Today, the 24th of February 2025, marks the third anniversary of the Russo-Ukrainian war. Despite reports of potential negotiations and a resolution, the mood of Ukrainians on achieving fair peace remains unchanged. They continue to go to work, attend school, volunteer, support the military, and mourn their losses.
The shock in the first weeks and months following Russia's full-scale invasion was profound and very different from their experience today. The initial period was marked by disbelief that it was happening, and the hope that the conflict would end in a few months. But over the years, we have learned to live in a constant state of war.
Now, the uncertainty is fuelled by the ongoing realities of war: from military losses and family separation, to the crushing feeling of lives put on hold, and the constant threat of death or loss of loved ones, whether on the battlefield or from rocket or drone attacks. Ukrainian society faces an agonising dilemma of when to seek some form of peace versus continuing to fight. They question whether any peace would be fair, or whether the agreement will be similar to the one signed in 2014, and never truly guarantee security from Russia.
It remains a painful fact for Ukraine that external support and interest is subject to shifting global political trends. Humanitarian assistance often hinges on policy changes that are disconnected from on-the-ground needs. There is no stability here, which is what a country at war needs.
After eight years of hybrid war with the Crimea and Dondas region occupation, the full-scale invasion on the 24th of February, 2022, changed everything in women’s lives — the place they live, their family situation and the career they might have had.
This war, like so many across the world, has exacerbated gender inequality, eroding hard-won gains in the struggle for equal rights and responsibilities. The majority of women take care of children and elderly relatives whilst balancing household work and a career. Men largely defend Ukraine's independence and their families. Alongside this, sexual and gender-based violence has increased, and there are a host of new challenges - displacement, unemployment, and the need to protect both themselves and their children.
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country
Ukraine
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European Network
Subject
Conflict, Humanitarian
This war, like so many across the world, has exacerbated gender inequality, eroding hard-won gains in the struggle for equal rights and responsibilities.
What it looks like to be a Ukrainian woman today
There is no safe place in Ukraine. Even relatively safe towns and villages can be targeted by Russian shelling, the front line can shift at any moment and your hometown can be occupied. Russian forces are shelling residential buildings, children’s play yards, kindergartens, schools, hospitals and shopping centres. They have no qualms about killing civilians, including women and children, even as they sleep.
In total, since the beginning of the full-scale war, the UN has recorded more than 12,456 civilians killed, including 669 children and more than 28,382 wounded, including 1,833 children (as of December 31st, 2024).
What burden does a Ukrainian woman bear daily, if she chooses to remain in Ukraine? If her partner has joined the Armed Forces of Ukraine, she not only needs to support him in this dangerous job but she must also continue taking care of children (if they have them) - often becoming solely responsible for organizing the household and providing children with everything they need.
Additionally, she must protect her own life and that of her children during air raid alarms and constant shelling near the frontline, all while striving to meet work and social expectations for career growth and success, and managing daily exhaustion and mental health challenges.
In the first months after the start of the full-scale war, sexual and reproductive health issues primarily affected women who were already pregnant, planning delivery or had gynaecological infections. The Ukrainian medical system didn’t crash, and thanks to that, now women and girls can choose pregnancy and childbirth, attend gynaecology check-ups again and have the opportunity to plan their families and lives without being pressured.
Throughout various humanitarian response projects, Ukrainian CF Women’s Health and Family Planning has established more than 50 barrier-free gynaecology clinic rooms and provided more than 42,000 sets of medicines and condoms to the state institutions to cover the needs of Ukrainian women and youth.
We’ve found that women's sexual and reproductive health is directly affected by the stress and realities of war. It can affect the possibility of getting pregnant, carrying a pregnancy successfully and the development of the foetus. Stress can lead to premature birth, critically low-weight babies, and heightened risks of complications in the mother's mental health and her relationship with the child through increased instances of postpartum depression.
“It is very difficult to explain to people who live in comfortable conditions what it is like to give birth in shelters under fire, what it is like to not have heat, light and basic hygiene standards. Because of such conditions women suffer from vaginal bleeding, pain and chronic stress-related illnesses. There are a lot of women who live close to the war zone and have very limited access to healthcare - the extent of the frontline is more than 3k kilometres. This is how we live in Ukraine today”, says Galyna Maistruk, Executive Director of Women’s Health and Family Planning (WHFP) CF says.
As of January 2025, more than 69,000 women serve in the Ukrainian army. Their frontline presence exposes them to significant risks of injury or death, compounded by immense psychological stress, including PTSD and other physical and psychological challenges. A special category is military medics, including a significant majority of women, who are at even greater risk because Russia does not comply with humanitarian law and shells medical evacuations constantly.
Furthermore, wartime conditions, often including limited access to clean water and sanitation, can lead to infectious diseases, frequently exacerbated by a lack of access to qualified medical care and examinations. Women may experience stress-induced menstrual disorders, absence of menstruation, infertility, hormone-dependent pre-tumour and tumour conditions of the reproductive system, vaginal bleeding, and breast pathologies. The tragic reality is that sexual violence within the military also exists.
Reproductive Pressures
A combination of declining population, low birth rates, premature mortality, an aging nation, disease, internal and external migration, and deportation have deepened Ukraine’s demographic since the beginning of the war that Russia started in 2014.
"Scientists cannot say for sure what will happen to the birth rate in Ukraine in the future. Various forecast scenarios are currently being developed, but they all depend on when and how the war will end and what the political and economic situation in post-war Ukraine will be like".
