislation was to look after the medical health of the mother and the child and thus promote the birth of more babies, who would then grow to be healthier children and adults than in previous generations.

The effects of this new maternity and child care system were, and still are, enormous. Modern Finland has one of the lowest infant mortality rates in the world. Life-threatening diseases, such as polio and whooping-cough, have been extinct from Finland for generations thanks to the nation-wide vaccination programs offered by child care clinics.

Today maternity and child care clinics operate as a part of the Finnish national health care clinics, and are regulated by nation-wide guidelines. The aim of these services continues to be to ensure the health of pregnant women and young children. However, many changes have taken place in the practices and aims of both these clinics as Finnish society has changed.

What are the practices and aims of Finnish maternity and child care clinics? How has their role changed in recent years as Finnish society has developed? What are their modern applications?

The Clinics' Role in Massively Reducing Infant Mortality During the 20th Century

The achievements of Finnish maternity and child care clinics can be clearly observed by looking at statistics of infant mortality rates in Finland over the past century. At the beginning of the 20th century, 153 infants out of 1000 died — 15.3 percent of all babies born in Finland. This number may seem surprisingly large, but can be explained by the fact that in those days Finland was a rural society with a largely poor population which was separated by long distances. Most Finnish women of the time did hard, physical labor even if they were pregnant. The delivery usually took place at home; in most cases no doctors or medical personnel were available if something went wrong. Moreover, doctors' fees were too expensive for the peasantry, and there was no public health care system to cover the costs. Even if a family could afford a doctor, it was likely that the closest one would be hundreds of kilometers away.

In the 1920s, when Arvo Ylppö initiated the first maternity clinics, the figure was still alarmingly high, at 9.6 percent. After the clinics had operated for a decade the number had gone down to 7.5 percent. In 1940 the infant mortality rate rose again, to 8.8 percent, most likely due to the Second World War. In 1940 Finland was fighting a war with Russia, the economic situation of the country was poor, and most doctors and nurses had their hands full taking care of wounded soldiers and civilians. There were simply no resources to take care of pregnant women and their babies.

After the war, special legislation was passed to guarantee free-of-charge maternity care for all Finnish women. The effects were enormous. By 1950, infant mortality rate had dropped to 4.3 percent, half of what it had been in 1940. Since the 1950s, there has been a steady decline in the infant mortality rate in Finland. In 1960 the number was 2.1%, in 1970 1.3% and in 1980 the number had declinded to 0.76%. By 2000 the number was as low as 0.38 percent (Tilastokeskus, Imeväiskuolleisuus).

A Mother-to-be's First Steps at A Maternity Clinic

Maternity clinics focus on the health and well-being of pregnant women and their children. They screen the progress of the pregnancy regularly and provide information on everyday-life and proper nutrition for pregnant women. Delivery training is also provided to both of the parents-to-be. Maternity clinics also pay attention to the psychological well-being of the families by supporting parenthood and providing relationship counseling when necessary (Mykkänen, Äitiysneuvola).

A mother-to-be needs to contact a maternity clinic in the municipality in which she lives as soon as she discovers her pregnancy. At the very latest a pregnant woman must visit a maternity clinic before the fourth month of the pregnancy. After that she has the right to receive maternity benefits (Mykkänen, Äitiysneuvola).

In practice the maternity benefit means two options: the mother-to-be can choose either a maternity pack, which includes various articles of baby clothing and other objects needed to care for a new-born (view the contents of the 2006 maternity pack here), or a tax-free sum of money in the amount of 140 euros. Maternity benefits are raised exponentially in the case of a multiple pregnancy. In practice the parents of twins get three maternity packs (one for the first twin and two for the second) or the amount of 420 euros, parents of triplets six maternity packs (one for the first triplet, two for the second, and three for the third) or the amount of 840 euros. In case of twins or triplets the parents-to-be can also mix and match the benefits, e.g. choose to have two maternity packs and 140 euros if they are expecting twins.

