“Журнал академії медичних наук України”, 2018, т. 24, № 3-4. — С. 340-348. UDK 618.39"477" Yu. G. Antipkin, V. V. Podolskyi, Vl. V. Podolskyi, L. Marions*, K. Gemzell-Danielson*, M. V. Makarenko**, D. O. Govseev** State institution “Lukyanova Institute of Pediatrics, Obstetrics and Gynecology NAMS of Ukraine”, 04050 Kyiv *Karolinska University, SE-171 76, Sweden **Bogomolets National Medical University, 01601 Kyiv AN UPDATE ON THE ABORTION PROBLEM IN UKRAINE Clinical and epidemiological studies were conducted in the women of reproductive age (WRA) population in order to find out the frequency and structure of artificial abortion (AA). The research was conducted in the industrial area. Kiev, which was chosen as such, which corresponds to a typical industrial region of Ukraine. A total of 1,000 WRA were surveyed in the industrial area of Kiev. To conduct clinical and epidemiological studies, a special program was created and the Questionnaire “Study of methods of contraception in women of fertile age in Ukraine” was developed. Clinical and epidemiological studies were of the nature of population, cohort, prospective studies. To find out how much the results are consistent with official statistics, we have been sent letters to government agencies of different levels to obtain official statistics, according to the indicators studied. Information was obtained from official sources regarding official statistics for 5 years (from 2009 to 2013, when there was no military action in the country and was not annexed by the Crimea). The conducted clinical and epidemiological and sociological studies have shown that in modern conditions, changes in reproductive health that are manifested by abortions (15.0 per 1,000 examined) are relevant. According to official statistics, the frequency of such changes in reproductive health, such as abortions in the structure of gynecological morbidity of the population of our country is quite high. The average number of abortions per 100 newborns alive, on average, over 5 years was 35.9. According to the polls conducted, the number of women who felt the support of the family (38.0 %) and did not have emotional support of the partner (35.2 %) was the highest, the values of these indicators compared with the trust in comrades and neighbors indicate a low level the socialization of women of fertile age undergoing or undergoing arthritic abortion procedure. A significant number of women interviewed noted abuse of their men by harmful habits in the form of tobacco smoking. More than half of the women who participated in the study felt psychological and physical tiredness, family conflicts and financial difficulties. Key words: fertile aged women, artificial abortion, clinical and epidemiological studies, psycho- emotional state. _______________________________________________________ Yu. G. Antipkin — Director of the Institute, acad. NAMS Ukraine V. V. Podolskyi — Deputy Director in Science, Head of the Department of Health problems of fertile aged women, MD, PhD Vl. V. Podolskyi — Head of clinical unit of Department of Health problems of fertile aged women, MD, PhD ([email protected]) Division of Obstetrics and Gynecology of the Demartment of Women’s and Children Health, Karolinska University K. Gemzell-Danielson — Head of the Division L. Marions — Senior Lecturer, professor Department of Obstetrics and Gynecology Postgraduate education Bogomolets National Medical University M. V. Makarenko — Head of the department, MD, PhD, professor D. O. Govseev — Docent, MD, PhD © Yu. G. Antipkin, V. V. Podolskyi, Vl. V. Podolskyi, L. Marions, K. Gemzell-Danielson, M. V. Makarenko, D. O. Govseev, 2018. 340 “Журн. НАМН України”, 2018, т. 24, № 3-4 AN UPDATE ON THE ABORTION PROBLEM IN UKRAINE 341 Artifical abortion (AA) is one of the most important The urgency of the problem of complications after parameters that characterizes the state of reproductive abortion in Ukraine is particularly serious in connection health (RH) of women. According to WHO in some with the decline in fertility [9,14]. The increase in the countries where the level of economic development is number of AA negatively affects demographic low, abortion is one of the main causes of maternal indicators, as it is an indicator of demographic mortality [1, 2]. reproductive losses, which is an adverse factor for the According to the Ministry of Health of Ukraine, country’s economic development [9, 14, 15]. For several and in our country, AA is one of the main factors decades, AA was the main method of birth control. The determining the level of morbidity and mortality of frequency of AA in our country remains higher in women. Abortion nowadays remains the main method comparison with many countries, although the officially of birth control in our country. The most unfavorable registered number of abortions has decreased, there is an is the tendency to increase the number of abortions in unfavorable tendency to increase the number of AA in nulliparous women. So, for example, the frequency of nulliparous women [9, 14, 16]. artificial abortions in our country