Galyna Maistruk adds. UNICEF and the Center for Social and Behavioural Change recently conducted a study on the attitudes of the Ukrainian population toward having a first or further child. 56% of respondents answered with a clear ‘no’ to planning a child in the near future, while only 15% answered affirmatively. Every fifth couple has been deterred by the ongoing war and unstable security situation. Based on the current situation and results of the study, the government of Ukraine has developed the Strategy of demographic development of Ukraine until 2040.
It is important to understand and listen to a woman's position on having a child, understand her personal wishes, her ability to become pregnant, to give birth, and to raise a child and provide for the child's basic needs. The government must formulate policies that balance the imperative to address the demographic crisis with the fundamental right of women to make autonomous, pressure-free decisions.
Historical examples show that after conflicts, radical opposition, including religious opposition, can use the losses during the war to control the birth rate through attempts to ban abortion and contraception to ‘motivate’ the restoration of the nation's population.
To support women's ability to fully exercise their reproductive choices it is essential to establish a context that offers comprehensive support. This means ensuring access to quality schools, reliable healthcare, safe recreational spaces, and overall child-friendly facilities. When these elements are in place, women are more likely to feel that all options are genuinely open to them. Currently, in Ukraine, such a comprehensive framework is only declared but not implemented.
Historical examples show that after conflicts, radical opposition, including religious opposition, can use the losses during the war to control the birth rate through attempts to ban abortion and contraception to ‘motivate’ the restoration of the nation's population. Manipulating the losses and psychological state of Ukrainians as a result of the events experienced during the war as a lever of reproductive pressure is one of the possible scenarios in Ukraine. CF Women’s Health and Family Planning is already working to counteract this, because every woman should have the right to make her own decisions about pregnancy and childbirth without additional pressure.
Ensuring easy access to sexual and reproductive health resources is essential. This includes providing accessible medical services for sexual and reproductive health, reducing the stigma and discrimination associated with visiting a gynaecologist, creating conditions where women can visit a doctor without hindrance, and a compassionate policy that promotes a woman's free choice about pregnancy and childbirth.
The WHFP CF advocates for free and unimpeded access to SRH services for women and girls. Through various projects, we raise awareness of women's SRH, their rights with doctors, and provides training to gynaecologists, family doctors and nurses to improve their professional skills in SRH areas. Since 2022 more than 10,000 medical workers have successfully attended SRH trainings. These efforts aim to enhance the overall quality of care and positively influence women’s self-perception and well-being.
Supporting Ukrainian Women’s Sexual and Reproductive Health
Ukrainian women’s sexual and reproductive health, even before the full-scale war, faced challenges. With the support from IPPF, the WHFP is working to improve women's access to high-quality sexual and reproductive health services and improve the technical infrastructure necessary for their delivery.
Efforts include training medical personnel, equipping hospitals with essential medicines and equipment, and launching informational campaigns to encourage regular gynaecological visits among women and girls. The goal is to ensure that women not only desire but also have the real opportunity to access local gynaecological care.
If air raids or shelling prevent in-person visits, women and girls can use the hotline or chat-bot developed by WHFP this year to address Ukraine’s realities including electricity outages. These platforms offer online consultations with gynaecologists that can assist with SRH issues, including gender-based violence (GBV) and conflict-related sexual violence (CRSV) response.
"It is highly important to give these women and girls the opportunity to contact the medical staff when they feel sick or just have some second thoughts on any SRH issue. There are regions in Ukraine that suffer from massive shelling every day, and people there prioritize safety and survival over good sexual and reproductive health," says Lesia Khmel, hotline and chatbot project coordinator.
Recurrent missile strikes by Russia have led to frequent power outages, severely hindering access to healthcare, quality food, education, and social services. While Ukrainians remain highly adaptive, the lack of electricity hugely impacts their quality of life.
Most medical facilities are now equipped to handle blackouts; however, the primary challenge for women is prioritising their own health and finding time for regular preventive check-ups and doctor visits.
WHFP plays a vital role in emergency response, ensuring the delivery of essential SRH commodities, medical equipment, and support to healthcare facilities in crisis situations. Since 2022, as part of a humanitarian response program supported by IPPF, WHFP has implemented 15 projects addressing women’s SRH needs during humanitarian crises. These efforts have resulted in 59 accessible gynaecology clinics, training for approximately 10,000 healthcare workers on SRH topics, including care for gender-based violence and unwanted pregnancies (including people with disabilities) and the provision of SRH services to over 330,000 women (including nearly 7,000 instances of counselling or services related to rape and gender-based violence, and about 6,500 uses of emergency contraception). Additionally, over 42,000 sets of medicines and 4,725 pieces of medical equipment have been distributed to healthcare facilities.
We support Ukrainian women by establishing barrier-free gynaecology clinics, providing medications, training healthcare providers, and offering technical support to medical facilities. This ensures that women are well-informed about the services available to them and empowered to prioritise their health.
Ukraine is not only defending its own independence but also upholding the fundamental values shared by Europe. In resisting the destructive aggression of the Russian Federation, which claims to “liberate” whilst destroying everything in its path, Ukraine is protecting peace and human rights across the region.
It is crucial that we continue to support Ukraine through all available means, recognising that a peaceful Ukraine is essential for safeguarding the rights and freedoms of its citizens. We must also address the humanitarian needs of Ukrainians. Their quality of life, health, and access to essential services, particularly sexual and reproductive healthcare, must be prioritised. By ensuring the well-being and dignity of its people, Ukraine will be better positioned to rebuild, restore, and chart a brighter future once the war ends. Let us stand with Ukraine, affirming our commitment to peace, democracy, and the protection of fundamental human rights.
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Valeriia Didenko is the Communications Manager for Woman Health and Family Planning and is based in Kyiv, Ukraine.