Comprehensive family planning services improve people’s lives because they give women options in their reproductive trajectory, including alternatives to relying on abortion for birth control. Ukraine’s goal of providing high-quality family planning (FP) services that are accessible to all is slowly but steadily becoming attainable.
Historically, Ukraine has had one of the world’s highest abortion—and lowest fertility— rates. In 2005, the number of abortions per 1,000 live births in Ukraine was 587, compared to 248 for European Union countries. Contraceptive use was also low, at a contraceptive prevalence rate (CPR) of 28.9. These rates were related to fears and misconceptions about the use of modern contraceptives; the Soviet health care legacy, which relied upon medical information that was decades out of date; and care provided by OB/GYNs who were not trained in FP counseling or provision, and who practiced almost exclusively in cities and towns. Non-OB/GYN medical professionals who practiced in rural communities were not authorized to provide family planning, so most rural women didn’t even have access to these subpar services.
Since 2005, JSI has been involved in the nation’s efforts to improve and modernize the FP service system, implementing two USAID-funded programs—Together for Health and the Healthy Women of Ukraine Program. JSI’s strategy for improving FP-related services through these programs includes: 1) ensuring the participation and input of national and local health care authorities; 2) teaching local trainers to disseminate modern FP knowledge and skills, and; 3) training health care providers—including family doctors, OB/GYNs, nurses, and midwives—on modern FP and reproductive health (RH) technologies. JSI has complemented these efforts with activities to generate demand for modern family planning services and methods among the nation’s women and men—including previously overlooked populations like adolescents and the disabled—and helping the Ukrainian government build an “FP-friendly” policy environment.
JSI’s programs have produced excellent results. About 15,000 health care providers across Ukraine have been trained in modern FP/RH. Access to FP services has increased six-fold, as the number of service points grew from 749 in 2005 to more than 4,283 in 2015. Over that same time, the CPR increased by 18 percent. And between 2005 and 2014, there was a 6.7 percent increase in the use of modern contraceptive methods.
Meanwhile, the abortion rate in Ukraine has decreased by 47 percent since 2005, from 19.5/1,000 women of reproductive age in 2005, to 10.4 in 2014. During the same period, there was a 19 percent increase in the birth rate, which shows that well-executed FP programs do not decrease birth rates. Furthermore, the incidence of child abandonment in maternity hospitals decreased by 66 percent between 2005 and 2014, which might be a result of fewer unintended pregnancies.
Although it’s impossible to isolate the impact of JSI’s work from other factors such as promotional efforts by pharmaceutical companies, indications are that our programs have transformed the way that family planning is provided and perceived in Ukraine. It has gone from a strictly (and unnecessarily) medical service to one centered on counseling and client choice. People are more comfortable discussing the topic. And most importantly, FP options are based on current evidence, and services are available closer to where people live and work.
As a former OB/GYN practitioner who has seen his nation move from an archaic medical structure to one doing its best to make modern family planning options available to all women and couples, I am proud of my country.
Learn more about the Healthy Women of Ukraine Program and the Ukraine Together for Health: Improving Family Planning and Reproductive Health in Ukraine Program.