Adoptive parents of children under the age of 18 are also entitled to the same maternity benefits, but obviously parents adopting older children tend to choose the cash compensation rather than the pack (Kela).

A mother-to-be’s first visit to the maternity clinic must be made between pregnancy weeks 8-12. During this first visit, she will receive information on pregnancy and the development of the fetus in general. Her blood hemoglobin level and blood pressure are tested to make sure these are within healthy limits. All pregnant women are also tested for HIV, syphilis and hepatitis B. In case of a positive result in any of the tests, preventative measures can be taken in order to make sure the condition is not passed on to the child.

The blood group of the mother-to-be is also determined, first of all so that the hospital is aware of which blood they can give the mother in case of extensive blood loss during a miscarriage or child birth, and secondly in order to pre-scan the possibility of a Rhesus-negative mother expecting a Rhesus-positive child. In this case it is possible that the immunological system of the mother will start to act against the Rhesus factor in the child’s blood, causing a serious condition, or even miscarriage. The condition can be prevented by an anti-D immunoglobulin injection ¹ . The amount of antibodies in the blood of the pregnant woman is also determined in order to make sure that her defensive system is working properly (Mykkänen, Äitiysneuvola).

Medical Check-ups at Maternity Clinics

Between pregnancy weeks 12-13 pregnant women have their first medical check-up, which is conducted by a physician. During this check-up the woman receives a basic gynecological examination, the heartbeat of the fetus is monitored and the blood pressure and hemoglobin level of the mother-to-be are determined. The maternity clinic also keeps track of changes in the woman’s weight (Mykkänen, Äitiysneuvola).

During an average pregnancy, a Finnish woman has between 12 and 15 visits to the maternity clinic. Before pregnancy week 30, women usually have one check-up every month; after that, check-ups are conducted every two weeks. Of these visits 2 or 3 are medical check-ups by a doctor, and the rest are conducted by a public-health nurse. Most (but not all) Finnish health care clinics also provide a free ultrasonic examination, which is conducted between the 12th and 16th week of pregnancy. Finnish women can also choose to take a screening test between pregnancy weeks 9-12 during which the possibility of Down-syndrome can be checked (Mykkänen, Äitiysneuvola).

In case there are any abnormalities in the progress of the pregnancy, high blood pressure of the mother for instance, the monitoring will be more constant and there will be more visits to the doctor. Women are also encouraged to contact their maternity clinic if they detect something that worries them, or if they have any further questions.

Fathers-to-be are strongly encouraged to accompany their partners² when they visit the maternity clinics. It is not essential that they be present during each routine examination, but most fathers are eager to attend at least those visits during which the heartbeat of the fetus is monitored and when the ultrasonic examination is conducted (Mykkänen, Äitiysneuvola).

Preparing for The Delivery and Giving Birth

The actual delivery usually takes place in a hospital. The maternity clinic refers a woman to the delivery hospital closest to her home, although in some largely-populated municipalities the mother-to-be can choose from several different hospitals. It is also possible to visit the maternity ward and meet the staff beforehand. Mothers-to-be can also give instructions on any preferences they might have before the delivery. This includes making choices such as whether or not you choose to have chemical pain relief, how you wish the delivery to take place³ and whether or not you wish your child to receive formula after he/she is born⁴. The hospital will take these wishes into account and act accordingly as far as it is possible without risking the well-being of either the mother or the child (Synnytystoiveita).

Many women are nervous about, or even afraid of, the prospect of delivery. This is especially true for women having their first child and for women who have had a previous, traumatic delivery experience. This has been taken into account at maternity clinics that offer a service in which the mother-to-be will meet a mid-wife who specializes in delivery fear, and will discuss the different stages of delivery with the prospective mother. It is also possible to have meetings with a psychologist or a psychiatrist if the situation is really difficult (Synnytyspelkopoliklinikka).

