NEWS AND VIEWS: Abortion in Ukraine: a health crisis (09/03/00)

NEWS AND VIEWS

Abortion in Ukraine: a health crisis

by Oleh Wolowyna

Recently released preliminary results from the 1999 Ukraine Reproductive Health Survey document an alarming level of abortions among Ukrainian women. Almost 40 percent of all women age 15 to 44 have had at least one abortion, and 18 percent had at least two abortions. Since January 1994 almost half of all the pregnancies that ended were terminated by induced abortions, and there were more abortions reported than live births.

To put these figures in perspective, in 1995 there were 311 abortions per 1,000 live births in the United States. In Ukraine the level of abortions was close to four times the level in the United States. Despite these dismal figures, the survey shows that there has been some improvement in recent years: abortion rates have been declining.

The Ukrainian Reproductive Health Survey (URHS) was carried out between June and October 1999. It was implemented by the Kyiv International Institute of Sociology, with technical assistance provided by the Division of Reproductive Health of the U.S. Centers for Disease Control and Prevention (CDC) and financial assistance by the United States Agency for International Development (USAID). The survey was the largest and one of the first nationwide, population-based surveys of reproductive health and related issues to take place in post-independent Ukraine. More than 7,000 women of reproductive age (age 15 to 44) were interviewed nationwide on topics such as fertility, pregnancy, abortion, contraceptive knowledge and use, maternal and child health, sexually transmitted diseases and domestic violence. Here we present the main results on the abortion situation.

The survey shows that nationwide there were more abortions than live births: 110 abortions for every 100 live births. In urban areas there were 140 abortions per 100 live births, while in rural areas there were 70 abortions per 100 live births. Another indicator is the percentage of women with one or more abortions. For all women between the age of 15 and 44, 39 percent had one or more abortions and 18 percent had two or more abortions. That is, about 40 percent of all women of child-bearing age had at least one abortion, and one in five had at least two abortions.

This high level of abortions has had serious health consequences. Among all induced abortions since January 1994, 14 percent had complications requiring medical attention soon after abortion; 37 percent of those with complications required additional hospitalization after abortion, and 5 percent had long-term health problems after abortion. These percentages are similar for urban and rural areas. Some of the most serious abortion complications that occurred soon after abortion were: severe bleeding (32 percent), pelvic pain (22 percent) and fever (8 percent). These figures are for the period 1997-1999. They are quite similar for the period 1994-1996, with the exception of fever, which decreased from 16 percent during 1994-1996 to 8 percent during 1997-1999.

This high rate of abortions is due to several factors. First, a large number of pregnancies are not planned. For pregnancies ending since January 1994, only 45 percent were planned, 17 percent were mistimed and 35 percent were unwanted. Among the unwanted pregnancies, 70 percent were ended by induced abortions.

Second, this high level of unwanted pregnancies is obviously due to the fact that a high percentage of women do not use contraceptive methods or use methods that are not highly reliable. Among all women in unions (married or consensual unions), 33 percent do not use any contraceptive method, and 30 percent use so called "traditional methods," which have been proven to be less effective in preventing pregnancy. Thus, about two-thirds of women in unions do not have adequate protection against unwanted pregnancies.

Third, among women currently in a union who are not using contraceptives, 35 percent gave reasons for not using contraceptives that are not justifiable such as: partner objections, fear of health effects, cost or availability, religion, prefer abortion, etc. Cost no longer seems to be an important factor; only 3 percent cited cost as a factor for not using contraceptives.

Fourth, another factor is the lack of knowledge about modern contraceptives. Only three methods are known by more than 90 percent of women: condoms, IUDs and oral contraceptives. Knowledge about other methods like female sterilization, diaphragms, spermicide, injectables and vasectomies are known only by 45-61 percent of all women.

Finally, family planning services provided by the health care system are not adequate. For women having an abortion, in only 41 percent of the cases there was talk about ways to prevent pregnancies, 16 percent left the facility with a contraceptive method or prescription, and only 7 percent were referred for contraceptive services or counseling. Among all women having a baby, in 26 percent of the cases a doctor or nurse offered to discuss contraception, 9 percent left the facility with a contraceptive method or prescription, and only 4 percent were referred to another facility for contraceptive counseling.

The high level of abortions in Ukraine, coupled with the fact that the number of births is well below replacement levels (mean number of live births for women age 30-34 is 1.5 children per woman, while replacement of the population requires 2.1 live births per woman), add indicates a dramatic situation with serious consequences for the present and the future of the nation. Although recently the government of Ukraine has expressed concern about the situation, there is little evidence of the necessary political will to change the situation. Technical and financial assistance by USAID and other international agencies is finally available, but its effectiveness is limited due to the lack of an adequate policy by the relevant authorities. If the health status of mothers and children is not improved in the near future, the potential of the nation will be seriously affected for many decades.

Oleh Wolowyna is owner and president of the consulting firm Informed Decisions, Inc., in Chapel Hill, N.C. He has worked for many years as a consultant in the international development field (population, health and education). He has also done extensive demographic and sociological research on Ukrainians in the United States and Canada, as well as demographic analyses of the situation in Ukraine.

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