Despite increased government health spending since 2000, the World Health Organization says the nation’s main health indicators have improved little except for maternal and infant mortality.
Although the early neonatal death rate and maternal mortality have both halved since independence, according to official statistics, the WHO and the United Nations Children’s Fund (UNICEF) consider the maternal mortality rate to be underestimated, undercounting being due to the punitive nature of the control system, which encourages health workers to disguise poor health outcomes.
The nation’s population has shrunk by more than 12 percent since independence in 1991 to less than 46 million, and continues to fall due the death rate exceeding the birth rate and because of outgoing migration. In addition, the World Banks says the nation’s life expectancy at birth is 69 years, still below pre-independence levels.
In the face of such grim numbers, maternal and child health have received a large amount of attention in and outside Ukraine leading to significant progress on the problem.
Partially buttressed by international assistance, including funding from the U.S. and Swiss governments, infant mortality fell by a third between 1995 and 2006, according to official statistics. And the numbers keep improving.
The maternal mortality rate in Ukraine was 25.4 per 100,000 live births in 2009, still three to four times higher than in Western Europe. For example in 2009, the rate was 2.62 in Austria, 1.65 in Estonia, and 1.62 in Norway.
“This issue was included in the nation’s millennium goals (that also targeted HIV/AIDS and tuberculosis in the health field), plus the government has been receptive to applying international evidence-based technologies,” said Ihor Pokanevych, Ukraine country manager for the WHO.
In 2010, President Viktor Yanukovych launched an initiative to further decrease the nation’s 3.3 percent early neonatal mortality rate even more.
One initiative, a 10-year, U.S.-funded maternal and infant health project that covered more than 20 regions and 54 percent of births in Ukraine witnessed an average 12.75 percent maternal mortality rate per 100,000 live births in 2007-2010, compared to the national average of 20.3 percent for the same period.
Evidence-based practices were introduced, some for the first time, at 533 health facilities, requiring little cost. And more than 14,000 healthcare workers were trained. When the project started in 2002, birth preparation, birth-giving practices, and newborn care were conducted with outdated Soviet perinatal technologies.
Mothers were allowed to choose the most comfortable delivery position instead of the forced Soviet method of lying on their backs with their feet placed in braces. Individual delivery rooms were also provided to mothers.
“This resulted in quicker delivery times and reduced unpleasantness,” said Janina Jaruzelski, director the U.S. Agency for International Development regional mission in Ukraine.
The project also encouraged partner deliveries and instituted the use of child delivery monitoring equipment, introduced skin-to-skin contact after delivery and immediate breast feeding practices after birth.
Partner attended deliveries provide much needed psychological support to delivering mothers, said Dr. Tamara Irkina, the project’s deputy head. Today up to 80 percent of the births covered by the project are attended by partners.
“A doting partner who massages the mother, brings water, and simply being in the delivery room, goes a long way,” said Irkina.
And while newborns earlier were hazardously placed on cold, metal tables after being dried after birth, they now are placed on the mother’s or partner’s chest wrapped in a blanket to get used to breastfeeding. This is the first crucial step to immunization, and helps newborns adopt quickly to the outside world.
“We supported active child delivery management for better outcomes and to minimize the need for surgery or drugs that would complicate delivery procedures,” said Jaruzelski from USAID.
The numbers speak for themselves.
More than 50 Health Ministry protocols were issued providing clinical guidelines for obstetric, neonatology, epidemiology, and preventive pediatric care.
All 22 pre-service obstetric institutions use revised curricula for post-graduate education in obstetrics and neonatology that now include the majority of effective perinatal care technologies.
As a result, the incidence rate of C-section births decreased from 31 to 16 percent, the rate of induced labor dropped from 29 to 1.5 percent, and episiotomies went from 25 to 5 percent, according to USAID.
“This was a constructive partnership with the health ministry and health practitioners in the region,” said Jaruzelski.
“We’re gratified to their receptiveness. This has been a serious almost 10-year effort. We’ve seen tangible results in the welfare and very lives of women and children in the country. Ukraine is well prepared to roll out this project nationwide,” Jaruzelski added.
Kyiv Post staff writer Mark Rachekvych can be reached at [email protected].