Home delivery is still a marginal phenomenon in Finland. This is partly due to the fact that the Finnish health care system does not support home delivery. According to a doctoral dissertation published in 2001, only 0.01 percent of Finnish women choose to deliver their child at home. However, roughly 6 percent of women would be interested in delivering at home if the public health care system would support it (Hirvonen). Many women feel that the home environment is a comforting and relaxing place to deliver. Home delivery also enables the woman to choose exactly how she delivers. Modern medical technology enables first-aid procedures in the home environment in case of excess bleeding and loss of oxygen. If a woman decides to give birth at home it is her own responsibility to find a mid-wife who specializes in home-delivery. The expenses of home-delivery are not covered by the health care system (Mykkänen, Synnyttäisinkö).

Within two weeks after delivery a public-health nurse will visit the new family in their home in order to ensure the well-being of both the mother and the newborn. After this, the family will no longer visit a maternity clinic; instead the baby’s health will be monitored during visits to a child care clinic (Mykkänen, Äitiysneuvola).

General Practices of Child Care Clinics

The work done at child care clinics focuses on promoting the health of children, preventing disease and diagnosing conditions at an early age. The physical, psychological and social development of a child is carefully monitored and supported. The effects of the environment in which a child grows up in are also taken into account. This means making sure that the home environment is safe for the child and promotes healthy development (Lastenneuvolaopas 5).

Nowadays child care clinics are instructed to pay special attention to families that have psycho-social difficulties. These include families with mental or chronic physical conditions, substance abuse, constant or violent arguments, marital problems or financial difficulties. In case of serious problems, the family in question will be referred on to the proper instances (Lastenneuvolaopas 26-27).

Medical Check-ups and Monitoring at Child Care Clinics

Infants are monitored in child care clinics at constant, close intervals due to their rapid growth and development. In practice this means that an infant is taken to a child care clinic once a month until he/she is six months old; after that a check-up is done every two months until the child is two years old. A child between the ages of 2 and 6 visits a child care clinic once a year. Children and families in need of special attention visit a child care clinic on a more frequent basis, according to a special schedule that is developed for them personally. Health care workers also provide families with house calls if the situation so requires, e.g. in case of the mother suffering from severe post-partum depression or a serious physical condition (Lastenneuvolaopas 9-11).

During each of these visits the child is measured and weighed and his/her eyesight and hearing are monitored. At infancy children are mostly monitored to scan for mental or physical handicaps or defects in the sensory system. At the age of 2 it is possible to recognize mild handicaps such as speech or attention disorders. Thus children between the ages of 2 and 5 are monitored for the development of their speech and cognitive skills. In case any abnormalities are detected, the child in question will be referred on to a specialist. The costs are also covered by the public health care system. After a child turns 7 years old, he/she will no longer visit a child care clinic, but his/her healthcare is provided by the public school system (Lastenneuvolaopas 9-22).

Dental Care Provided by Child Care Clinics

It is also the responsibility of child care clinics to provide dental care for all pre-school children. Dental care focuses on teaching the children the basics of dental hygiene and dietary influences on their teeth. One of its goals is also to educate parents on the usual dental diseases and measures that can prevent them. After a child starts to attend school (at the age of 7 in Finland) dental care is provided by the public school system (Lastenneuvolaopas 23-25).

Vaccinations – Keeping up The Good Work

Vaccination is also an important part of the Finnish child care system. Vaccinations are free-of-charge, provided during normal check-ups at the child care clinics, but voluntary. 90 percent of all Finnish parents choose to vaccinate their children against such serious diseases as polio, diphtheria, tetanus, whooping-cough, measles, mumps, rubella and infections caused by hemophilia-B bacteria (Rokotukset).

One of the major achievements of the Finnish child care system is that all of these diseases are nearly extinct in Finland. On the other hand, a number of Finnish parents are refusing to vaccinate their children⁵. This is due to the fact that some studies indicate that there is a connection between vaccinations and certain malfunctions in children’s immune systems, which in effect can cause serious conditions such as autism, allergies, diabetes, MS-disease and deterioration of the central nervous system.

