We generally assume that family planning is a settled matter in Ukraine. After all, the country loses almost 300,000 people per year because fewer babies are born than old people die. So family planning must be working, right?
As with most things in life, the answer is somewhere between yes and no. Yes, 85 percent of the population have used contraceptives at some point, although only 59 percent are using it right now. That, by the way, includes large numbers of women who use contraceptives for reasons other than family planning, such as skin problems, cramps or hormone therapy. And yet, it will come as a shock to many to hear that one-fourth of all pregnancies in Ukraine end in abortion. Abortion is not about choice – no sane person believes that any woman actually wants to have an abortion. This is entirely about the failure of family planning.
Ukrainian women today have 1.5 children on average. This means that fewer children are born each year than people are dying. If you add to this the number of people who leave Ukraine annually, estimated in the hundreds of thousands, it is easy to see where this will eventually lead: a country with a population of 35 million by 2050, down from today’s 44 million. So why have family planning, then? Would not it make more sense to have more children?
Well, no. Family planning is not about having fewer children – it is about deciding if you want to have children, how many, and when. It is a basic human right. Couples – or more precisely women – exercise that right by making these choices based on the time they have available, the money they have now or expect to have, how they see having children will impact their employability and career prospects, and of course whether anyone will help them raise these beautiful babies.
Therefore, the actual prevalence rate of contraception is just one part of the picture. Unless a woman does not fear being left without a job when she returns from maternity leave, she will think twice before getting pregnant. The current law is stacked against women in that sense – when employers need to choose between a male and a female candidate for a position, there is always the specter of the woman taking long maternity leave, currently a very generous three years in Ukraine. So guess who will get the job? In addition, the fact that women spend two to three times more on household chores than men, especially when there are children in the household, also makes having a child a less attractive proposition for many women. And finally, the absence of part-time work, as well as work-place based child care, is a definite turn-off for many women – this is the single-most important element quoted by working women when deciding to have (another) child.
In addition, fifteen percent of all Ukrainian families have fertility problems – that is close to one million families. And yet only 69,000 couples seek help with assisted reproduction each year.
Treatment is expensive – at least 60,000 hryvnias per couple. So hundreds of thousands of couples want to have children but do not have the money to access the technology to would allow them to have a child. Most cases of infertility are the result of sexually transmitted diseases, for both men and women, followed by repeated abortions earlier in life for women and, in the case of men, smoking, alcohol and drug abuse. Consistent use of contraceptives early in their sexual lives would have gone a long way towards avoiding many cases of infertility later in life, when people are in fact ready to have children.
So here is where the problem with contraceptives comes in: access. While there are many different methods on the market, oral pills are out of reach for many women, especially young women. Many simply cannot afford to pay 270 hryvnias per month for this method – research shows that almost 70 percent of women consider 150 hryvnias per month the maximum they are willing to pay. So there is a dire need for methods in the price range of 30-40 hryvnias, considered affordable by virtually all women.
Condoms have been promoted heavily for many years, particularly as they protect from both pregnancy and STIs, including HIV. And yet, forty percent of women and girls under 20 have been pregnant at one point in their lives, and three-quarters of these pregnancies end in abortion. Of the remaining 25 percent who end up being mothers before they turn 18, almost half never finish school. And as expected, 80 percent of the young fathers end up not marrying the mother of their new baby. Also, one out of every seven HIV-positive persons in Ukraine is under 18. The true story here is one of lives disrupted and opportunities lost. Consistent use of contraceptives by young people could have prevented most of these terrible outcomes, and have empowered tens of thousands of young people to lead productive lives instead.
Contraception is not as easily accessed by young people as we think, even today. Price is an issue: the cheapest condoms on the market today are about 25-30 hryvnias for a pack of three. Unfortunately few supermarkets and pharmacies carry the cheaper varieties – profits are higher for more expensive varieties, which young people often cannot afford. In small towns, where everyone knows everyone else, young people will think twice before going into the local pharmacy to buy condoms. Then there is the idea that not telling young people about sex will keep them from having sex. Nothing could be further from the truth. By age 17, close to half of all young people in Ukraine will have initiated their sexual lives, whether or not to have received any information about sex. Instead of having a discussion on responsible sexual behavior, young people are being told it is immoral to have condoms on them. As a result, one out of every three adolescent girls does not use a condom when having sex, and tens of thousands end up pregnant or with STIs. On top of this, it is often considered that condoms are the responsibility of the man, not the woman. This leaves women in a vulnerable position of not being able to negotiate safe sex.
Family planning is, perhaps more than any other issue, where inequalities in society play out: while many women have no problem buying the contraceptive method of their choice, many others cannot afford the methods they want, and do not want the methods they can afford. The result is that those less privileged in life, and especially the young among them, go without contraceptives and so end up with more pregnancies, abortions, STIs, and infertility. The cost of not providing the young and the poor with affordable contraceptive services is, ultimately, borne by all of society, through increased health budgets, lowered productivity and fiscal intake, and a younger generation less capable of shouldering the burden of an aging society.
Family planning, ultimately, is about planning your life. And that is not a luxury.
Caspar Peek is the United Nations Population Fund representative in Ukraine. World Population Day is celebrated on July 11 every year. In 2017 the theme is “Family Planning: Empowering People, Developing Nations.”
