For those of you in the audience who are still awake (I'm sorry for the continued long absences... chalk it up to laziness and a lot of traveling for my field research... I know, I know, I'm pretty important), I would like to provide an update on life in the U-Krane.

I am spending the majority of my time in Ukraine on researching the "obstacles and motivations to use of contraceptive and abortion services" (that's the title of my project), which involves traveling to the various regions of Ukraine (called oblasts) and setting up shop in hospitals, women's clinics, and gynecologist offices to speak with women about their experiences with abortion and contraception. (As a side note: all of these interviews are done under informed consent and according to ethical regulations. I promise.) This has at times proved rather awkward or surreal, due both to my not-yet-perfect-and-often-quite-tactless Russian language skills and to the lack of an awareness of patient rights in Ukraine. For example, I have been led into post-abortion recovery wards and invited to ask the group questions about their experiences (I mean, really?) or some lack of subtlety in my questioning has led doctors to ask aggresively, "Well, you have abortions in the States, too, right?!" (clearly, I said something wrong...). However, at the risk of sounding really touchy-feely, for the most part these interviews have yielded some very frank and meaningful conversations about reproductive health, family, the woman's role in society, and yes, even the future of Ukraine.

The most frequent question that I have been asked is, "How is contraception different in the US?" And the truth is, it's not that different. The contraceptives on the market right now in the States are pretty much the same as the ones available in Ukraine, with a few exceptions (hormonal implants are not widely available in Ukraine, mostly because there is not much of a market for them). Where differences do exist, however, is in the access to and attitudes towards contraception in the respective countries. While contraception is often available on a sliding price scale in the US-- condoms are even free in New York City-- price is a significant barrier for many women in Ukraine, especially those from the rural areas (Ukrainian villages and Ukrainian cities are two totally different ball games economically and socially). In the US, most young people know that they can go to the school nurse or the college health center or a local Planned Parenthood for birth control counseling (this may be less of the case since Bush's abstinence-only policies), but in Ukraine, most people only trust the doctor for providing such advice, and they rarely visit the doctor because of the long waits (no appointments), the under-the-table costs (I'm not kidding, I saw this in action), and the total lack of confidentiality (if you're waiting in the village clinic for a prescription for the pill, the whole village will know about it by the time you're through). There are other pretty major differences in terms of what people believe is safe to use (IUDs are widely popular in Ukraine but not in the US, while the pill, the most popular form of birth control after condoms in the US is thought to cause women to grow tails and beards in some parts of Ukraine).

But one of the most significant differences, as far as I can tell, is a lack of a connection between reproducive rights and reproductive health in Ukraine, a link that is almost too strong in the US. While working at Planned Parenthood, one of our constant refrains was about the way that choosing to use birth control EMPOWERS women, and how the whole issue isn't the morality of birth control or abortion, but the woman's right to CHOOSE either. But when I ask women about their thoughts on "reproductive rights" here, I get blank states (or rather, sort of condescending stares that indicate that they think I don't really know what I'm talking about... who knows, maybe I don't). Seriously, though, whereas in the US reproductive health is a social and political issue, in Ukraine, it is a purely medical one.

I will be the first one to admit that the politicization of reproductive health in the US is often detrimental. When women can't access safe abortion services because of spousal consent laws or abortion clinic protesters, or when the teenage pregnancy rate increases because of abstinence-only education in public schools, there is clearly a problem with over-politicization of some very basic health services and needs. However, in Ukraine, these services are not politicized enough. This missing link is due primarily to a highly medical view of health care (when asked if contraception was purely a medical question, almost all respondents answered "yes"), a lack of a human rights tradition, and a history of antipathy towards “special interest” groups (such as women’s rights) in the political philosophy of the Soviet Union.

The problem in Ukraine is that the lack of politics and "a human-rights approach" (in NGO speak) in reproductive health means that other sectors do not get involved and that no one thinks to fight for these rights when they are taken away. This hasn't been a problem in the past, since abortion and IUDs were free and frequent during the Soviet period and there aren't as yet very many widely-spread social or religious movements against abortion or contraception use. However, an opposition is developing. There are posters all over clinics, metro stations, and the cities that say things like "Abortion is murder" or "Mama, don't have an abortion," and both the Catholic and Orthodox churches have started campiagns against both abortion and some types of birth control (the so-called "abortive methods"-- which are not abortive at all-- such as IUDs and emergency contraception). If and as these movements develop, there needs to be a healthy pro-choice group (composed of multiple sectors, social, political, and medical) as well that can ensure that women still have the choice to access safe and comprehensive reproductive health services.

There's a fine line to walk between imposing one's cultural view and promoting women's rights. I don't mean to try to transpose US politics on Ukraine (as many international agencies do... more on the Global Gag Rule later...), but one of the reasons that I think that access to health care of any kind is so important is because it provides an individual with choices that they can make about their body, something that is truly theirs. Knowledge about one's body and access to health services are basic principles that allow a person really to have control over their own life on the most basic level. (There's a really good article by Nikolas Rose about this that expresses "the politics of the body" much better than I can.) So it's important for people in Ukraine-- and everywhere, for that matter-- to understand this connection between health and human rights, espcially as the health system develops and transitions from a centralized Soviet system to a more localized, patient-friendly one. Due to its sometimes controversial nature, reproductive health is especially important to protect as a human right.

As my mom says, "you don't have anything if you don't have your health" (thanks, Mom), and since health is such a basic thing, it needs to be fought for from all sides. Put in a more formal manner:

"Where in many countries politics need to be divorced from public health policy in order to guarantee women’s equal access to quality health care, in Ukraine, the politics of women’s rights need to be incorporated into health care issues. Not only will this emphasize the importance of prevention in reproductive health, but it will also increase the number of reform actors pushing for public health development."