However, it is disputable whether vaccination has any effect on the development of any of these diseases. Some children can also be allergic to some of the ingredients of vaccinations and can thus develop symptoms varying from a reddish, itchy rash to high fever (Nieminen). To some parents the risk of obtaining any of the conditions above from the vaccination seems higher than being infected by the actual disease the vaccination is for, since the diseases have in practice vanished from Finland anyway. However, this way of thinking adds to the risk of reintroducing these diseases in Finland, as it is possible that an unvaccinated child would contract one or more of the diseases e.g. on a family holiday outside of Finland, or via contact with an affected foreigner visiting Finland. For this reason child care clinics strongly advise all parents, including those who may be unwilling to do so, to vaccinate their children (Lastenneuvola 178-179).

It is worth noting that most parents who have doubts on whether or not to vaccinate their children do not refuse to give them any vaccinations, but rather choose to vaccinate their children only against the most common or dangerous diseases, such as polio. The most common vaccination that parents refuse to give their children in Finland is the combination vaccination that gives protection against measles, mumps and rubella (Nieminen 9).

Effects of The 1990s Recession on the Clinics' Funding and Services

At the beginning of the 1990’s Finland experienced an economic recession. This resulted in less funding for public health care, including maternity and child care clinics. In addition, municipalities were given more freedom to self-govern, and the general norms governing maternity and child care clinics were relaxed. This is why, even today, different municipalities offer different services to their clients. There are municipalities which offer more and better services and those that offer less. The lack of funding combined with the freedom to cut down services has led, over the past decade, to a decline in the services provided by both maternity and child care clinics.

As a result, the staff of the clinics have often found that they lacked the resources which would enable them to take care of families as individuals. They have also found they are unable to recognize and solve many of the problems the young families were experiencing due to the lack of time and funding (Hakulinen-Viitanen 21-23).

Also the problems of the children themselves have changed over the years. Contemporary children are more likely to have psycho-social problems than the previous generations. These include symptoms such as learning disabilities, feelings of insecurity, and obesity. Often possible mental-health issues, substance abuse and violence within the family unit are reflected in the children. According to a study conducted in 2004, between 10 to 30 percent of all Finnish children require special attention provided by child care clinics (Hakulinen-Viitanen 21).

In short, the range of concerns both clinics are expected to address has increased at the same time as their funding and staffing has decreased. However, despite this very negative-sounding development, both the maternity and child care clinics are continuing to work hard to keep up with the modern pace of life, as can be witnessed by the following overview of their more recent activities.

A New Priority: Encouraging The Early Role of The Father

Traditional childcare focused highly on the role of the mother during the infancy of the child. The mother was thought to be the sole care giver. The role of the father was emphasized later on, when the infant had become a toddler, and the symbiotic relationship between the mother and the child had to be broken. Previously it was even thought to be harmful to the development of the child if the father took an active role in child care from early on. However, this view has been greatly challenged in modern times (Säävälä 4-5, 7).

In 2001 the Finnish Ministry of Social Affairs and Health issued a guidebook to maternity and child care clinic workers which focused on the role of the father from early on, and how it should be reinforced. Research done prior to the publication of the guidebook showed that the infant benefits greatly if both parents are available as primary care givers. In the case of a sudden unavailability of the mother, the child would have a safe relationship with his father to compensate for the loss of the mother. Infants with two primary care givers have also been shown to experience more stimuli and feelings of security than those infants whose primary care giver is solely the mother (Säävälä 6-7).

In addition to this it has been shown that the close involvement of the father benefits the whole family. An active focus on childcare by the father enables the mother to rest and maintain her social life outside the family circle, which in effect makes her a better care giver. It is also easier for the mother to return to work if the father is active in sharing the child care responsibilities. Research also shows that fathers who took part in childcare early on continue to have a close relationship with their children later in life (Säävälä 7-9).

