Improved access to safe abortion in Ukraine: Comprehensive Care for Unwanted Pregnancies project results, 2009-2013
Anastasiya Dumcheva1, Galina Maistruk2 1World Health Organization, Kyiv, Ukraine, 2Charitable Foundation "Women Health and Family Planning", Kyiv, Ukraine - firstname.lastname@example.org
Introduction: Before 2009, most of the pregnancy terminations in Ukraine were unsafe, which contributed from 8.5% to 16.0% to the maternal mortality in Ukraine over the period from 2003 to 2009. To address this issue, Comprehensive Care for Unwanted Pregnancies (CCUP) project was introduced in 2009 in partnership with Swiss Agency for Development and Cooperation, MoH Ukraine, NGO "Women Health and Family Planning", and WHO. Objective: The project goal was to improve availability, accessibility and quality of safe abortion in Ukraine. Methods: The project included activities at the national - improving legislation, monitoring and evaluation system, and regional levels - strengthening capacity of health care professionals, improving quality of abortion services and enhancing communication in five pilot regions of Ukraine. Results: Over the period from 2009 to 2012, the contribution of unsafe abortions into overall maternal mortality in Ukraine has steadily decreased from 9.2% (12 cases) to 4.6% (3 cases). The main reason for the overall decrease was the development and endorsement of new national legislation documents - organizational and clinical protocols, which adapted WHO recommendations on safe abortion. The percentage of women undergoing safe abortion methods in the first trimester (medical abortion, manual or electrical vacuum aspiration) vs unsafe (dilatation and curettage) has increased in pilot regions from 25-32% in 2011 to 53-75% in 2013 (variability is due to the regional context and time of project start in the region). The percentage of women who received local vs general anaesthesia has increased from 11% in 2011 to 29-37% in 2013. By the end of 2013, most of the women received pre- and post-abortion counselling sessions (82-95% compared 59-62% in 2011). Conclusion: The project interventions contributed to the overall decrease of abortion-related maternal mortality in Ukraine. Interventions piloted at the regional level are acceptable for healthcare professionals and women and can be disseminated nationwide.