Nothing is new about the ideas of a baby boom coming after such a hard winter as we have just had in Ukraine, and with Ukraine suffering a savage depopulation in the last 10 years the state needs all the babes that can be produced.
The population has now dipped below 46 million and the growth rate is minus 4.2 per 1,000 population.
Ukraine has one of the lowest fertility rates in Europe and at 1.25 per 1,000 women is nearly half that of France, although southern European countries like Italy and Greece also have low rates. Population decline has been higher in the east with some cities losing up to 11 percent of their population in the twelve years from 1989.
Ukrainian children are playing during a street festival at the National Botanical Garden in Kyiv on June 26. (Ukrainian photo)
Population decline has been considerably less in western Ukraine with Volyn having one of Europe’s highest birthrates and some 5 western regions having positive growth rates.
Factors affecting the birthrate in Ukraine are both medical and socio-economic.
Amongst medical factors are the still-prevalent use of abortion for birth control with the subsequent complications of infection causing infertility, whilst the high incidence of sexually transmitted infections such as chlamydia cause infertility in childbearing years. Socio-economic factors revolve around the necessity for young mothers to return to work after the birth of one child and the prevalence of inadequate housing for more than one child.
Perhaps added to this is the special attention given to babies and infants in Ukraine which would be culturally difficult to share between several children.
The promises of large sums of money for having children and for special housing initially appeared to be good incentives. But the reality is that the money is often slow in coming and there are waiting lists for houses.
Housing is probably a very major factor in some areas of Ukraine. At the end of the Joseph Stalin era there was a savage housing shortage which his forerunner Nikita Krushchev responded to by building many of his famously inadequate apartments which are often the small homes of those who would choose to have a second child.
However once a Ukrainian woman has become pregnant the outlook is somewhat brighter and much progress has been made. Ukraine ranks ahead of Bulgaria, the Russian Federation and Belarus having an infant mortality rate of 9.3 per 1,000 births which places it in league with such Eastern European countries countries as Poland, Lithuania and Estonia, but well below Iceland at 2.9 which rates as the safest country in which to be born.
Factors delivering this comparative success are the young age of mothers at childbirth, good antenatal care, good nutrition, the adoption of safe anesthetic techniques, and the recognition of problems in childbirth, their monitoring and resolution along well researched guidelines.
Non-government sector has been active in promoting these standards and in highlighting the need for incubators and the simple necessity of keeping all babies warm after birth.
Standards of care for new-born babies has also radically improved. In all these areas Ukraine is to be congratulated in greatly improving the outcomes of pregnancy.
For expatriate mothers there is always a sense of concern and anxiety about being pregnant and delivering a baby in a foreign culture.
Some of this anxiety revolves around amount of care they may receive in Ukraine. Whilst in some European countries visits to the doctor or midwife and scans are essentially minimal in pregnancy, much more attention will be given within Ukraine, often accompanied by more blood tests and screens for infection.
Some mothers have found this difference merely adds to their anxiety but they should be reassured.
Standards in the best private clinics in big cities are more than comparable with Western Europe and America.
They are well-equipped and have good facilities for the care of both mothers and new born babies.
Private rooms are more than comfortable and mothers are often given the choice of having a Caesarian section if they wish. Modern medicine now makes this generally safer for the baby than natural delivery, although risks to the mother remain higher.
Medical care still follows the rather Soviet model of received care and Ukrainian doctors will be a little less responsive to detailed discussion about treatment options and about their own standards of care.
Mothers can expect to stay longer in hospital than in western Europe, but nursing care will be good. Most hospitals offer potential patients the ability to visit before the delivery and clinics are now beginning to recognize that an important part of care for expatriate mothers lies in the psychological support through the emotionally demanding months of pregnancy, delivery and those early months of settling a new baby into a routine.
Pregnancy, childbirth and early childhood are generally viewed as especially important times in Ukrainian culture – this again perhaps stems from the fact that in recent history one child was the norm.
Conversely, in western societies there has been a recent tendency to discount these important experiences. Unfortunately, this sometimes leaves mixed marriages at a huge disadvantage and again good support through the ante natal period can help to smooth out such different expectations.
Some families, both Ukrainian and expatriate, choose to have their children in other countries, and most airlines are happy to fly pregnant women on short hauls up to 36 weeks. But regulations do vary. Of course, nobody can predict the occasional premature labor, so plans have to be flexible.
Whilst Ukraine continues to offer improved services for both pregnant mothers and newborn babies, depopulation continues and both the socio-economic and medical factors driving such a low fertility rate need to be addressed urgently.
Dr. Richard Styles is a British family physician at American Medical Centers, a full-service clinic, in Kyiv.
