• by Ed Holt (bratislava)
• Wednesday, January 07, 2026
• Inter Press Service

BRATISLAVA, January 7 (IPS) - “It was an emergency caesarean section when the life of the pregnant woman was at risk. We did the operation with just flashlights and no water, and against a backdrop of constant explosions,” says Dr Oleksandr Zhelezniakov, Director of the Obstetrics Department at Kharkiv Regional Clinical Hospital, in eastern Ukraine.

He is recalling what he says was “one of the most difficult” medical procedures he has been involved in since the start of Russia’s full-scale invasion of his country.

But it was far from the only time he has had to work in extreme conditions while his city is pounded by Russian shelling. In fact, he says, it has become routine for him and his colleagues.

“The current reality is that, given we are in a frontline city, we work like this almost every day, because the alarms never stop and we hear explosions almost every day,” he tells IPS.

“You just do what you have to do to save a life, to save the future. In such moments, you only think about saving a life. We work [in these conditions] because life must always prevail,” he says.

Zhelezniakov’s hospital has, like many other medical facilities in Ukraine, been repeatedly attacked and damaged since the start of the war. The World Health Organisation (WHO) had documented more than 2,700 attacks on Ukrainian healthcare facilities since February 24, 2024.

These have included attacks on more than 80 maternal healthcare facilities – with devastating consequences for maternal health, as recently released data has shown.

According to analysis by the United Nations Population Fund (UNFPA) released in December, there has been a sharp rise in the risk of dying in pregnancy or childbirth in Ukraine as the conflict grinds on.

The agency says repeated strikes on hospitals and the breakdown of essential services are forcing women to give birth in increasingly dangerous conditions, and health workers have warned that a combination of violence, chronic stress, displacement and widespread disruption of maternity care is driving a surge in pregnancy complications and preventable deaths.

Its analysis of national data shows a 37-percent increase in the maternal mortality rate from 2023 to 2024 – the most recent full year of national data available. In 2023, Ukraine recorded 18.9 maternal deaths per 100,000 live births. In 2024, that figure rose to 25.9. The organisation says most of these are preventable deaths, reflecting a health system operating under extreme strain.

It said it had also seen sharp increases in severe pregnancy and childbirth complications. Uterine ruptures — among the most dangerous obstetric emergencies — have risen by 44 per cent. Hypertensive disorders of pregnancy have increased by more than 12 per cent, while severe postpartum haemorrhage has risen by nearly 9 per cent – from 2023 to 2024. Delays in accessing care, stress, displacement and disrupted referral pathways are key contributing factors.

Meanwhile, the situation in frontline regions is particularly acute. In Kherson, premature births are almost double the national average, and the region has the highest stillbirth rate in the country, according to UNFPA.

It cites contributing factors including stress, insecurity and difficulties in accessing care, which can lead to preterm labour and premature rupture of membranes.

Another indicator of system strain is the Caesarean section rate. Nationally, the rate now exceeds 28 per cent, already above recommended levels. In frontline regions, the figures are among the highest in Europe: 46 per cent in Kherson and approximately 32 per cent in Odesa, Zaporizhzhia and Kharkiv. These high rates often reflect the need for doctors and women to time deliveries around short windows of relative safety and can additionally show an increased pregnancy complication rate that requires surgical intervention, according to UNFPA officials.

“Attacks [on healthcare, including maternity and neonatal facilities] have had measurable and severe consequences for maternal health. Ukraine is entering another winter under conditions that sharply increase risks for pregnant women, newborns and the health workers who care for them,” Isaac Hurskin, Head of Communications, UNFPA in Ukraine, told IPS.

In early December, a maternity hospital in Kherson, a facility supported by UNFPA, was struck by artillery fire. During the strike, hospital staff moved women in labour and newborns into a bunkered maternity ward—one of many such facilities constructed by the government with help from groups like UNFPA to protect mothers and babies during active hostilities.

While everyone survived the attack and a baby girl was born in the bunker during the shelling, Hurskin said it was “a stark illustration of the conditions under which pregnancy and childbirth are now taking place — conditions no woman or health worker should ever have to face”.

