Goals and objectives of the research
The project aims at mobilizing activists and changing the attitude of health care workers and reproductive health workers towards women with drug use experience through a broad advocacy campaign to improve the access of these women to medical services and realization of their reproductive rights.
According to preliminary estimates, women who use drugs have a number of problems in obtaining reproductive health services. In Ukraine, for example, there is no protocol for the antenatal care and the birth of children that takes into account the specificities of women who use drugs and/or participate in substitution maintenance therapy programs (hereinafter – SMT), which in turn leads to cases of refusals for such women to provide gynecological care.
To change the situation, there is a need to assess the difficulties that exist, and then plan a women’s mobilization campaign to uphold their rights in dealing with doctors and also plan broad advocacy campaign to stimulate systemic changes in the health care delivery.
It is important to note that there was no such research in Ukraine before, it is intelligence research. That is why the sample was formed conveniently and was small (77 people). The main points of the questionnaire were doctor visits (in particular, gynecologists), whether patients register their pregnancy. In addition, cases of patients’ interaction with the police and social services, as well as cases of violence were recorded.
Summary of results
The first results in Ukraine on the access of women, who have taken or are taking drugs (including SMT clients), to the medical services have been received. 77 women from five regions of Ukraine aged 26 to 55 were interviewed, mostly with secondary education with a predominantly low average monthly income and a long (over 5 years) experience in the use of psychoactive substances. It was shown that 80% had problems with pregnancy registration, and only a quarter received completely satisfactory medical services when the doctor knew that the patient was taking drugs and had a hepatitis C-positive or HIV-positive status. The main factors associated with denial in medical care for women who use drugs are age group 36+, inactivity in sex work, lack of experience in domestic violence, long experience of drug addiction and staying in the SMT program. The majority of interviewed women indicate problems when applying for assistance to the National Police of Ukraine. Respondents feel urgent need of a wide range of services of non-governmental organizations.
Description of the received data
Socio-demographic indicators. The vast majority of respondents have an age range of 26 to 55, with this interval they are distributed approximately evenly in ten-year intervals. Almost half of respondents have secondary special education and about one third have complete or incomplete higher education. The family status of the sample is approximately the same (one third) married (both officially and in civil marriage) and unmarried women, while widows make up about one fifth. Two thirds have a permanent partner or partners, with only about a tenth of them denying the use of this partner of drugs. The sample was constructed so that approximately the same proportions of respondents lived in Kyiv (north), Kharkiv (east), Poltava (center), Vinnytsia (west) and Odessa (south). Half of the polled women do not work anywhere, one third indicated that they had official or unofficial part-time employment, and only a quarter had full permanent employment; respectively, salaries are the main source of income for only one third of respondents, another third live on pensions or similar social benefits, while two-thirds have either situational income or live with relatives. Respondents were distributed almost equally in groups with low and middle income (from 1000 to 6000 UAH per month).
Motherhood. Two thirds of the respondents have one child or several children, with the majority being women with one child. The vast majority of respondents assessed their paternal experience as positive, although in some cases, women pointed out some difficulties encountered in the process of raising children.
The experience of using narcotic substances. The overwhelming majority of polled (almost 90%) women have a history of drug use that exceeds 5 years; two thirds now are clients of the substitution maintenance therapy program, another third was previously on SMT.
Experience of Violence. At least one third of respondents have experience of domestic violence in various forms – from physical to psychological or economic.
Experience of appeals to medical workers. Only a tenth part had no experience in seeking medical assistance. It should be noted that the wording of this question is unsuccessful, since it is not clear whether it is a question of medical care at all or in the context of the use of narcotic substances. Since almost all had the experience of participating in SMT programs, 8% of those respondents who objected to contacts with physicians at all looked strange. Approximately half of the respondents indicate cases of refusal to provide medical care due to the fact that the patients used drugs.
The experience of contact with medicine in the context of reproductive disorders should be highlighted separately. The overwhelming majority (over 90%) did not seek treatment for infertility; 30% of respondents did abortion during an SMT; one third during the pregnancy used drugs; about 80% of those polled who had positive status of hepatitis C or HIV complain of certain problems with gynecologists during pregnancy registration. In half of the cases, patients had complications of pregnancy. Only 24% of those who used drugs and had positive status of hepatitis C or HIV, said they were professionally serviced during childbirth by their doctor.
The experience of applying for help to the police. A half of interrogated addressed for aid to National police, but only one fifth of them believe that they had been given the necessary assistance.
Experience with NGOs. The overwhelming majority has the opportunity to get help (mostly social and psychological) from specialized NGOs in their city, and 23% said that they themselves are involved in the activities of such initiatives.
Need for services. From half to two thirds of the respondents would like to receive information on activities of local NGOs in order to be able to become participants in educational, informational, advocacy or human rights events. The most convenient way to receive such information by the respondents is considered phone (79%), the second place is facebook, SMS and e-mail (one third of the survey participants).
Factors related to receiving health care
In this section, we will try to find the key factors that are statistically significantly related to the variable “denial of medical care because the respondent is using (or was using) drugs.” Since the number of respondents is small and the sample was constructed unrepresentative, it is not meaningful to use complex statistical models, and the results obtained should be taken exclusively as a benchmark for future research. To illustrate the results and simplify calculations, this variable is reduced to binary type: “not faced with denial” (55%) / “faced with cases of denial” (45%); In the same way, other variables were simplified.
As can be seen from the table (below are only those factors that are statistically significantly related to denial of medical care at the level of p <0.05), the main factors associated with the refusal to provide medical care to women who use drugs are age group 36+, inactivity in sex work, lack of experience in domestic violence, long experience of drug addiction and staying in the SMT program, presence in the city where the interviewee lives, organization or initiative group, which provides services for this category of women. This list can be conditionally divided into factors arising from the composition of the sample (involvement in sex business, the victim of domestic violence, the presence of an organization in the city), and factors that can be interpreted in the extent of the common sense. Thus, the long experience of drug use is directly related to the age of the respondent and the experience of participating in SMT programs – these three factors are also mostly visualized and embedded in public perceptions of more or less useful people, that is, those who, from the point of view of physicians, get help in the first place or who get help later.