Bad experiences with surgery involving epidural administration, used to control labor pain, during her first birth prompted Jarmila Hnilicova to became more interested in the quality of maternity hospitals and the performed surgeries.

Before her second birth, she wanted to review complete statistics on all maternity hospitals in the Czech Republic. "I wanted to know how frequent complications were after epidural administration. I found out that such data is almost impossible to get, and what's more, one does not even get the most basic information about the care in maternity hospitals," she explained to the news site Lidovky.cz.

She was interested in the total number of births, caesarean sections, and episiotomies that ended trauma to the perineum or cervix, as well as births that ended with the same problems. She also wanted to know how many of them were forceps deliveries. This information should have helped facilitate her decision about where and how to give birth to her second child.

No 'poking around' hospital stats

The Institute of Health Information and Statistics (IHIS), however, continued to deny this information for nearly two years, at least in full form – for a fee, Hnilicova received only an anonymized summary. Although this confirmed her assumption that there were considerable differences among the hospitals, without the names of the facilities she could hardly make a comprehensive picture of the situation. Not even the Ministry of Health, as the supreme authority, helped her in the matter.

"I think that they do not want anybody poking around this, perhaps there is far too much pressure from the obstetricians," said Hnilicova.

The failed quest for information began at the end of 2014, when Hnilicova learned from an official that she needs approval from the maternity hospitals to get the information, even though she was promised it would be possible without it.

In January 2015, she filed an official request, as permitted by the Czech Freedom of Information Act. IHIS refused the request, referring to the law on state statistical service and the law on health service. Specifically, officials stated that she sought confidential statistical and personal information that cannot be provided in conjunction with the names of the maternity hospitals without their consent.

"They are explaining it, among other reasons, by the obligation to protect the individuals. It is clear that they can not give detailed information that for example 'Mrs. Smith' gave birth under such and such circumstances. But I never wanted that information. I only asked for the names of maternity hospitals and their statistics," said Hnilicova.

The fight for an informed decision

Together with her attorney, Zuzana Candigliota, who has long advocated for patients' rights, they also drew attention to other supposedly odd arguments by IHIS. "My client has a constitutionally guaranteed right to information," argued Candigliota, who is cooperating with the League of Human Rights.

Hnilicova also noted that data on procedures performed in maternity hospitals are "necessary for the free and informed choice" of women and can improve the quality of health services. The lawyer subsequently appealed and forwarded the matter to the Ministry of Health, which agreed to review the situation again.

Hnilicova waited months for an answer, but received nothing. "After seven months, I was told that a letter from the Ministry was lost somewhere along the way. Funny thing is that the Institute and Ministry are housed in one building," she recounted with a desperate laugh.

Protecting public health?

In July 2016, however, she did finally receive another negative verdict from the Ministry of Health. "The appellant's right is limited in order to protect the rights and freedoms of others, as well as the protection of public health," explained Jan Bacina, the director of the legal department of the Ministry of Health, in a 10-page document. According to him, IHIS made the right choice when it did not provide Hnilicova's request for information.

The text also states that consideration of statistical data when selecting a medical facility could be misleading: "The mere fact that a particular hospital has performed, for example, statistically more caesareans than elsewhere, does not reflect the quality of the healthcare provider. Larger health providers will, logically, have more pathological births, which inherently means more performed medical interventions."

Hnilicova is not content with such explanation. She and her lawyer are planning further action. "It will be directed against the Ministry of Health because of their illegal decision," Hnilicova said.