But the devastation wrought by the war in Ukraine is also impacting wider reproductive health.

IPS has spoken to women in Ukraine who have admitted they are avoiding getting pregnant because of concerns about their ability to access maternal healthcare safely but also the conditions in which they may have to raise an infant.

“Women in conflict-affected areas have specific reproductive needs. It is very hard to meet them when a maternity hospital gets bombed on a regular basis, or when energy infrastructure is targeted, limiting the functionality of hospitals and forcing pregnant women to unequipped hospital shelters. A woman considering getting pregnant needs to make a decision based on these factors – whether a hospital is safe, whether she can have access to services, and whether she is able to care for the child afterwards, with no electricity, heating, or water at home,” Uliana Poltavets, International Advocacy and Ukraine Program Coordinator at Physicians for Human Rights (PHR), told IPS.

“This is a trend which is being observed,” added Zhelezniakov. “Women fear not only for their lives and the lives of their unborn children during childbirth under shelling but also an uncertain future—a lack of safe housing, work, and normal conditions for raising a child. This is a rational fear in the irrational conditions of war. It is one of the reasons for the sharp decline in the birth rate.”

But he added that conversely, the effects of the war were impacting women’s ability to conceive.

“Chronic stress, high cortisol levels, anxiety, and sleep disorders directly affect hormonal balance and reproductive function. Constant stress also leads to hormonal imbalances (dysfunction of the hypothalamic-pituitary-ovarian axis). This causes an increase in cases of secondary infertility, premature ovarian failure, and endometriosis. We are already seeing an increase in the number of pathological menopauses in young women,” he said.

These threats to fertility and maternal health come at a time when Ukraine is facing a demographic crisis.

According to UNFPA, since 2014, when Russia illegally annexed Crimea and supported separatist paramilitary movements in eastern Ukraine, the country has lost an estimated 10 million people through displacement, mortality and outward migration. Fertility has fallen to below one child per woman — one of the lowest rates globally.

It says that rising maternal deaths, increasing complications and pervasive uncertainty about the safety of childbirth reinforce one another, with long-term consequences for families, communities and national recovery.

“This is not only a humanitarian emergency. It is a demographic crisis with implications that will extend far beyond the end of hostilities. Protecting maternal health is central to Ukraine’s long-term recovery and future stability,” said Hurskin.

Indeed, examples from other recent conflicts where there has been widescale destruction of healthcare have shown the long-term effects of war on maternal and reproductive healthcare long after they have finished, from problems with rebuilding damaged and destroyed facilities, ongoing displacement, and continued shortages of medical staff just some of the barriers to women being able to access services.

“Look at Syria, for example. The healthcare system is being built back up, there is rebuilding of facilities, things are improving, but it will take decades to get back to where it was before. And maternal healthcare tends to be deprioritised both during and after a conflict – resources tend to go to other areas such as emergency and trauma care. Women in Syria will have problems with accessing maternal healthcare for years and years to come,” an expert on healthcare in war zones working for an international human rights group, who spoke on condition of anonymity for security reasons, told IPS.

Zhelezniakov admits that a worsening of the demographic crisis in Ukraine is inevitable.

“The expectation is that it will get worse. The destruction of the maternal health care system only exacerbates existing problems caused by the war: the migration of women and children abroad, loss of life, economic instability, and psychological pressure,” he says.

But he adds that even now measures can be taken to improve maternal healthcare, including strengthening primary care, improving digitalisation (e-health systems), investment in prevention, mental health support programmes, environmental improvement, legislative regulation, and raising awareness of reproductive health to reduce mortality and disability, among others.

Developing international cooperation by creating “medical hubs” in relatively safe regions with the support of international partners, such as UNFPA and WHO, to ensure services, would also help.

“Even during active hostilities, we can and must work to adapt the system,” he says.

He also vows that, no matter what happens, he and other medical staff will not stop their work, recalling the emergency caesarean section performed by flashlight as shells rained down on Kharkiv.

“The birth of a child in such conditions is always a miracle and a powerful motivator to continue working, despite everything,” he says.

IPS UN Bureau Report

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