Responding to Restriction on Abortion Practices & Political Threats in Ukraine

In Ukraine a woman's right to safe abortion is one of woman's fundamental rights which is guaranteed by the Constitution of Ukraine, Basic healthcare legislation, and Order of the Ministry of Health of Ukraine No. 1177, based on WHO recommendations for safe abortion (2004 and 2012) and the findings of key international organizations working in reproductive health and reproductive rights sphere (e.g., Gynuity, Ipas, and others).

There are also international and national commitments to reproductive health and reproductive rights secure in Ukraine, which are following:

Ukraine has ratified 8 key international documents;
Committed to achieving the Millennium Development Goals;
Implementing national programs:

- State Program for Reproductive Health of the Nation, 2006-2015.

- Nove Zhyttja national project for a new quality of maternal and child health aimed at improving the quality of care and better access to high-quality perinatal care.

- Strategy for the Demographic Development of Ukraine for 2006-2015.

Woman's right to safe abortion in Ukraine has being exercised according to The Order of MOH No. 1177 as of 31 December, 2010 (Clinical Protocol) and within the "Comprehensive Care for Unwanted Pregnancy" (CCUP) Project, being implemented in strong cooperation of Ministry of Health, WHFP Foundation and WHO. It is planned that the Implementation Strategy for CCUP at the National Level will be prepared and will start in 2014.

Despite the improvement of the legislation regarding the right to safe abortion, an opposition movement aimed to confront pregnancy termination policy in Ukraine has also become stronger during last few years. In March 2012 Roman Catholic and Ukrainian Greek Catholic Church representatives made a loud statement about the need to ban abortions, announcing manipulative information that 40 million abortions were carried out in Ukraine for 20 years (which is almost several times higher than official data). Abortion has also been declared as a main reason of low birth rates and demographic crisis. In addition, Member of Ukrainian Parliament Andrew Shkil registered a Draft Law for total ban on abortions in Ukraine, except cases when pregnancy and childbirth might endanger woman (Draft Law nr. 10170 dated 12.03.2012). ThiseventwasatthecenterofpublicdebatesduringMarchandApril 2012 and according to media monitoring the largest number of related media references falls on this period.

However, above-mentioned Draft Law has a low chance to be approved (it was not included in the agenda of the next session of Ukrainian Parliament) and rather seen as political declaration or a part of pre-election campaign publicity. At the same time the Ministry of Health of Ukraine, Ukrainian Parliament Legal Department, Women Group of Members of Parliament, Institute of Demography and Social Studies of the National Academy of Sciences of Ukraine, medical community, civil society and human rights organizations as well as influential national media strongly opposed an attempt to ban abortions in Ukraine:

The MOH has taken a categorical position against the introduction of this law, and referring to the results of WHO/MOH Strategic Assessment provided reliable data on constantly decreasing abortion ratio in Ukraine (156 193 cases in absolute numbers or 13,4 per 1000 women of reproductive age in 2011) emphasized on the importance of access to contraceptives, safe abortion services and effective family planning counseling.
Ukrainian Parliament Main Expert and Legal Department emphasizedthat Ukraineratified the Convention on the Elimination of All Forms of Discrimination against Women, which clearly defines the right of women to freely decide on the number of children, spacing of their birth, access to information, education, and tools that allow them to exercise that right. Department expressed serious concern of high risk that legal prohibition of pregnancy termination will increase number of criminal abortions, but will not improve the demographic situation in Ukraine. Department does not support the introduction of the proposed draft ammendments to the cuurent Ukrainian legislation.
Institute of Demography and Social Studies of the National Academy of Sciences of Ukraine proved that social standards, state social guarantees, employment, economic security, improving living conditions and access to child care services may encourage birth rate and improve demographic situation. Main reason for demographic threat in Ukraine is high mortality of the working population, but not abortions.
Medical community, civil society and human rights organizations referred to historical experience of former Soviet Union when ban of abortion in 1936 - 1955's led to an increase of maternal mortality resulted by criminal abortions up to 70% and dramatically increased the number of cases of newborns killings.

