Risk Factor

Recently Ukrainian lawmakers discussed the right to life. This January several amendments to the corresponding paragraph in the Civil Code will come into force. For example, abortions for medical reasons after the twenty-second week of pregnancy will be considered criminal, a change from the current twenty-eight weeks. The people’s deputies have also voted to outlaw forceful sterilization: since January 1 this procedure will be possible only with the consent of an adult. If an individual is legally incapacitated, this decision can be made by a guardian. Health Minister Andriy Pidayev believes that all these amendments, along with the more specific wording of the term “reproductive technologies,” will make it possible to raise the standards of medical care for newborns to the European level. Moreover, they will guarantee the right to life for premature babies with a small body mass.

Such changes are indeed necessary, given the fact that last year there were 86 abortions per 100 births in Ukraine; child mortality was 9.7 per 1,000 live-born children, and maternal mortality-22.5 per 100,000. These statistics are twice as high as Europe’s average. Where abortions are concerned, comparisons are meaningless. Germany, for one, has a ratio of 100 births per nine abortions. Still, Ukraine’s current statistics are proof of major progress. Compared to the 1990s, the key strategic indicators have increased by an order of magnitude. Only six years ago the number of abortions in Ukraine exceeded the number of births by 1.5 times.

Many experts claim that this is the very reason fewer first-graders will be enrolled in schools in the coming years. Even though many regions have reversed this unfortunate trend, reporting more births over deaths, the sad truth is that only 6% of newborns are absolutely healthy. By the time a Ukrainian woman reaches reproductive age she suffers from a host of often chronic diseases. “Hence it is unlikely that the next generation of mothers will be healthier than the current one,” says Vira Pyrohova, MD, chair of the Faculty of Obstetrics, Gynecology, and Perinatology at Danylo Halytsky Lviv State Medical University. Today only 30% of all births occur without pathologies. According to antenatal clinics, the incidence of anemia and cardiovascular and endocrine disease in expectant mothers is 2.3, 1.6, and 8 times higher, respectively, not to mention venereal diseases, which are often revealed only when women decide to have children.

Incidentally, half of all pregnancies in Ukraine are unplanned. This would be acceptable only if women were healthier. Today a whole range of uncured and unrevealed diseases can affect the offspring. Add to this the so-called risk factors that differ from region to region. For example, doctors in Luhansk oblast complain about poor water quality, while MDs in Donetsk and Zaporizhia are concerned about air pollution and in Kherson and Rivne, about unbalanced diets. Paradoxically, Ukrainian traditions can also be classed as a risk factor. According to Vira Pyrohova, it is the custom here to have children at a very young or very mature age, with the former happening more and more often. Among European nations only Bulgaria has a higher percentage of mothers younger than nineteen years of age. At the same time, early parenthood carries a very high risk of infant mortality or premature childbirth. However, doctors say that mothers over thirty face an equal number of problems. As a rule, true to European traditions, they decide to have children only after they get a foothold in life. However, they continue working throughout their pregnancy. “As a result, stress, chronic fatigue, and excessive strain result in premature childbirth and countless complications,” Ms. Pyrohova complains.

Doctors also complain about the latest fad — alternative deliveries assisted by a spiritual guru or private obstetrician. The latter have no licenses in Ukraine, which makes it impossible to prove that a private individual has handled the delivery. These quacks find customers without too much trouble: they begin by vividly describing the horrors of Ukrainian maternity homes and proceed to praise the benefits of alternative delivery. The consequences of this practice differ. Often women are rushed to the maternity home in critical condition. Granted, alternative delivery is practiced in the West, but only by qualified obstetricians with at least ten years of experience. Moreover, they select only absolutely healthy women for alternative childbirth, because obstetricians immediately lose their licenses if anything goes wrong.

Experts believe that the current negative trends can be reversed only by means of preventive treatment. According to Prof. Olha Tymchenko, chair of the genetic monitoring laboratory at the Institute of Hygiene and Medical Ecology, not even the richest societies can afford the mass introduction of complex life-prolonging technologies. Meanwhile, everyone can afford preventive treatment. For example, genetic monitoring conducted by the institute has helped reveal the top risk factors for congenital disease, miscarriages, and infertility. Apparently the risk of miscarriages in women suffering from diabetes or disorders of the thyroid gland is twice as high. If an expectant mother suffers from chronic venereal diseases, the chances of a child being born with pathologies are three to seven times higher. In the case of radiation-polluted Kyiv oblast, smoking and infections increase the possibility of miscarriages under the influence of radiation several times over. Ms. Tymchenko believes that if Ukrainians were examined en masse and regularly, including by geneticists, many unfortunate consequences could be avoided. Today only risk groups are being monitored. Unfortunately, these groups do not include those who really need it.