One factor which also promotes the need for a greater role of the father is post-partum depression, a serious condition affecting as many as 10 to 20 percent of all women who have given birth. In families affected by this condition it is absolutely vital that the father is able to take responsibility for some of the childcare in order to ensure the security and wellbeing of the infant. One of the modern goals of child care clinics is to recognize the families affected by postpartum depression and to give tools to the father so he can take an active role as the primary care giver of the child while the mother is unable to take part (Säävälä 7).

Maternity clinics in Finland provide a specific family training for couples who are expecting their first child. It is estimated that 80 to 90 percent of all fathers-to-be attend these meetings with their spouse. As a part of this family training some maternity clinics also offer special “father groups”. In these groups fathers-to-be discuss issues concerning pregnancy, delivery and fatherhood among their peers. They have a chance to share their joys and fears among men who are in similar situations. The goal of these meetings is to prepare and support men who will soon become fathers (Säävälä 29-34).

After the infant is born, some men continue to share their experiences in father-child groups. The idea of these groups is largely the same. The men of the group meet approximately once a month, and bring their babies with them. The discussions vary from delivery experiences to relationship issues and everyday life with the newborn. The goal of father-child groups is to reinforce the positive experiences and provide an outlet for the negative. The idea is to support the new fathers in their role as a parent and give them confidence to care for the child (Säävälä 38-43).

Preventing Divorce and Supporting Single Mothers

In the year 2000 one in five of all Finnish children lived with single mothers. The increase in the number of divorces and single parenting, especially during and after the economic recession of the 1990’s, has led to a large amount of discussion on whether it is harmful for children to be raised without a father. Some go so far as to say that single parenting causes various problems in society, ranging from teen pregnancy to violence. Others state that it is not so clear cut, that the lack of a father as such causes none of these problems as long as the mother is capable of filling the roles of both parents. Obviously it is more demanding to raise children as a single parent. Child care is less demanding if two people take part in it; two people can fulfill the social and emotional needs of a child more efficiently than one (Säävälä 10-11).

The growing number of single mothers in Finland has also been taken into account in maternity and child care clinics. More emphasis has been put on supporting the relationship of parents-to-be and couples with young children. Statistics show that most of the couples that do split up, do so when their children are young. Maternity and child care clinics are trying to work against these statistics by offering professional counseling to all couples who are willing to take the help (Säävälä 10-11).

Culture Clash: The Immigrant Population in Maternity and Child Care Clinics

According to the law, all families living in Finland are entitled to free medical care provided by health care clinics. This includes the services provided by maternity and child care clinics. As the number of refugees and asylum seekers in Finland started to grow during the 1980’s and 1990’s, it became necessary to create guidelines for the usage of maternity and child care clinics so that they would also be capable of serving people from non-Finnish origins (Lastenneuvola 249).

To solve the problem, it is necessary for the workers of maternity and child care clinics to familiarize themselves with the culture of the immigrant client. They also need to take into account different cultural habits – e.g. in many cultures women are not used to communicating with male doctors, especially gynecologists. It is vital to offer these women the opportunity to meet with female medical personnel.

Interpreters are used to enable fluent communication between the client and the clinic personnel. Many immigrants from third world countries have a profound distrust of officials of any field. It is therefore very important to make sure the immigrant client understands that the interpreter, as well as all health care workers, is bound to professional secrecy. Often — particularly when the conversation is between women and their physicians — it also helps if the interpreter is female. The costs of the interpreter services are covered by the municipality, and the costs can be heavy; sometimes it is difficult, if not impossible, to find an interpreter of a rare language. However, it is worth noting that the children of the family are never used as interpreters in maternity and child care clinics (Lastenneuvola 249).

Refugees and asylum seekers are most likely to come from difficult circumstances, such as war zones or refugee camps. Many have been subjected to mental and physical torture, and most have witnessed very disturbing things in their countries of origin. It is therefore important that the personnel of maternity and child care clinics have the tools and the information to recognize those immigrant clients who may be in need of psychological aid. These clients will be referred on to receive professional aid elsewhere and expenses will be covered by the public health care system (Lastenneuvola 251).

