Almost 16 years after the collapse of the Soviet UNI0N, the stigma associated with modern forms of contraception along with misconceptions regarding health risks associated with their use still linger in modern day Ukraine. “In Soviet times women did not have access to modern methods of contraception. The options then were abortion, which was very widely used, and the IUD, which was mostly used by women who for medical reasons should not become pregnant. In general, there was a more curative approach to health in the Soviet UNI0N, and much less preventative as you would find in Europe or the US,” explains Asta Kenney, director of the USAID project Together for a Healthy Future, whose aim is educating Ukrainian women and health practitioners in modern family planning methods. While some women used the IUD, use of the contraceptive pill was exceptionally limited because women had a deep mistrust for it, and this mistrust lingers today. “The legacy of Soviet times is that people feel that the pill was dangerous, because in those days the only pill available was the old high-dose option that we had in the West in the 1960s, and these had a lot of unpleasant side effects and in fact did carry some health risks,” says Asta. One common misconception still widely held here today, is that using the pill can cause infertility, but that has never been the case. “There has never been a risk of infertility from using the pill. The early high-dosage pill carried some increased risks of cardio-vascular problems, but since the 1960s oral contraception has improved dramatically. The dosage of oestrogen, which is the hormone which causes these problems, has gone down.”
The Reality of the Situation
A significant percentage of Ukrainian women still put their faith in traditional methods of contraception such as withdrawal, lemon juice and herbal remedies, all of which, of course, result in pregnancy therefore necessitating abortion if the child is not wanted. This is fuelled by the common misconception still widely held in Ukraine that oral contraception can cause not only infertility, but also all manner of ailments including weight gain, cancer and many even believe it will make them hairy. “People perceive that abortion is no more risky than contraception, and in some cases they feel contraception is a bigger risk. That is a huge barrier to overcome,” Asta explains. The truth is that oral contraception does not contribute in any way to weight gain, increased risk of cancer, and can’t possibly make you more hairy. In fact, the opposite is true in that taking the pill can actually help reduce risks of many diseases including a wide range of cancers. “Western women have been taking oral contraception for decades and they are living longer and more healthy lives,” says Asta. Risks associated with abortion in Ukraine are, in fact, much higher than those in Europe and the US because many of the abortion techniques in use here are outdated. “Contraception is considerably safer than abortion, not to mention far more pleasant. In this country in particular there is a lot of concern about the link between abortion and infertility and infection. According to Minsitry of Health statistics around 80% of incidences of infertility in Ukraine are attributable to abortion. On the other hand, driving a car or playing football are statistically far more dangerous than taking the pill,” Asta explains.
While the Soviet attitude towards contraception has lingered longer than it should have, things are definitely beginning to change. Nowadays 47% of married women in Ukraine are using modern contraception, and while this is still a lot less than the 70% in the West, it a drastic improvement. The younger generation is leading the way, and has a much better knowledge of the subject than their parents, but the situation is by no means perfect. Asta says: “Initially people tend to rely on condoms as it is seen as the safest method, and that’s a very good choice in a country where the risk of HIV and AIDS is so high, but in terms of pregnancy, especially among young people who may not use them right or every time, it is not always the best option. Of course, the right choice is always a combination of condoms and some other method such as oral contraception – oral for birth control and condoms for protection against infection – which is how nearly everyone in the West operates. Progress is taking place, but Ukraine is still a long way behind the rest of the world. USAID’s Together for a Healthy Future is working hard to increase the rapidity of this mind shift through public education through smallgroup seminars, the mass media and disseminating information through brochures. However, a very important part of their work is educating health workers and pharmacists who, in some cases, are also still very ignorant of modern contraception.
“When people have made the decision, as most Ukrainian’s have, that they only want one or two children, then they will stick to that by whatever means are necessary whether it is abortion or contraception.”
“Basically, we view this as a market place, and therefore we need to work on the supply side as well as the demand side. We are training a significant number of doctors. Up until now the health service has considered contraception only in those cases where childbirth represents a health risk for the mother, and we are trying to change that attitude to one of choice. That means giving the women or couple the right to choose. Handing the decision over to the individual is quite a big shift in ideology,” Asta explains. The last but still very important group Asta and her team work with is the pharmacists, where they provide one-day courses focused on dispelling some of the myths and misinformation to which they like everyone else holds. They also recommend that the pharmacists stock a minimal range of contraceptives because many only carry a very limited range.
Demographics and Contraception
In a country with a falling population, views have been slow to change because in some political circles contraception was not seen as a health measure and there was a fear that it would make the situation worse. This, of course, is nonsense, as Asta explains: “In reality, when people have made the decision, as most Ukrainians have, that they only want one or two children, then they will stick to that by whatever means are necessary whether it is abortion or contraption. When you compare the post-Soviet countries with Europe you find that contraception takes the place of abortion and family size remains stable.” Thankfully, the attitude towards this issue within the government has changed drastically in recent times and at the end of 2006 it launched the Reproductive Health of the Nation programme through which it will invest $150 million over a ten-year period in a range of reproductive health activities. “This is a massive step forward in ideological terms,” says Asta. “It’s not a huge investment, but it is significant. They are trying to improve family planning as well as taking steps towards improving reproductive health services and programmes and procuring contraceptives for disadvanteged sections of the population who don’t have the money to pay for them.” Every 5 years, doctors in Ukraine have to get recertified, and part of this governmental initiative will focus on providing better and more up-to-date information to the doctors going through this process. Asta says: “At the moment, there is a very limited network of doctors trained to provide contraception. For example, when we started working in Lviv 18 months ago there were only 39 health facilities where you could go to get contraception. Now there are over 200 providers in the oblast. That’s a big step in the right direction.”
To comment on this feature please go to www.whatson-kiev.com.
We will print the best letters in a future issue of the magazine.