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Ukraine’s New Health Rules Spotlight Barriers to Emergency Contraception

Authorities Should Eliminate Prescription Requirement for “Morning-After” Pill

A customer walks out of a drugstore lit by a portable generator during a blackout in the Western Ukrainian city of Lviv following massive Russian airstrikes on January 14, 2023.  © 2023 Yuriy Dyachyskyn/AFP via Getty Images

As of April 1, Ukraine’s Ministry of Healthcare introduced electronic prescriptions as an alternative to paper ones, which have been required for all prescription medicines until now.

Authorities say the change will help track and monitor prescriptions and ensure quality care, but it has renewed concerns about medication that shouldn’t require a prescription at all – emergency contraception, also known as the morning-after pill, which can prevent pregnancy after contraceptive failure or unprotected sex, including in cases of rape. It is most effective when taken as soon as possible after unprotected sex, and levonorgestrel – the most commonly used emergency contraception pill in Ukraine – must be taken within 72 hours.

Unlike most European countries, emergency contraception still requires a prescription in Ukraine. Although in practice, some pharmacies have sold it over the counter, women and girls cannot rely on finding a pharmacy willing to do so and time is of the essence. Reducing any barriers to access is essential, and additional obstacles during wartime make it even more pressing.

Dr. Nataliia Lelyukh, a gynecologist in Kyiv, told Human Rights Watch that current conditions in Ukraine mean prescriptions for the morning-after pill – paper or electronic – are impractical and likely to cause harmful delays.

“We do not have normal logistics to pharmacies, there are not even enough pharmacies in small settlements. If there is no connection, no electricity, it is not clear what can be done,” she said. To get the prescription, women must see or contact their doctor, who can issue electronic prescriptions only from their offices. Women do not always have direct contact with their doctor or may not have a doctor in their village at all. This process may be especially daunting and burdensome for girls.

Sexual violence survivors may be hesitant to turn to local healthcare professionals because of stigma, the doctor added. 

The World Health Organization says emergency contraception should be accessible and available as part of routine reproductive health care. It also says emergency contraception should be integrated into health care services in high-risk settings, including emergency and humanitarian situations. Guidance endorsed by the International Federation of Gynecology and Obstetrics explicitly states that emergency contraceptive pills “are safe for all women” and “appropriate for over-the-counter, non-prescription provision.” The EU medicines regulator European Medicines Agency has long approved over-the-counter sales of emergency contraception.

When rapid access is key, there should be no additional obstacles that could keep women from seeking and receiving necessary treatment. Ukraine should urgently allow the sale of the morning-after pill without prescription.

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