Countries Abortion Profile

Ukraine

1. Law related to Abortion

Abortion practices in Ukraine were similar to those throughout the former USSR. The Soviet Decree of 27 June 1936 prohibited the performance of abortions except in cases of a danger to life, a serious threat to health, or the existence of a serious disease that could be inherited from the parents. The abortion has to be performed in a hospital or maternity home. Physicians who performed abortions outside a hospital or without the presence of one of these indications were subject to one to two years’ imprisonment. If the abortion was performed under unsanitary conditions or by a person with no special medical education, the penalty was no less than three years’ imprisonment.  A person who induced a woman to have an abortion was subject to two years’ imprisonment.  A pregnant woman who underwent an abortion was subject to a reprimand and the payment of a fine of up to 300 roubles in the case of a repeat offence.
 
In its Decree of 23 November 1955, the Government of the former USSR repealed the general prohibition on the performance of abortions contained in the 1936 Decree.  Other regulations issued in 1955 specified that abortions could be performed freely during the first 12 weeks of pregnancy if no contraindication existed and after that point when the continuance of the pregnancy and the birth would harm the mother (interpreted to include foetal handicap). The abortion had to be performed in a hospital by a physician and, unless performed in cases of threat to the mother’s health, a fee was charged.  Persons who performed an abortion illegally were subject to criminal penalties established by criminal laws under the Criminal Code. For example, if the abortion was not performed in a hospital, a penalty of up to one year’s imprisonment could be imposed, and if it was performed by a person without an advanced medical degree, a penalty of up to two years’ imprisonment was possible. In the case of repeat offences or the death or serious injury of the pregnant woman, a higher penalty of up to eight years’ imprisonment could be imposed. A woman who underwent an illegal abortion was not penalized.
 
Despite the approval of the 1955 Decree and regulations, the problem of illegal abortions did not entirely disappear in the former Soviet Union. This situation resulted in partly from the Government’s conflicted attitude towards contraception. Although at times the Government manifested support for contraception, it did little to make contraception available and in 1974 effectively banned the widespread use of oral contraceptives. The situation was also due in part to a revived pronatalist approach to childbearing adopted at times by the Government, which looked unfavourably on abortion. The result was a reliance on abortion as the primary method of family planning.

Concerned with the high rate of illegal abortions, the Government in 1982 issued a decree allowing abortions for health reasons to be performed through the twenty-eighth week of pregnancy.  Continuing this approach of increasing the circumstances under which legal abortions were available, on 31 December 1987 it issued an order setting out a broad range of non-medical indications for abortions performed on request through the twenty-eighth week of pregnancy. These included the death of the husband during pregnancy; imprisonment of the pregnant woman or her husband; deprivation of maternity rights; multiparity (the number of children exceeds five); divorce during pregnancy; pregnancy following rape; and child disability in the family. Moreover, the order provided that, with the approval of a commission, an abortion could be performed on any other grounds. (Source: Population Policy Data Bank maintained by the Population Division of the Department of  Economic and Social Affairs of the United  Nations Secretaria, 2000)
 
An abortion requires the consent of the pregnant woman; it is authorized if performed by a licensed physician in a hospital or other recognized medical institution. Abortion is available on request during the first 12 weeks of gestation. Thereafter, induced abortion is available within 13- 22 weeks from conception on judicial, genetic, vital, broad medical and social grounds, as well as for personal reasons with the special authorization of a commission of local physicians. Since 2006 according to Order N508 MOH Ukraine 20.07.2006 “Statement on abortion procedures and obligatory requirements regarding statistics, recording” and Resolution N144 of Ministry cabinet of Ukraine “Realization of Civil Code Chapter N281 15.02.2006 the social grounds and personal reasons discontinue to be indicators for abortion performance in 2nd Trimester.

Short summary of conditions for legal abortion within the law:
To protect  woman’s life  -   Yes                                                                                       
To preserve physical health  -   Yes                                                                                
To preserve mental health   -  Yes                                                                                   
Rape or incest   -  Yes                                                                                                        
Fetal impairment   -  Yes                                                                                                   
Socio-economic factors  -  No                                                                                           
Available on request  -   Yes before 12 weeks of gestation.
 
The access to new abortion technologies including medical abortion and MVA is extremely low.  Medical abortion has been approved since 2001 by MOH.
 
From 1 January 2007 Ukraine follows WHO standards - a baby born after 22 weeks of gestation with weight ≥ 500 g is not considered as “an abortion material” more.

2. Policy

In fact, Ukraine uses double standards policy. On the one hand, abortion is not prohibited. And moreover, a fourteen year-old girl can keep her parents unaware of her visiting gynecologist and being given treatment there (according to MOH resolution). This has been done to limit the number of criminal abortions. On the other hand, the negative attitude to abortion is supported by the state as its policy is aimed at population increase.