Summarizing, as a respond to restrictions on safe abortion the following methods of advocacy were used:

open letters to the President of Ukraine and Parliament deputies (MPs);
collecting signatures from Ukrainian NGOs and activists via Internet portal;
involvement of medical community authorities (MoH, Regional Health Depts);
press packages with targeted messages and fact-sheets;
press conference for representatives of key national and regional media outlets;
national round table in partnership with women MPs;
permanent media monitoring;
involvement of youth organizations and HIV/AIDS organizations.

There key messages used within advocacy campaign against ban of abortion in Ukraine were used:

The legislative initiative to ban abortion in Ukraine may have a negative impact on women's health and, in some cases, endanger their lives;
Limited access to health services for unwanted pregnancies would pose greater risks for women from the most vulnerable groups-low income individuals, those with limited education, without access to welfare services, and those who live in rural areas;
There will be an increased risk of an evolving black market for abortion services and a rapid increase in the number of illegal abortions.

The analysis of media coverage proved that along with the discussion of abortion ban, a lot of very important topics were raised, such as reproductive health, reproductive rights, sexual education, social services, mother and child welfare, access to family planning services and modern contraception, which can effectively prevent unwanted pregnancies and reduce abortion rate. Content analysis of media messages proved that most of the publication had balanced information content, highlighting the arguments of both opponents. At the same time, the most influential leading national media demonstrated deep understanding of the problem and possible negative consequences of the introduction of such restrictions for women in Ukraine. Publications voted for complete abortion ban are minor and more common among small local newspapers or media affiliated with church or other religious organizations. As a leading expert organization in the field of public health, reproductive health and reproductive rights, WHFP several times was invited by media, women NGOs and Parliament Members to provide a commentary on the abortion ban initiative and its possible consequences.

But of course, the opposition movement was visible also before 2012 events and has its continuation later, and here is a short chronology of events, which counted as threats to women's right to safe abortion in Ukraine:

Joint Committee on Ethical Issues within the MHU (2006-2010)
Appeal of the Ukrainian Greek Catholic and Roman Catholic churches to the deputies of the Verkhovna Rada (VR) to introduce a complete ban on abortions (March 2012)
Deputies of the VR submitted a bill to ban abortion to the parliament (March 2012).
Deputy of the ruling party of the newly elected Parliament submitted law on abortion regulation to the parliament (March 2013)
3 VR deputies from the opposing party (nationalists) have submitted law on the full ban of abortion to the VR profile committee (early April 2013)
Recent VR deputy's initiative - draft law on the ban of contraception, including condoms, advertisement in Ukraine (late April 2013)

Thus, even though, the mentioned pro-choice steps have been successfully made, there are still a lot of threats to women's right to safe abortion in Ukraine. In general, threats can be divided into four main groups: political and legal, medical and financial aspects. The political threats include a possibility of repeating attempts of introduction the bill to ban abortion in Ukraine within the newly elected Parliament (some political parties committed to election promises); and, on the other hand, growing influence of the church on government institutions in the area of reproductive health and reproductive rights. The legal aspect includes the lack of separate Reproductive Health Law based on reproductive-rights approach.

The medical threats caused by the following factors: lack of trained MA providers; lack of motivation for safe abortion methods introduction; ethical and moral issues, in particular, within medical community and medical abortion hasn't become routine practice in second-trimester abortion. And the financial threats consists of the high cost of medical abortion drugs and services for individuals; Ministry of Health didn't include MA medications into National Essential Drug List; and the Total Market Approach (TMA) for family planning is not introduced in Ukraine.

Taking into account the above described situation in the country, there are seemed the following next steps for responding to restrictions improvement of safe abortion and quality of services strategy:

1) Development of international cooperation and implementation of projects:

research (Gynuity, WHO);
training (Gynuity, WHO, SDC, UNFPA, IPPF);
service delivery (Gynuity, WHO/CCUP project);
advocacy (ICMA/EEARC, Gynuity, ESC).

2) Implementation of scaling-up strategy:

addiction and sustainable policy of MoH of Ukraine;
integration of high quality services (CCUP project approach) into existing system;
improvement of legal environment;
improvement of University and post-graduate education;
encouraging of the population for high quality services and information.