Efforts are under way to get emergency contraception into Ukrainian hospitals as quickly as possible, as reports of rape after the Russian invasion continue to rise.
About 2,880 packets of the medication, also known as the morning-after pill, have been sent by International Planned Parenthood Federation (IPPF) to Ukraine, while a network of volunteers across Europe has been collecting donations of the medication from abroad and delivering them to hospitals.
“The timeframe for treating victims of sexual violence is really essential,” said Julie Taft, of IPPF. “If a woman is seen within five days of an event, then that medication should automatically be given to her.”
Taft said the IPPF was also sending medical abortion pills, which can be used up to 24 weeks of pregnancy.
While emergency contraception was widely available in Ukraine, the war has destroyed local supply chains, caused a displacement of patients and healthcare providers, and increased the rate of sexual assaults.
“There is a demand for emergency contraception, but very rarely from hospitals in the west. It is mostly hospitals to the east, in Kharkiv, Mariupol, those regions,” said Joel Mitchell from Paracrew, a humanitarian aid organisation delivering food and medical equipment to Ukraine. “As soon as we made contact with hospitals in those regions, we had standing orders for that medication.”
It is not clear how many of the recipients of the medication are sexual assault victims, but a volunteer with Paracrew told the Guardian that he delivered emergency contraception directly to one hospital in a town north of Kyiv, where he says he was told by hospital staff a number of rape victims were being treated.
Ukraine’s human rights commissioner, Lyudmila Denisova, said in early April that there were nine official cases of women who were pregnant after being raped by Russian soldiers. The reports of rape victims raise concerns about areas in the east, which continue to be under Russian occupation.
Jamie Nadal from the United Nations Population Fund (UNFPA) said that in a crisis situation reported cases of violence, including rape, are likely “just the tip of the iceberg.”
The UN has previously included emergency contraception in “post-rape kits” to hundreds of women and girls in armed conflicts around the world, including the Bosnian war. In addition to emergency contraception, survivors typically were given medication preventing STDs such a hepatitis B and HIV. Distributing the medication to rape survivors in post-conflict zones remains a UN policy. So far UN has sent 40 metric tonnes (40,000 kg) of reproductive health supplies to Ukraine and 33 Clinical Management of Rape (CMR) and Post-Exposure Prophylaxis (PEP) kits to 19 Hospitals in 10 regions in Ukraine.
Denisova has said her office had officially documented the cases of 25 women who were kept in a basement and systematically raped in Bucha, a town north of Kyiv now synonymous with Russian war crimes, but the true number of victims could be far higher.
A volunteer who evacuated residents from the towns north of Kyiv at the beginning of April told the Guardian: “What usually happens is that survivors of rape initially want to tell their story but then they go away and it isn’t until months later that they come back to talk.” She said she had encountered three women in the region who came out of houses and basements naked. One, immediately taken by ambulance, had been badly beaten and had broken bones.
The Guardian reported this week that postmortem examinations on bodies in mass graves north of Kyiv revealed evidence that some women had been raped before being killed by Russian forces.
“There are multiple psychological, emotional and physical health issues that the survivor is coping with and the anxiety around possible pregnancy is really enormous for many women,” said Taft. “It can lead to stress and PTSD, so being able to prevent it in the first place is key.”
However, the supply of pills within Ukraine has been badly damaged by the invasion and volunteers who spoke to the Guardian described multiple logistical issues delaying attempts to get the much-needed medication into the country.
“Many pharmaceuticals were previously produced in Ukraine but much of that manufacturing has stopped or became stuck in major cities because transportation is not safe,” said Taft. “Additionally, the current capacity of health providers and commodities [is insecure], particularly because we’re seeing a lot of destruction of health facilities.”
Aleksandra Weder Sawicka, a Polish activist based in Oslo who worked with Paracrew, coordinated a collection of 500 pills from Norway but drew scrutiny from the Norwegian directorate of health, which did not condone the informal donation of the medication. A big pharmacy chain in Norway also refused to deliver the medication to her for that reason. She has had to stop further donations while she tries to reach an agreement with Norwegian authorities to allow her to continue the work.
Taft said the strict control of the medication in some countries along Ukraine’s border, such as Romania, Hungary and Poland, had made the procurement of the pills more expensive, challenging and time consuming. “In those countries you can’t buy emergency medication in bulk,” she said, “so we had to procure them from providers in Denmark and the Netherlands.”
Krystyna Kacpura, director of Federa, a Polish organisation advocating for women’s rights and reproductive health, said: “International organisations reached out in the first days of the war offering to send over emergency contraception, but we had to advise them to send it straight to Ukraine through the Czech Republic, as we couldn’t be seen handling controlled substances.”
• This article was amended on 28 April 2022. The IPPF has provided about 2,880 packets of pills to Ukraine, not about 25,000 packets as an earlier version said.