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Obstacles to Obtaining Emergency Contraception in Ukraine Amid War and Crisis

Ukraine’s Ministry of Healthcare has recently introduced electronic prescriptions as an alternative to paper prescriptions for all prescription medicines. While authorities believe that this change will help monitor and track prescriptions and ensure quality care, it has also raised concerns about medication that should not require a prescription, such as emergency contraception, which is commonly known as the morning-after pill.

The morning-after pill is a form of contraception that 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. Some pharmacies have sold it over the counter, but women and girls cannot rely on finding a pharmacy willing to do so, and time is of the essence. Therefore, reducing any barriers to access is essential, and additional obstacles during wartime make it even more pressing.

Dr. Nataliia Lelyukh, a gynecologist in Kyiv, has noted that current conditions in Ukraine make prescriptions for the morning-after pill 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. Women must see or contact their doctor to get the prescription, but they may not always have direct contact with their doctor, or they may not have a doctor in their village at all. This process may be especially daunting and burdensome for girls.

Survivors of sexual violence may be hesitant to turn to local healthcare professionals due to stigma, added Dr. Lelyukh.

The World Health Organization states that emergency contraception should be accessible and available as part of routine reproductive health care. Emergency contraception should also be integrated into healthcare 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 essential, there should be no additional obstacles that could keep women from seeking and receiving necessary treatment. Therefore, Ukraine should urgently allow the sale of the morning-after pill without a prescription.

While authorities may believe that electronic prescriptions will help track and monitor prescriptions and ensure quality care, these prescriptions can be impractical and may cause harmful delays in emergency situations. Emergency contraception, such as the morning-after pill, should not require a prescription, as this can reduce access for women who need it urgently. Ukraine should follow the guidance of the World Health Organization, the International Federation of Gynecology and Obstetrics, and the European Medicines Agency by allowing over-the-counter sales of emergency contraception.