Ukraine scales up services for women with unwanted pregnancies

Andrey Solovyov

Participants of the meeting were very enthusiastic about the National Clinical Protocol on Comprehensive Care for Unwanted Pregnancies recently approved by the Ministry of Health

Update on the Comprehensive Care for Unwanted Pregnancies (CCUP) project (2015)

In 2006, the Ukraine MoH  officially requested support from WHO to analyze the current situation with regards to contraception, unintended pregnancies and unsafe abortions in order to receive relevant up-to-date evidence-based information and to introduce adequate policy actions to further decrease the number of abortions and related complications.
In response to this request, WHO/Europe supported the MoH in organizing the WHO/MoH Strategic Assessment (SA) of policies, programmes and research issues related to unwanted pregnancies in Ukraine throughout the period 2007-2008. As a result of the SA, a number of key priority recommendations were developed to improve the situation in Ukraine.
The recommendations developed during the SA formed the basis for the following initiatives in Ukraine. The implementation of the recommendations began in 2009 in the framework of Phase I of the Comprehensive Care for Unwanted Pregnancies (CCUP) project, with financial support from Swiss Agency for Development and Cooperation (SDC), in close partnership with MoH Ukraine, Women Health and Family Planning (WHPF), and WHO/Europe.

CCUP project achievements:

Phase I of the CCUP project (2009-2011)  was developed and approved nationally on 31 December 2010 and resulted in:

  • three new model clinics in Donetsk, Vinnitsa and Kiev, and were supported with capacity building activities on CCUP provision; 
  • health care providers from three pilot regions received intense education on CCUP through cascade training; 
  • a client-oriented approach with the principles of confidentiality, non-blaming and supportive attitudes improved the satisfaction for women receiving the service;
  • new training curriculum on CCUP was developed, tested, approved and implemented within the postgraduate course for obstetricians and gynaecologists; and
  • monitoring and evaluation of CCUP services in pilot regions were strengthened. 

Phase II of the CCUP project (2012-2014) included two additional pilot sites, namely Odessa and Poltava regions  and:

  • national legislation on safe abortion has been further strengthened. In particular organizational services on CCUP services were developed and approved by both the MoH and Ministry of Justice. In addition, WHO supported the MoH with the development of scaling-up strategy for CCUP, which has been also approved by the MoH and distributed to all the regions of Ukraine for implementation;
  • special emphasis was given to improving services for women in need of second-trimester abortions (according to the national legislation, they are mainly done for medical reasons); 
  • a needs assessment on second trimester abortions was organized and conducted in 2013, which produced important conclusions and recommendations for future work in Ukraine in this area;
  • the feedback highlighted that second trimester abortions in Ukraine is provided by gynaecologists without specific training in abortion. There is no post-graduate training in second trimester abortion, and gynecologists often lack skills in ultrasound, have limited or no experience in counselling for second trimester abortions and in post-abortion care; and 
  • insufficient attention is paid to contraception immediately after an abortion. The training agenda and curricular for the second-trimester training has been developed with WHO support in September 2013, with the following Training of Trainers (ToT) and cascade training organized throughout 2013-2014.

The project has contributed to the improvement in the national monitoring and evaluation of CCUP services through changes in data collection forms and developing relevant indicators. 

The communication strategy, which was developed during the first phase of the project, has been implemented throughout its second phase targeting health care managers, clinicians and patients, During the project implementation, a web-portal on CCUP issues was developed, as well as number of relevant printing materials.