Condoms and Empowerment: Adventures in the Field of Ukrainian Reproductive Health Care

I spend the majority of my time in Ukraine researching the obstacles and motivations to use of contraceptive and abortion services, which involves traveling to the various oblasts in Ukraine and setting up shop in hospitals, women's clinics, and gynecologists' offices to speak with women about their experiences with abortion and contraception. This has at times proved rather awkward or surreal, due both to my not-yet-perfect-and-often-quite-tactless Russian language skills and to a lacking awareness of patient rights in Ukraine. For example, I have been led into post-abortion recovery wards and invited to ask the group questions about their experiences or some lack of nuance in my questioning has led doctors to ask aggressively, "Well, you have abortions in the States, too, right?!"

However, for the most part these interviews have yielded some very frank and meaningful conversations about reproductive health, family, a woman's role in society, and even the future of Ukraine. Sometimes the picture painted by women in their interviews is both shocking and upsetting: married women who use lemon and hot wine as contraception, doctor's visits that involve moralizing and humiliation, women who have had intrauterine devices inserted after an abortion without their knowledge or consent.

In spite of these circumstances, though, there have also been some incredibly hopeful attitudes towards improvement in women's health, and what improved reproductive health can do for women in society. Some women tell me proudly that they have brought their husbands along with them to gynecological appointments to discuss contraception or partner births, or that after learning about sexually transmitted infections at school they have started using condoms in addition to their normal birth control. One young man looked at me shocked when I asked him if he used contraception with his girlfriend, responding, “Of course we do! We both want children, but we want to do so much before then!” These comments might seem to be only of minor importance, but in a country where abortion was the primary form of birth control for decades and the term “public health” does not yet have a Ukrainian translation, examples of women and men taking responsibility and initiative for their own reproductive health and futures indicates movement towards a healthier nation.

As I speak with these women, the most frequent question that I have been asked (and that I ask myself) is, "How is contraception different in the U.S.?" And the truth is, contraception itself is not that different. The contraceptives on the market right now in the States are pretty much the same as the ones available in Ukraine, with a few exceptions. Where differences do exist, however, is in the access to and attitudes towards contraception in the respective countries. While contraception is often available on a sliding price scale in the U.S., price is a significant barrier for many women in Ukraine, especially those from the rural areas. In the States, most young people know that they can go to the school nurse or the college health center or a local clinic for birth control counseling, but in Ukraine, most people only trust the doctor for providing such advice, but they rarely visit the doctor because of long waits, expensive under-the-table costs, and a lack of confidentiality. There are other pretty major differences in terms of what methods people believe are safe to use: IUDs are widely popular in Ukraine but not in the States, while the pill, the most popular form of birth control after condoms in the States is thought by some in Ukraine to cause women to grow tails.

One of the most significant differences, however, is a lack of a connection between reproductive rights and reproductive health in Ukraine, a link that is almost too strong in the U.S. While working in reproductive health in the U.S,, empowerment and choice were constant refrains. But when I ask women about their thoughts on "reproductive rights" here, I generally get blank stares. Whereas in the U.S. reproductive health is a social and political issue, in Ukraine, it is a purely medical one.

The politicization of reproductive health can be detrimental. When women can't access safe abortion services because of spousal consent laws or abortion clinic protesters, or when the teenage pregnancy rate increases because of abstinence-only education in public schools, there is clearly a problem with over-politicization of some very basic health services and needs. However, in Ukraine, these services are not politicized enough, so that no one thinks to fight for these rights if they are taken away. This hasn't been a problem in the past, since abortion and IUDs were free and frequent during the Soviet period. However, an opposition is developing. There are posters all over clinics, metro stations, and the cities that say things like "Abortion is murder" or "Mama, don't have an abortion," and both the Catholic and Orthodox churches have started anti-birth control campaigns. If and as these movements develop, there needs to be a healthy pro-choice coalition that can ensure that women still have the choice to access safe and comprehensive reproductive health services.

This pro-choice attitude is developing, as is indicated by the comments I mentioned above, and by a conversation I had with one young woman about her worries about the conflicts between her religion and her decision to use birth control. She told me that she had given birth to a child-unplanned, but wanted-when she was young, and that because she wanted to be able to raise her son and have a career eventually, she had decided with her husband to use hormonal birth control pills for contraception. A Catholic, she had discussed the issue with her priest, who told her that use of any sort of contraception is a sin. She looked at me earnestly, though, and told me, “But I think it would be even more of a sin if I couldn't take care of my son the way I want to. Or if my husband and I couldn't plan our future in the way we want. That's why I am using birth control.” Her desire for a better life for her son and a future that she can control indicates not only an awareness of the empowering nature of contraception and preventative health care, but an honest desire and belief in the possibility of a better future for herself and her country.