3. Second Trimester Abortion

4. Practice

Any abortion is performed by a licensed physician in a hospital or other recognized medical institution, as usual - a fee was charged in state hospitals.
Adolescents aged 14+ can visit a gynecologist without parents.

5. Reproductive Health Perspective

Signatory to ICPD, CEDAW:   Yes

6. Abortion Statistics

Induced abortion rate among women aged 15-44 years
Total abortion rate per woman   -  1.2
General abortion rate per 1,000 women – 21.1 in 2004; 19.5 in 2005; 18.6 in 2006.
Abortion ratio per 100 live births - 64.0 (number of abortions for every 100 childbirths) in 2004; 50.5 in 2006.
Age specific abortion rate (per 1,000 women) age 15-19  -  4.7 (per 1,000 women aged 15-17)
Total number of abortions (indicate source; period)
Total legal abortions in Ukraine - 264,074 (absolute number) according to the MOH report in 2004; 229,618 – in 2006. Number of medical abortions performed in 2004 is only 1205 in absolute number.
1st TM – 93% (2005)
2nd TM – 5,7% (2005)
Safe – 32.8% MVA (<3 wks LMP) + medical abortion 0.46% + spontaneous 4.7%
Unsafe – legal surgical 62.01%  + criminal abortions 0.03%
Married women – no data
Unmarried women – no data
Adolescents – no data

7. Public sector

Abortion services available:

 2nd Trimester – Yes

Cost
Free of charge (officially), but sometimes it can be as low as $20-40.

8. Private sector

Abortion services available:

For medical abortion: from $120 to $300 which women must cover by there own.
For surgical abortion: $50-150.
For EVA and MVA: $50-150.

9. Methods used

1st Trimester
D&C (≤12 weeks),
EVA (≤8 weeks),
MVA (≤8 weeks),
MA with Mife+Miso (<= 49 days, Mife 200 mg or 600 mg per os (presence of gynecologist), 48 hours later – Miso 400 mg).
MA with Miso alone ( not used),
MA with Methotrexate+Miso (not used)

2nd Trimester

  • Gestation age 12-22 weeks    
  • Procedure only in accredited hospitals 
  • Decision of Special Medical Commission   
  • Written request from women or legal representative (parents, est.)

Indication for abortion in 12-22 weeks (according to 10 International Statistic Classification of diseases):

  • B06 Rubella during pregnancy
  • B20-B24 HIV/AIDS
  • A15 A16 A18 A19 Tuberculosis
  • C00-C97 Tumors
  • E10 Diabetes with complications
  • E21 Hyperparathyroidism with complications
  • E70-E85 Hereditary diseases
  • D60-D61 Anemia
  • F01 Dementia
  • F04; F06; F07; F09; F10-19; F20; F22; F25; F28; F29; F60-F69; F70-79Mental diseases    
  • G30 Alzheimer's disease 
  • G30; G71-72 Nervous disease    
  • I05-I08; I34-I35 Heart disease   
  • I10-I13 Essential hypertension III 
  • I25 I27.0; I27.1; I27.9; I31; I42.0; I42.1; I42.3-I42.9; I50; I71 Heart disease
  • Q20-Q28 Disease of blood circulation 
  • J44.8 J96.1 Respiratory disease  
  • K22.2 K72.9 K74 K76.6 Digestion disease 
  • N13.0-N13.3; N17; N18 Kidney disease   
  • M30-M36; M40 Arthropathy and muscle disease 
  • Q00-Q89; Q91-Q93; Q99,8 Chromosome diseases and malformation   
  • Pregnancy after violation/rape   
  • Disability during pregnancy 

Methods, that use in Ukraine (Order N508 MOH Ukraine 20.07.2006 “Statement on abortion procedures and obligatory requirements regarding statistics, recording”)

  • Intraamniotioc injection of 40 mg (8 ml) Dinoprost (By abdominal amniocentesis injection of Dinoprost 40 mg (8 ml));
  • Intraamniotioc instillation of Hypertonic saline (20% NaCl) (By abdominal/vaginal amniocentesis withdrawal of 150-200 amniotic fluid, followed by instillation of 200 ml of 20% NaCl (40 mg) Hypertonic saline. Induction-abortion intervals range from 17 to 21  hours);
  •  Endocervical gel Dinoproston with follow-on of Dinoproston intravenously (Every 6 hours 3 gr. gel Dinoproston endocervicaly with purpose of cervical delatation. Next - Dinoproston 0,75 mg + 0,9% NaCl 500,0 intravenously);
  • Mifepristone, Misoprostol and Prepidil new! (Mifepristone 200 mg per os (presence of gynecologist). 22-26 hours later Dinoprostone 0,5 mg. (3 gr. Gel) endocervicaly. After next 22-26 hours Misoprostol 800 mg: 400 mg per os and 400 mg vaginaly);

 
Ethacridine lactate (not used);
D&E (used, in limited cases);
Hysterotomy (not used).