Maternity and child care clinic workers need to bear in mind that the cultural traits of immigrants must be respected. This comes into the picture especially when dietary habits are discussed. The guidelines that are given to mainstream Finnish clients often cannot be used, because people coming from different religious and cultural backgrounds may have different cultural habits. Therefore the individual dietary habits of each immigrant family are discussed and evaluated to see if any changes are indicated. The most common dietary problem among immigrants from warm climates is the need to supplement their diets with foods that are rich in vitamin-D. The human body usually produces vitamin-D from sunlight, but during the Finnish winter months there is not enough sunlight. Foods which are rich in Vitamin-D and easily available in Finland include dairy products and fish (Lastenneuvola 249).

While cultural and religious traits of others must be respected in general, there are also instances in which these very traits act in contrast to the Finnish laws. One of the responsibilities of maternity and child care clinics is to explain the laws and regulations of Finland, especially when it comes to family life and children. It is categorically explained that physical punishment of children is a criminal offence in Finland, as is also the custom of female circumcision in some Islamic cultures, even if the girl is taken to another country where the operation would be performed. The rights of women and the concept of domestic violence are also discussed (Lastenneuvola 249-250).

In many municipalities child care clinics have also set up peer groups for immigrants of the same cultural origins. These groups make the process of familiarization into Finnish culture easier and also minimize the risk of seclusion from society (Lastenneuvola 249).

The Latest Development – The Net Clinic

The latest development in the field of maternity and child care clinics relies on modern information and communication technology. In 1997 a project called the Beginning of Life was launched at the Polytechnic of Pohjois-Savo in Kuopio. Its purpose was to develop an online maternity clinic in order to make the available maternity services more efficient. The first version of what became known as the Net Clinic was tested in December 1999. In December 2000 the testing of the clinic was completed and the whole concept was revised, based on the experiences of the test users, to better serve the general public. After the revision the concept was marketed to municipalities wishing to offer this service to their clients (Nettineuvola-projekti).

The underlying idea of the Net Clinic is to provide further information to pregnant families concerning pregnancy, delivery, taking care of an infant and looking after the well-being of the whole family. The registered users of the Net Clinic have the possibility of consulting experts anonymously via a protected internet connection.⁶ They are guaranteed a personal reply. These families also have a possibility to take part in peer group discussions online; these groups function on an anonymous basis. In order to further enhance the reliability of the Net Clinic, all experts who take part in the discussions or answer the questions use their real names and titles. It is important to note that the online maternity clinic does not function as an alternative to the traditional Finnish maternity clinic. It is merely targeted as a supplementary function to the original clinics (Nettineuvola-projekti).

The Present State of Maternity and Child Care Clinics

Finnish maternity and child care clinics have made a world of difference in the development and well-being of the Finnish nation. Infant mortality rates in Finland have been extremely low for decades. Vaccination programs have been successful. Moreover free maternity and child care enables all women, regardless of their social or economical status, to have a healthy pregnancy, and all of their offspring to have a healthy childhood. This goal is achieved through the medical help, check-ups and information provided by maternity and child care clinics.

In contemporary times psycho-social disorders are more common than ever among both the child and adult population. The social and economical hardships of parents are also directly mirrored on their children. Substance abuse by parents is growing alarmingly. Single parent households need extra support so they can maintain a healthy environment for their children to grow up in. The growing immigrant population is in need of specialized maternity and child care counseling. These are just some of the pressing modern issues that are dealt with daily by maternity and child care clinics in Finland.

It remains open whether Finnish maternity clinics should support home delivery. There is a growing demand for such a service, but it would require considerable additional costs, and the risks involved are still debated. Whether home delivery will be encouraged in the future remains to be seen.

Contemporary maternity and child care clinics are putting a greater focus on the wellbeing of the whole family. The attention is not only on the mother and the child: fathers are also encouraged to take part in childcare. Couples counseling is organized to all parents who wish to attend.

Maternity and child care clinics are also beginning to use modern information technology to their advantage. Services like the Net Clinic will certainly be utilized as a part of their operations in the future.

