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Monday, 09 May 2022 07:31

The War in Ukraine Is a Reproductive Health Crisis for Millions

Russia's invasion is making it harder to deliver babies and provide birth control, abortion services, and other essential care.

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THE WAR IN Ukraine is becoming a crisis of reproductive health. Over the next three months, more than 80,000 Ukrainian people are expected to give birth, according to the United Nations Population Fund (UNFPA). That’s about 1,000 deliveries per week. The World Health Organization (WHO) estimates that 15 percent of pregnancies—in a war zone or not—will require skilled medical care for a potentially life-threatening complication.

Women have already given birth in underground shelters and in subway stations. UNFPA posted a woman’s firsthand account of delivering a baby in Kyiv on the first day of the conflict. “I was lucky,” she wrote, “it did not happen in the basement.”

“Babies don't wait because there's a war. Periods don't stop because there's a war,” says Caroline Hickson, the European regional director for International Planned Parenthood Federation (IPPF). Experts are raising concerns about both the short- and long-term tolls of neglecting sexual and reproductive care in Ukraine, including surrogacy and abortion services, disease prevention, and help for survivors of sexual assault. “More than 50 percent of the population are women. And these are non-negotiable needs,” Hickson says.

And yet people are running out of options for safe places to seek care. More than 3 million Ukrainians have fled the country, and others have sought refuge in cities less affected by Russian attacks. The war has strained food, power, and water supplies and cut people off from emergency and routine medical care. According to an online tracker maintained by the WHO, as of Tuesday, attacks had affected 34 health care facilities in Ukraine since the invasion began. These include a maternity and children’s hospital in Mariupol that was destroyed last week in an air attack, an action the US condemned as “barbaric.” (A pregnant woman and her baby died following the attack.)

“Sexual and reproductive health services should be at the core of our assistance to both women refugees crossing the borders and also women staying behind,” Isabel Yordi Aguirre, technical officer of gender and health for the WHO, told WIRED during a press briefing last week. Ukraine’s rate of maternal mortality, or when a mother dies from a pregnancy-related cause, has historically been high, due in part to insufficient access to family planning services. Aguirre notes that conflict and displacement threaten to increase that mortality rate. “Those women may have moved from having a life-changing experience to a life-threatening experience,” she says.

GALYNA MAISTRUK SAW this coming. Maistruk is a gynecologist-oncologist from Kyiv who also directs Women’s Health & Family Planning for Ukraine. Maistruk has helped fill gaps in humanitarian aid for reproductive health care in eastern Ukraine since the Russian invasion of Crimea eight years ago. She had helped supply equipment to Mariupol’s maternity and children’s hospital—the one destroyed last week.

It’s been clear to her that the conflict would inevitably expand. Still, when it finally did approach Kyiv, she couldn’t avoid the shock. “I understood that it would be very bloody,” she says. “Because I saw this Russian world in Donetsk and Luhansk—how it looks, how people are suffering.”

Medication is now hard, if not impossible, to access because supplies have been depleted or destroyed and logistical chains broken, says Maistruk. Terminals and storage are generally located near Kyiv, Ukraine’s most populous city. “Now everything is in very poor condition. Unfortunately many companies lost the possibility to transport,” she says. Some health care workers have fled for safety, including Maistruk, who recently left Kyiv to go west. Her husband stayed behind to continue work in a maternity hospital. Emergency supplies are short: oxygen, blood, antibiotics, antiseptics—all of which can be ​​critical ​in emergency obstetrics.

And a family’s needs don’t stop once the baby is safely born. “The women stay in their clinics for two, three days and then they need to go home,” says Maistruk. “And home is under bombing. Home is under air alarms, when you need to leave everything and in one minute go to the shelter. Imagine: How can you breastfeed—how can you organize your care?”

Global health infrastructure had already been pushed to its limits by the pandemic, says Ann Moore, a researcher with the Guttmacher Institute, a New York-based research and policy organization for sexual and reproductive health and rights. “This humanitarian crisis is starting with depleted resources,” she says. “Health care provider resources, commodity shortages—a weakened health infrastructure overall, globally. That puts all of these reproductive health care needs at even greater risk.”

A rush of humanitarian aid has streamed into Ukraine and bordering countries to help fill this gap. The UNFPA has delivered essential supplies and has made sexual and reproductive health a priority. Médecins Sans Frontières (Doctors Without Borders) has done the same and begun training health care workers in the west on war zone trauma care. Unicef has provided 62 metric tons of supplies, including midwifery kits. The UNFPA also deploys packages of equipment meant to help with normal deliveries, complicated ones, and C-sections. (Maistruk remembers these kits as “excellent” when she previously used them in Luhansk. “It includes the whole operation room,” she recalls. “You can open the box, and in one, two hours you can organize the operation room.”)

