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Czechoslovakia HEALTH AND SOCIAL WELFARE
In the 1980s, Czechoslovakia had a comprehensive and
universal system of social security under which everyone was
entitled to free medical care and medicine, in theory at least.
National health planning emphasized preventive medicine. Factory
and local health care centers, first aid stations, and a variety
of medical clinics supplemented hospitals and other inpatient
institutions. The ratio of physicians to inhabitants has improved
steadily, climbing from 1 per 745 in 1954 to 1 per 278 in 1985,
although there were shortages of doctors in rural areas. The
shift in the distribution of health resources in the 1960s and
1970s was dramatic; facilities were improved, and the number of
health care personnel in Slovakia and rural areas increased in
general. Despite the improvements, there still remained serious
problems in the health-care sector. About 40 percent of all the
medical equipment was obsolete, facilities were outdated and in
short supply, the bureaucracy was excessive, bribery was
widespread (if not the rule), and many urgently needed
medications were available only on the black market.
Spas in Czechoslovakia were part of the health care system.
In 1985 more than 460,000 people (5 percent of whom were
children) stayed at the 35 spas in the Czech lands and 23 spas in
Slovakia. Many spas had been in existence for centuries, such as
Bardejov (since the thirteenth century) in Slovakia and Karlovy
Vary (Karlsbad) in the Czech lands. Many of them specialized in
the care and treatment of particular kinds of ailments. All had
either mineral or hot springs, and some also offered mud
treatments. In bygone days, the spas were frequented by European
royalty and the wealthy, but now they are open to all, including
foreign tourists (who made up 10 percent of the patients in
1985). A number of people visited spas on vouchers provided by
their trade unions.
In 1984 life expectancy in Czechoslovakia was sixty-seven
years for men and seventy-five years for women. In 1950 women's
life expectancy was approximately 4.6 years longer than men's; by
1983 this difference had increased to nearly 7.5 years. Infant
mortality stood at 10.5 per 1,000 live births in 1984, down from
15.6 per 1,000 in 1975. As with medical care, the gap in life
expectancy between the Czech lands and Slovakia was narrowed
during this period.
In 1985 slightly more than one-quarter of the Czechoslovak
population received some kind of pension; the elderly, the
disabled, widows, and orphans were all entitled to assistance.
Social security benefits (primarily retirement and disability)
were equal for all wage earners. The average pension was less
than Kcs1,000 per month (workers received an average pension of
about Kcs 1,130, cooperative farmers about Kcs880, and
independent farmers about Kcs720); this put pensioners among the
lowest income earners. A substantial minority of the retired (23
percent) again took up employment to supplement their pensions.
Women workers had a full complement of maternity and childcare benefits. Maternity leave (at 90 percent of full pay) was
twenty-six weeks in the 1980s; an additional nine weeks were
available for single mothers or for months having multiple
births. Employers could not deny a woman's request for an
additional year of unpaid leave for child rearing (without loss
of job seniority). A system of child allowances and maternity
grants also assisted women who took unpaid leave. Women were
allowed three days of annual leave in case of illness within the
family. There were substantial family allowances, in addition to
direct grants, to single parents or families with handicapped
children. An unmarried mother, widow, or divorced mother could
not be fired if she had a child under three years of age; if she
had children between three and fifteen years of age, her employer
had to find her another job before dismissing her.
Nursery facilities for younger children were in very short
supply; in 1984 they could accommodate less than 10 percent of
children under five years of age. Beyond the sheer lack of space,
nurseries were poorly distributed and were often concentrated in
older centers rather than in new housing developments where young
families were likely to reside. Kindergartens were in better
supply, and a much higher percentage of children between the ages
of three and six years attended these schools. High employment of
women and inadequate services contributed to the decline in
Czechoslovakia's birthrate in the 1960s. Live births during the
decade averaged 16 per 1,000 inhabitants, a significant drop from
the 1950s. By 1968 the fertility rate was 2 percent (in
comparison with 3 percent in the 1950s); at this rate the
population would not replace itself. In the Czech lands, the
population growth rate stood at its 1930s low; in Catholic
Slovakia, it was the lowest on record.
The government adopted a variety of explicitly pronatalist
policies in the 1970s. Family allowances increased, especially
for second and third children. By 1973 a family with three
children received roughly one-third the average worker's salary
in allowances. Birth grants doubled so that they were the
equivalent of two to four weeks of family income. Low-interest
loans to newlyweds were designed so that a portion of the
principal was canceled with the birth of each child (Kcs 1,000
for the first and Kcs4,000 for each subsequent child). All told,
the financial incentives were substantial. In addition, couples
with children had priority on apartment waiting lists and were
entitled to larger living quarters, no small inducement in the
face of Czechoslovakia's chronic housing shortage.
Pronatalist policies appear to have had a strong influence on
population growth during the 1970s. The birthrate climbed from
its 1968 low (14.9 per 1,000 inhabitants) to a peak of 19.9 per
1,000 inhabitants in 1974--one of the highest rates among
industrial nations. Perhaps a quarter of this increase reflected
the increase in the number of women of child-bearing age in the
1970s. After 1974, however, the birthrate steadily declined,
falling to 14.5 by 1985. Figures indicated that a trend toward
one-child families was emerging. The message seemed to be that
after one decade the government's aid program was ineffective.
A major factor influencing the birthrate was the abortion
rate. The number of abortions fluctuated between the 1950s and
1980s, dropping in the early 1960s and the early 1970s. In 1985
there were reportedly 144,712 abortions, or 39 abortions per 100
pregnancies (33.5 per 100 in the Slovak Socialist Republic and
42.1 per 100 in the Czech Socialist Republic). It has been
suggested that abortion has remained one of the most favored
means of birth control, despite the risks involved. A 1986 change
in the abortion law (eliminating the panel needed to approve a
request for an abortion) suggested that the regime was giving up
in its efforts to reverse at least this aspect of the adverse
demographic trends.
Data as of August 1987
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