Ukraine Healthy Women of Ukraine Program (USAID)

Family planning used to be a comparatively new concept in Ukraine. Although many women and men of reproductive age were aware of modern contraceptive methods such as contraceptive pills and IUDs, their knowledge was often shallow, which led to inconsistent and sometimes ineffective use. Ineffective use was one of the reasons for Ukraine’s relatively high abortion rate.

According to the Ministry of Health, about one-third of pregnancies ended in abortion. Women’s uptake of modern family planning methods have been complicated by rumors, myths, and other misinformation about contraceptives, particularly hormonal methods. Only 3.7% of Ukrainian women of reproductive age used contraceptive pills; 12.1% used IUDs. Surprisingly, health providers (particularly gynecologists) were often the conduits of this misinformation.

USAID supported JSI’s implementation of programs aimed at protecting women’s and couples’ reproductive health. The first program, Together for Health (2006-2011), was implemented in 15 oblasts of Ukraine. The second program, Healthy Women in Ukraine (2011-2016), worked in an additional 15 oblasts. Both programs worked with the general population, health service providers, and government to increase the uptake of modern contraceptives.

JSI’s program approach was made up of three components: 1) educating the public to make informed reproductive health and family planning choices; 2) improving the knowledge, attitudes, and skills of family planning and reproductive health service providers through in-service training and capacity building; and 3) influencing the development of pro-family planning and reproductive health policies.

Key results since the start of the program, quoted directly from the Final Report, include:

• 10% INCREASE in clients who reported receiving family planning/reproductive health.
• 13% INCREASE in clients reporting “positive” or “very positive” attitudes toward hormonal contraceptives.
• 6% DECREASE in clients perceiving hormonal contraceptives as “unsafe” or “very unsafe”.
• 5% INCREASE in clients reporting current use of any modern contraceptive.

In addition…

• More than 10 million Ukrainians received user-friendly information about the benefits of family planning, modern contraceptives, and how to access high quality family planning and reproductive health services.
• As of September 2015, all medical postgraduate educational institutions began using a revised version of a more effective and practice-oriented FP/RH pre-service education curricula.
• Much-needed attention was brought to the FP/RH needs of women with disabilities, improving their access to FP/RH services in hospitals.
• There was a continual increase the number of service delivery points since TfH, providing quality FP/RH services in oblasts going from 749 to 5,000 delivery sites in 2005 to 2016.
• Mobilization of more than $1,650,000 in counterpart contributions to support continuous medical education occurred.

Health Impact:

• According to MOH data, the national abortion rate fell from 19.5 abortions in 2005 to 9.8 in 2015 in MOH health facilities.
• As the abortion rate and ratio decreased from 588 to 255 abortions per 1000 live births from 2005 to 2015, the rate of unintended pregnancies decreased over the same time period, from 15% nationally 2005 to 6% in 2015.
• The rate of unintended pregnancies decreased over the same time period, from 15% nationally to 6%.
• Meanwhile, Ukraine’s birth rate simultaneously increased, from 9 to 11 births per 1000 people from 2005 to 2014.

Although it is inaccurate to say that any particular health impact was solely related to JSI’s activities in Ukraine, it is reasonable to say that the USAID-funded TfH and HWUP projects have contributed to positive changes in Ukraine’s FP/RH health outcomes.