BACKGROUND:
Despite global trends recognizing out-of-hospital births as a legitimate option within maternity care systems, home births in Croatia, Serbia, and Bosnia and Herzegovina remain marginal, institutionally unsupported, and poorly regulated. In Croatia, midwives are legally recognized health professionals with competencies for managing physiological births—but aren't authorized to attend home births, leaving this option in a legal gray zone.

OBJECTIVES:
To explores how the lack of policy and regulatory frameworks for home births reflects deeper flaws in health system design, particularly in the context of reproductive care governance.

METHODS:
Through policy and legislative analysis, supported by original qualitative data collected during COVID-19 pandemic, we examine how systemic rigidity and political neglect contributed to the marginalization of home birth options.

RESULTS:
During COVID-19 pandemic, Croatia experienced a rise in out-of-hospital births (52 in 2018, 97 in 2020), as women sought alternatives to restrictive hospital protocols. Similar trends were observed in Serbia and Bosnia and Herzegovina. In a sample of 108 women who planned home births during this period, majority cited institutional distrust, lack of autonomy, and the absence of respectful care as key motivators. Most births were attended by foreign midwives or occurred as freebirths due to the absence of legal pathways for domestic midwifery support.

CONCLUSIONS:
The fact that Croatia is a part of EU and subjected to policies doesn't necessarily mean that the situation is more regulated. This underscores the need to critically review and revise national frameworks and also EU-level standards and policies. The rise in home births during the pandemic highlights critical gaps in health system design and reproductive care policy. Without legal recognition, structured support, home births remain an unmanaged, politically invisible aspect of maternity care.

KEY MESSAGE:
Home births in the Western Balkans aren't merely personal choices but indicators of systemic and political failure to ensure safe and rights-based maternity care options. Poster session 4 (Group B)