Unicef supplies dignity kits containing underwear, soap, a bucket, and other hygiene products, plus basics for safety: a flashlight, a whistle, and information about gender-based violence. “We know that when social norms break down, sexual violence—especially among the most vulnerable—always follows,” says Moore, pointing out that young women and girls, people of color, and the LGBTQ+ and disability communities are always at the most risk. Survivors may have injuries that require immediate medical attention and treatments: antibiotics, post-exposure HIV prophylaxis, and emergency contraception.

People will still need access to routine medications, too, like hormonal birth control. “If people can’t access contraception, they may be confronted with unintended pregnancies at a point which is just perhaps the very worst time in one's life to have to manage that,” says Hickson. “If you are a person with HIV and you're taking antiretroviral therapy and it suddenly stops, that's going to be massively detrimental. There are transgender people who are taking hormone therapy, that's massively detrimental if they no longer have access.”

The Inter-Agency Working Group on Reproductive Health in Crises (IAWG), identifies these on its list of priority services for humanitarian aid, which includes safe abortion and post-abortion care. All of these may be in demand among Ukrainians. Some people may have been separated from their partner, as Ukraine banned men ages 18 to 60 from leaving. Pregnancies that were previously desired may no longer feel sustainable.

Still, these medical needs are among the last to receive attention during crises, says Sara Casey, a public health and humanitarian aid expert at Columbia University. “There are no excuses for this. None of these services are highly complicated to provide,” she says, including providing abortion via pills, typically a combination of misoprostol and mifepristone.

But such services can also be politically fraught. Ukraine has liberal abortion policies. Some of its neighbors, countries into which people are fleeing, do not. Poland has a near-total ban on abortion. It is only permissible there in the case of rape, incest, or threat to a mother’s health. (Poles have been known to travel to Ukraine for abortions.) “And that ban will apply equally to a Ukrainian refugee woman as it would to a Polish woman,” says Hickson. “That is a huge challenge.”

Post-abortion care—to prevent problems like sepsis—is less controversial, says Casey. “Essentially, no country is going to say the person should die, even if they think abortion itself is wrong.”

Ukraine has one of the largest networks of surrogacy in the world; an estimated 2,000 children are born to surrogate mothers there every year. Agencies have raced to ensure the safety of those women. Susan Kersch-Kibler, founder of Delivering Dreams Surrogacy Agency, says her agency took seriously the early reports that Russia might invade, and managed to relocate all but one surrogate mother to the western city of Lviv weeks before the war began. She says personnel risked their lives to rescue biological material from Kyiv, such as eggs, sperm, and embryos. “These are people that are older, and sometimes have gone through tons and tons of IVF. So the embryos we have are extremely precious,” she says.

But despite the peril, there is some room for hope. Aid has gotten better and smarter, Casey notes, thanks in part to advocacy groups that have fought for years to make policymakers and NGOs focus on reproductive health. In the 1990s, during the crisis in Bosnia, she says, services for sexual assault were so bad that humanitarian organizations “would set up places with signs that said, like, ‘rape center’ and then wonder why nobody came to them.” But the response was much better in 2016 in the Rohingya refugee camps in Bangladesh, she says, noting that aid organizations rallied resources to provide access to safe abortion. "I would say that's probably the first major humanitarian emergency where I felt like safe abortion care really was available in the camps fairly quickly after arrival," she says.

The job of these aid groups, Hickson says, is now to support Ukrainian health care workers who already know their communities well. “They are there even when the bombs are falling,” says Hickson. “Doctors and nurses working in incredibly tough situations to deliver babies and care for people, no matter what.”