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Notes

1. Anti-D immunoglobulin is manufactured from the plasma of human blood. It is administered as an injection in a treatment known as anti-D prophylaxis. The Anti-D immunoglobulin destroys the Rhesus-positive blood cells that have gained access to the Rhesus-negative mother’s circulation (Kansanterveyslaitos).
   
   
2. The word "partner" was used here instead of "spouse," because currently 40 percent of Finnish children are born out of wedlock (Tilastokeskus, Yhä).
   
   
3. There are many alternatives positions in which you can give birth. Some women prefer to stand up and others to squat, while most simply lay on their backs while delivering. Some hospitals offer also specific delivery tools, such as the delivery pool, where a woman can give birth in a pool of water.
   
   
4. Some women wish their child to receive only breast milk. However, unless otherwise notified, current practice is that new-born babies are given formula if the mother is unable to produce enough breast milk, or if the child is initially unable to feed from its mother.
   
   
5. It is difficult to state exactly how many parents refuse to vaccinate their children, because the numbers vary greatly and children are vaccinated at different ages. A study conducted in 1999 showed that 6.7% of Finnish children did not have all of the vaccinations recommended by Finnish health care officials (the study used a random sample of 1000 Finnish children). In 3.1% of these cases the lack of one or more vaccinations was due to the parents having refused permission for the vaccination. However, only one of the children who took part in the study had not been given any vaccinations (Nieminen 11).
   
   
6. Finns are eager users of modern information technology. According to a study conducted in 2003, 45 percent of all Finnish households had an internet connection at home (Tilastokeskus, Internet).
   
   

Appendix

• Research Followup Report [PDF]

Works Cited:

• Hakulinen-Viitanen, Tuovi, Marjaana Pelkonen, and Arja Haapakorva. Äitiys- ja lastenneuvolatyö Suomessa. Helsinki: Sosiaali- ja terveysministeriö, 2005.
  
  
• Hirvonen, Hanna. Väitöskirja synnytyksen valinnoista. 5 February 2006.
  
  
• Kansanterveyslaitos. Raskaudenaikaiset veriryhmävasta-ainaseulonnat tärkeitä jokaisessa raskaudessa. 10.1.2004.
  
  
• Kela. Äitiysavustus. Site consulted 3 December 2006.
  
  
• Lastenneuvolaopas. Lääkintöhallitus. Helsinki: Vapk-kustannus, 1991.
  
  
• Mykkänen, Eeva. Synnytäisinkö kotona? 28 June 2006
  
  
• - - - . Äitiysneuvola huolehtii tulevasta äidistä ja lapsesta. 27 September 2006.
  
  
• Nettineuvola-projekti. Site consulted 20 November 2006.
  
  
• Nieminen, Ulla, Tarja Simonen and Johanna Tinnilä. Vanhempien kokemuksia rokotuksista.
  
  
• Lastenneuvola lapsiperheiden tukena. Sosiaali ja terveysministeriö. Opas työntekijöille.Site consulted 13 November 2006.
  
  
• Rokotukset. Sosiaali ja terveysministeriö. 13 November 2006.
  
  
• Synnytyspelkopoliklinikka. Site consulted 2 December 2006.
  
  
• Synnytystoiveita. Site consulted 2 December 2006.
  
  
• Säävälä, Hannu, Eero Keinänen, and Jari Vainio. Isä neuvolassa – työvälineitä ja ajatuksia vauvaa odottavien ja hoitavien isien kanssa työskenteleville. Helsinki: Tasa-arvoasiain neuvottelukunta, Sosiaali ja terveysministeriö, 2001.
  
  
• Tilastokeskus. Imeväiskuolleisuus vuosina 1751-2004. Site consulted 9 May 2007.
  
  
• - - - . Internet kotitalouksissa yleisempi kuin kaapeli-tv tai satelliittiantenni. 23 October 2003.
  
  
• - - - . Yhä useamman lapsen vanhemmat asuvat erillään. 11.4.2007.

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Last Updated 24 April 2010