If last year Estonia saw a record-low birth rate, this year even fewer children are being born. In August, 798 births were registered — 32 fewer than a year earlier. Over the past five years, the number of births has fallen in all hospitals, nearly by half at Järva and South Estonia hospitals and by almost one-third at Rakvere, Narva and Kuressaare hospitals.

"The 500-birth threshold has appeared in Estonia's development plans as the level that ensures minimum competence. We can't say that following 10 pregnancies or 10 births a month gives enough competence. So yes, it is important to look at the numbers from time to time," said Vivian Arusaar, head of midwifery at East Tallinn Central Hospital.

According to Arusaar, the number of births matters because the more experience a medical professional has, the better they can notice and recognize critical situations.

"For a small hospital, maintaining a maternity ward requires a lot of extra resources. You need round-the-clock coverage from a gynecologist, as well as an anesthesiologist, and you need to maintain a full team of midwives, even though a child may be born only once every two, three or four days," said Aleksei Gaidajenko, member of the board at West Tallinn Central Hospital.

Gaidajenko stressed that maternity care is part of the entire healthcare system, and keeping underutilized delivery teams running costs taxpayers money while potentially leaving others untreated due to a lack of funds. He argued that this is why Estonia should begin planning a maternity care reform.

The Ministry of Social Affairs said it cannot close maternity wards itself, since hospitals operate either as public limited companies or foundations.

"Such major strategic decisions have to be made by the hospital's owner, meaning its supervisory board. And that's exactly how it has been — if we look at the recent past, three maternity wards have been closed and those decisions were made by supervisory boards," said Heli Paluste, a healthcare network expert at the Ministry of Social Affairs.

Paluste noted that it is a very sensitive decision, especially before elections, and both the quality of care and financial aspects must be considered.

"As for financial feasibility, the Health Insurance Fund estimates the threshold to be about 300 births per year. If managed very efficiently, it might be 250," Paluste said.

Among county hospitals, only Pärnu and East-Viru Central Hospital exceeded 300 births last year.

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