10. Provider level allowed for surgical and medical abortion

Ob/Gyn only.

11. Abortion related morbidity mortality statistics

The indicator of maternal mortality in year 2004 was 10 (for 100000 childbirths). Abortion is one of the basic causes of the maternal mortality in Ukraine. In the structure of preventable causes of maternal mortality, abortion account about 25%. In year 2005 the absolute number of maternal death after abortion was 12. The situation can be explained by high level of complications during surgical abortion procedure and postabortion complications (haemorrhage, infections, etc.), lack of postabortion management and contraception.
 
In 1980-90 – 60% of cases of the maternal mortality in Ukraine were caused by abortion. In 2006 this rate was 5,6%.

12. Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment).

Availability of equipment (MVA) is rather limited. The reasons are: lack of information among medical staff and limited practical skills and experience.  Also unsatisfactory system of distribution. EVA  equipment is mostly old-fashioned.

13. Manufacture/ import of Mifepristone, Misoprostol

Import - $90 per set (600 mg Mife + 400 mg Miso) per case.

14. Facility and provider certification norms in brief

Procedure only in accredited hospitals ( in gynaecological clinic)  with twenty-four-hour medical services.

15. Information available in national service delivery standards

Lack of information on WHO Safe abortion recommendation.

16. Informal / illegal providers – if present who are they

No data.

17. Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population

Urban population in Ukraine – 32 million, rural – 15 million.
Women of reproductive age (15 - 44 years) - 12, 3 million.  
Negative attitude of population, lack of information regarding contraception, inconsistent supply to vulnerable groups and high cost of contraception have ensured that abortion still is the method of fertility control in Ukraine.
With a total fertility rate that declined between 1990 and 2004 from 2 children per woman to 1.1 (1.24 – in 2007).
Population growth rate: - 0.675% (2007).
Birth rate: 9.45 births/1,000 population (2007).

18. Role of government

After the International Conference on Population and Development, held in Cairo in 1994, the Government implemented a special plan of action on population issues and a series long-term national programmes (National family planning programme 1995-2000, Reproductive health programme 2001-2006, Reproductive health programme 2006-20011, ect).

19. Role of religion/ religious leaders

The Orthodox Christian Organizations actively inform the population against abortions. Practically every gynecological consultation has posters saying that abortion is a murder. A special organisation, called The Association against abortions, works with doctors and medical students.
 
The organization unites people to prevent abortions. According to their data, they prevent every second abortion.

20. Local Ob Gyn societies

Local Ob/Gyn society support MA formally. Some doctors in public sector prefer “honorarium” for surgical abortion then to earn nothing for advice on MA.
 
As private clinics included honorarium for doctors in the price of MA, they support MA more effectively.

21. Current status and potential of research

Since 2006 till now – with Gynuity Health Projects “Acceptability and Feasibility of Medical Abortion in Low Resource Settings” (Clinical research).

22. Awareness amongst community members

Awareness on MVA/EVA, medical abortion (among women)
A lack of comprehensive information for women.
Doctors propose MA just for “rich patients”, not for everyone.
Surgical abortion is more available method then MA.
MVA/EVA is used in 30% of cases.
Awareness on MVA/EVA, medical abortion (among medical providers)
Medical providers in small towns and villages are afraid of complications after MA.
No information on MA among medical providers in countryside, for students, school teachers. No trainings and comprehensive information.

23. Role of member organization/ individual

NGO “Women’s Health and Family Planning” - Ukraine

  • 2006, October  – International conference “Medical Abortion in Ukraine: promoting awereness & enhancing service delivery”;
  • Since 2006 till now – with Gynuity Health Projects “Acceptability and Feasibility of Medical Abortion in  Low Resource Settings” (Clinical research);
  • Since 2006 - Developing, publishing and distributing information materials on MA (brochures) for students and general population;
  • 2007 April –  National Conference with MOH of Ukraine for Chief oblast Ob/Gyn “Medical Abortion in Ukraine: promoting awereness & enhancing service delivery”;
  • 2007 September –  International conference for Og/Gyn “MA in Crimea: promoting awereness & enhancing service delivery”;
  • 2008 Participation in WHO Strategical assessment on abortion in Ukraine.