In the villages of Mikolaiv there are hardly any men. You see children holding their mothers’ hands in the capital, elderly people on their way to the supermarket, but it is difficult to see groups of Ukrainians between 30 and 60 years old, much less in rural areas. Most of the male population is at the front. A broad front line that runs more than 1,000 km, stretching practically from the north, from the border with Belarus, to the south, 60 km from Mikolaiv.
In it Perinatal Center of the Mikolaiv Regional Clinical Hospitalwhere the United Nations Population Fund has opened the barrier-free gynecological surgery room thanks to EU funding, the doctor Natalia Pushlenkova remembers the “happy days” before the war, with many pregnant women, births and newborn babies. “Life was good”he confesses.
However, in the first days of the Russian invasion, several towns in this oblast were occupied by the Russian Army, fulfilling the worst fears of the Ukrainian population. Russian troops wanted to advance through the entire region, making it difficult to live under the continuous bombardments.
«Before the war, every year between 500 and 600 children were born in this hospital», says the center’s senior obstetrician. Last year, only 150 babies were born. In the first nine months of 2023 there have been 171 births.
«Many citizens who had the opportunity to leave left. “It was very scary to be here,” she confesses. It’s more, Pushlenkova admits that she is concerned about the demographics of Mikolaiv and Ukraine in general.
“The situation is very complicated. Production in factories has stopped, there is a lot of unemployment, and it is logical that many families decide not to have children” in the face of this difficult situation and in the midst of an invasion.
As in most European countries, the demographic trend in Ukraine was towards a declining birth rate. The fertility rate in 2020 was 1.22 children per woman. But since the start of the full-scale Russian invasion, on February 24, 2022, 5.8 million Ukrainians have left their country, according to UNHCR data. To this we must add that the male population in the country has also decreased. Among the military casualties, although the Armed Forces do not give specific data, it is believed – according to what the former Ukrainian Minister of Defense told LA RAZÓN – that there are around 50,000 deaths. So births on Ukrainian soil today have been considerably reduced.
Given this breeding ground, The birth rate in 2023 is 0.8 children per woman. This setback, together with migration and mortality due to the war, could lead the country to a serious population reduction. If the invasion continues, some metrics point to a decrease of a third of the inhabitants.
At the Ukrainian Institute of Demography and Social Research they consider that, if the war continues, Ukraine could lose 11 million inhabitants in the next ten years (from 37 to 26). Some figures that hurt Ukrainians.
Pushlenkova ha continued working in the hospital despite the war conflict. First they protected the windows of the building to prevent broken glass from flying everywhere during the bombing. They also quickly equipped the hospital’s bomb shelter so that the patients could be taken down as soon as possible. Most women who were preparing to give birth had complicated pregnancies. One of them had not been able to get pregnant for years, and she was already older than the average in Ukraine, with the resulting risk.
During the first two weeks of the invasion, Pushlenkova and other colleagues stayed to “live” in the maternity hospital. The surgeries and births took place with hardly any light, so as not to attract attention from outside.
«At the end of February and beginning of March, the number of births was still relatively high. But then it dropped significantly: our patients were not even able to go to the hospital».
Difficult days crowd in Pushlenkova’s memory. Remember the case of a birth of two sets of twins. «They were in intensive care when on April 3, the doctors decided to discharge them (even though they were still weak). “The next morning, at 7 am, the building was bombed and the ICU completely destroyed.”
The health worker is moved when she remembers when the hospital was bombed and partially destroyed by Russian troops and how the bombings returned again during the previous winter. The situation was so bad that, “just a year ago, we didn’t know what was going to happen tomorrow or in an hour,” so understands perfectly well that Ukrainians are not interested in having children.
The population in Mikolaiv has changed a lot since 24-F. While some of its inhabitants continue not to return, thousands of inhabitants from neighboring Kherson, which was taken by the Russians, have moved to this oblast, and now have children there as well.
«The people who come to the hospital now are in worse medical conditions than before the war. They have lost a lot of time, they have not received medical services and appropriate treatments when it was still easy to resolve,” admits Pushlenkova.
“Before we didn’t have any patients from Kherson,” he insists. Furthermore, in most of the villages that were invaded in Mikolaiv where they work – thanks to a novel consultation service in mobile clinics – “the patients’ conditions are more complicated due to the lack of medicines and treatments” during the Russian occupation. He missed vital time.
The acting head of the Department of Surgery, Dmitro Bachynski, 39 years old, spent the first six months of the invasion residing in this maternity hospital. He describes in front of the exact place how he narrowly escaped death when the hospital was bombed with cluster munitions that April 4. “It is a prohibited weapon, a war crime, but so is attacking a hospital,” he denounces, faced with the challenge of not being safe even in a medical center. “It was the hardest day of my life,” he admits, but not before criticizing “Russian terrorism.”
«Compared to the first months of the war, there are more women giving birth, as it is directly connected to the fact that at the beginning many Ukrainians left Mikolaiv. Now some of them have returned. This is coupled with the fact that many people from Kherson has moved here, because that region has basically been left without medical services and hospitals after the occupation “Russian,” says the surgeon.
“There are almost no men left in the villages of the region,” explains Pushlenkova. “Those few who have stayed are either very young or very old,” she asserts in relation to the demographic problem that Mikolaiv suffers. However, each new birth fills this hospital with optimism.
«Seeing these babies being born gives hope. You feel that people will come back, Ukrainians will return to Mikolaiv, and life will go on», Pushlenkova predicted.
Another challenge joins the daily lives of Ukrainians and of this hospital in particular. Many doctors and nurses have left the medical center to join the ranks of the Ukrainian Army. “Even women,” adds Pushlenkova, who does not mind that they had to coordinate even better and increase shifts.
“Now we have to work more hours to cover them,” he says. Along the same lines, Bachynski describes how they have been updated and accustomed to operations in the middle of war.
«My colleagues and I learn every day. We have modified our methods, our surgeries, how we treat a specific wound in certain patients. We have renewed the logistics, the approaches… We have undergone a constant process of improvement,” in the face of the demanding situation.
The head of surgery takes the opportunity to show his gratitude “to all the countries that are supporting us in the most difficult moment in the history of Ukraine. You have helped us to continue standing, to resist and continue fighting. Our victory will be common. Together we will prevail and win,” concludes Bachynski.
Shortage of workers
The governor of Mikolaiv, Vitalii Kim, recognizes that despite the fact that unemployment is around 20% in the region, “the majority of our men are fighting in the Army. “Everyone is looking for people to work in agriculture, although it is difficult to find men.” Additionally, 164 businesses have closed, many of them affected by damage.
“Some people will not return and will stay in other places. That is not good for making long-term plans,” predicts Kim, who promises to create the conditions for investment and transparency.
“Some companies have already come, but we need many to win the loyalty of investors. We have materials, good workers, shipyards, agriculture, universities… There is a lot of potential. But military risks mean that we cannot take advantage of that potential.”