Trends in population reproductive health and the performance of obstetric and gynecological services

Abstract

Purpose. To identify trends in reproductive health and to assess the state of obstetric and gynecological care delivery in order to substantiate priority measures for improving its quality. Materials and methods. The study focuses on population reproductive health and the system of obstetric and gynecological care. The research materials included national regulatory and legal documents on reproductive health protection, data from the Ministry of Health of Ukraine for 2000–2024, and data from the WHO European Region. The analysis covered the regulatory framework for reproductive health protection, demographic indicators, morbidity indicators characterizing reproductive health, as well as resource provision and performance outcomes of the obstetric and gynecological service. The study employed bibliosemantic, informationanalytical, epidemiological medical-statistical methods and content-analysis. Results. It has been established that Ukraine has generally developed a regulatory and legal framework aimed at ensuring the protection and strengthening of reproductive health, safeguarding reproductive rights, improving access to quality healthcare, developing family planning services, preventing diseases, and reducing maternal and child morbidity and mortality. Positive trends in reproductive health indicators were identified. In particular, during 2000–2024, the proportion of pregnant women with anemia decreased from 42.5% to 25.1%, and with circulatory system diseases from 7.2% to 6.3%. The incidence of sexually transmitted infections declined, and the abortion rate decreased 7.5-fold per 100,000 women of reproductive age and 4.5-fold per 100 live births. Improvements in somatic health and healthier behavioral patterns contributed to a reduction in childbirth complications, as well as to declines in maternal and infant mortality and stillbirth rates. However, maternal mortality demonstrated inconsistent trends over time. Between 2000 and 2015, it decreased from 26.2 to 15.1 per 100,000 live births (–42.4%). Between 2015 and 2021, it sharply increased to 42.5 per 100,000 live births (2.8-fold), followed by a decline to 19.3 and 18.5 in subsequent years. In 2024, the indicator increased again by 40.0% compared to the previous year. At the same time, negative trends were observed in pregnancy and childbirth complications. The rate of miscarriage increased from 4.3% to 7.1% during 2001–2024. The incidence of late gestosis rose from 5.8% to 7.3% in 2015–2022, while anemia among pregnant women increased from 24.2% to 25.1%. Severe obstetric complications, such as grade III–IV perineal tears and uterine rupture, increased 5.4-fold and 4.0-fold, respectively, over 2000–2024. Despite certain positive developments, many reproductive health indicators in Ukraine remain worse than the averages for the WHO European Region and the European Union. In 2019, the abortion rate per 1,000 live births in Ukraine exceeded the WHO European Region average by 22.8% and the EU average by 33.7%. A downward trend in the availability of obstetric and gynecological specialists and hospital beds was also identified. Between 2000 and 2023, the number of such specialists decreased from 2.53 to 1.98 per 10,000 population (–21.7%). The number of obstetric beds declined by 20.7% (2000–2017), and gynecological beds by 33.0%. The average length of hospital stay decreased from 10.6 to 7.7 days in obstetrics and from 8.7 to 7.9 days in gynecology. Bed turnover increased from 22.3 to 30.3 for obstetric beds and from 38.8 to 39.8 for gynecological beds. Conclusions. The current state and trends in reproductive health and the performance indicators of obstetric and gynecological services in Ukraine reveal the presence of persistent negative tendencies and systemic challenges. These require in-depth investigation of underlying causes and the development of evidence-based strategies to preserve and improve reproductive health, as well as to optimize the organization of obstetric and gynecological care.