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We have been very satisfied, I have been comfortable at the clinic and with my doctor. I was heard. I could ask any questions. I like you have hu-mor, despite the circumstances. Great clinic. Your service has been very good. You have been a huge support and very spacious. You have been available 24 hours a day. You have the answer to all the questions we have been asked. You have accommodated our nervousness, you have rejoiced with us, you have been there throughout. I could not have wished ...
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A and S
The communication with surrogate is easy and better than what we expected. The updates are provided as scheduled with occasional surprises
The support was great. It was easy on us that the coordination was done by the delivering dreams team while being completely transparent with us on the progress. The communication with the delivering dreams team was always fast, responsive, and easy.
E and K
Thank you kate. You have been great today and all the other days ❤ you are a great team. We are very satisfied and happy for your help.
We were confident before in our choice, but this experience has confirmed beyond any doubt that we choose the best agency.
I loved working with Susan and her team and highly recommend them to anyone considering her services. She's is great at every aspect of a process and knows how to handle delicate matters.
Diana Lyakhovetska
Susan truly understands the needs of parents using surrogacy, and offers comprehensive emotional support to parents as they experience the journey!
Christine Hughes Pontier
The team at Delivering Dreams is amazing! Their attention to detail and ability to put your mind at ease while growing your family is like none other. They handled everything for us, and I never once doubted they would help us accomplish our dreams.
Margaret Jones
I’ve known Susan for several years now, and I’ve always been impressed by her attention to her clients’ needs. I’ve known her to work ardently and diligently to solve whatever challenges, no matter how unique, that prevent her clients from completing their families. She is a problem-solver, and she earnestly believes in providing the best options and in making surrogacy opportunities realities: this is not merely a business for Susan. She will help customize the process for your needs and to ...
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Mary Woods
Susan has a keen sense of business and goes to the max to solve her clients’ problems. She is super knowledgeable on business, laws and how things work in surrogacy in general, and specifically on Ukrainian surrogacy. She is an advocate for transparency in a market that’s often opaque and full of hidden risks. I really enjoyed working with Susan. She really pays attention to detail and was always looking out for my best interest above all. Highly recommend!
Laurie Tham
Delivering Dreams goes above and beyond what other surrogacy agencies offer. After speaking with Susan, I see how they anticipate every part of the process, down to details that I had never even considered. I didn’t know what I didn’t know! Surrogacy can be really complicated and confusing. What an amazing sense of relief to have a company so dedicated to managing the WHOLE process and taking away as much of the stress as possible.
Kate Varness
I have gotten to know Susan through a group where we are members. I have found her to be a genuine and caring person. Her consideration for others and love of her work with Ukrainian surrogates and parents-to-be are evident in all her decision making. She is passionate about being a force for the greater good and helping where she can. I have been amazed at the way she is able to smoothly navigate the complicated maze of requirements in the surrogacy process. I am happy to give her my highest...
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Rose Anne Barbour Huck
Susan Kibler is kind.  She clearly loves those she works with and loves what she does.  Susan listens deeply and compassionately and can make you laugh all in the space of one conversation.  She is wonderful!  If you are feeling worried, she'll hear you.  If you have questions, she will find answers for you. If you need help, she does her very best to support you.  I feel so fortunate to have found her and imagine you will too.
Frances Russell
Susan has the ability to really connect on a personal level quickly.  I have found her easy to talk to and have been so grateful for her guidance.  She is one of those people who offers so much to her clients.  She sees the big picture and has a heart for the most intimate concerns.  She is highly skilled and able to manage what can certainly be challenging and uncomfortable experiences, making them feel easier.  She will take charge at the perfect times and guide you when you really need her...
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Susan Seare
The international surrogacy world is complicated. Susan Kibler knows its ins-and-outs. She knows the people and outfits you can trust and the ones to avoid. She insists on the best for her clients and handles the details so they don't have to worry about them. If you want to take the international surrogacy journey, you can trust Delivering Dreams International Surrogacy Agency to guide you on that path.
Nancy Linnerooth
My friend and I had a positive experience working with Susan. Susan is always super responsive and caring. She is very professional, helpful and reliable. My friend has soo much troubles trying having a baby for many years. My friend and her husband were about to give up their dream of having a baby. Susan Kersch Kibler found the way to help. She has unlimited energy, attentive to detail and super efficient. Great to work with!
Polina Clend
Susan is passionate about helping people become families. She is a trustworthy confidant to have on your side.
Kristen Ancker
Our experience with Delivering Dreams has been overwhelmingly positive. The team seems to be genuinely dedicated to helping us to realize our dream of having a child. The constant communication leading up to the trip and the numerous touch points made us feel comforted in what has been a very challenging and uncomfortable situation. We always had streamlined communication through the group chat and was frequently checked on during our stay.

Under Ukrainian law, surrogacy is a legal affordable option for traditionally married couples to have children using their own embryos, or with either an egg or sperm donor. There must be a medical reason you can’t carry a child. You are also able to participate if you have had 4 unsuccessful IVF attempts.


Under Ukrainian law, surrogacy is a legal affordable option for traditionally married couples to have children using their own embryos, or with either an egg or sperm donor. There must be a medical reason you can’t carry a child. You are also able to participate if you have had 4 unsuccessful IVF attempts.