in 2011 was 23.71 % Official statistics do not always reflect the real on every 100 pregnancies, and in total this year 156,193 amount of AA. This situation is due to the fact that abortions were done, and today these indicators have not this information is reliably provided to the statistical changed much [3, 4, 5]. authorities only from public medical institutions. The Despite the considerable efforts of the authorities of commercial medical institutions that also provide this our country, doctors and the public, the problem of state operation mostly either not filing at all or submitting of RH of the Ukrainian population remains the most in a reduced volume the information about surgical urgent. The complexity of solving issues that make up abortion rate. this problem is due not only to the health status of our The State Programs that were implemented in country and its RH component, but also to a Ukraine and aimed at preserving the RH of our significant number of risk factors that have an impact country’s population were implemented, aimed at on the development of reproductive disorders [6]. preventing unwanted pregnancy by introducing Obstetricians-gynecologists of our country and abroad modern methods of contraception, family planning and have now determined the main factors that have a direct abortion reduction. Of great importance is the question impact on the development of violations of the state of of postabrtion contraception and rehabilitation and women’s RH [7, 8, 9, 10]. Among these factors, first of all, treatment measures aimed at restoring health after it is necessary to note inflammatory diseases of the genital surgical abortion and minimizing the complications organs (the frequency of which has increased by 1,3 times) that lead to violations of RH [9, 14, 15, 16, 17, 18]. and the recurrent miscarriage — (46,3 %) [11, 12]. Today, the problem of AA remains relevant for our AA is one of the frequent causes of gynecological country, that’s why we conducted clinical and diseases and a violation of the childbearing function. epidemiological, sociological and statistical studies to More than in 10 % women, and according to other determine the current state of problem with abortion in data in 21.7 % of women that had surgical pregnancy Ukraine [19]. termination the various gynecological diseases are The aim of the study. To determine the current developing [7, 8, 13]. The complications of surgical state of the abortion problem in Ukraine on the basis abortion may appear in the form of perforation of the of clinical and epidemiological, sociological and uterus that occurs, according to various authors, in statistical research. 0.01-1 % of cases [3, 7]. Perforation of the uterus can lead to damage to the large vessels of the uterus, injury Materials and methods of research. Clinical and to the septum, intestinal loops, bladder. epidemiological studies were conducted in the This operation is especially dangerous when it is population of women of fertile age in order to performed on the background of inflammatory determine the frequency and structure of AA. The diseases of the genital organs of a woman and without research was conducted in the industrial district of a thorough examination and preparation for this Kyiv, which was selected as being representative of the intervention. The dissemination of septic infections typical industrial region of Ukraine. We examined 1,000 after surgical abortion can develop as salpingo- women of fertile age (WFA) residents of the industrial oophoritis — in 3.5-5.7 % of cases, metroendometritis — district of Kyiv. For the conduct of clinical and in 1.7-3 %, parametritis in 1.34 % of cases, as well as epidemiological research, a special program was created metritis, pelvic peritonitis, thrombophlebitis of uterine and the Questionnaire “Study of methods of veins and many others post-abortion infectious diseases. contraception in women of fertile age in Ukraine” was The frequency of all inflammatory complications after developed. The questionnaires were distributed among surgical abortion is 8.5-20 % [4]. WFA, residents of the industrial district of Kyiv. “Журн. НАМН України”, 2018, т. 24, № 3-4 342 YU. G. ANTIPKIN, V. V. PODOLSKYI, VL. V. PODOLSKYI, L. MARIONS, K. GEMZELL-DANIELSON ET AL. Clinical and epidemiological studies were of registered in 2011 The frequencies of AA in Kyiv from population based, cohort, prospective studies. 2009 to 2013 tend to decrease from 15.6 — 2009 to Determination of the population of WFA and individual 13.3 in 2013, however, as there is no significant work with each woman was conducted in accordance decrease in this indicator in the industrial district of with existing methods of conducting clinical and Kyiv. epidemiological studies and adhering to the principles of Table 2 bioethics. Frequency of artificial abortions in women of fertile age (per 1000 women) in the industrial district of Kyiv and in Kiev All received information was entered in database for 5 years (official statistics data) and a further analysis of the research results was conducted.