Ukraine's population suffers dramatic decline in health (08/24/97)

UKRAINE'S INDEPENDENCE: THE SIXTH ANNIVERSARY

Ukraine's population suffers dramatic decline in health

by Irene Jarosewich

CAMBRIDGE, Mass. - If not consciously, then in their souls, Ukrainians see themselves as a healthy, robust people - not as a sickly nation. Ukrainian folk culture and traditions - toasts, songs, proverbs, food, family habits - emphasized health, fertility and long life. Those already born in the West were told stories about their parents' large families, remember being surrounded by dozens of cousins and relatives during holidays, of having grandparents who lived well into their 80s.

Heartiness, robustness, endurance: these qualities were almost taken for granted, were intrinsic, to the national psyche. Therefore the demographics of Soviet and post-Soviet Ukraine are disturbing, and even shocking. The past several decades have not been kind to Ukraine, and today, sadly, Ukraine is not a healthy nation.

At the recent "Ukraine Since Independence" symposium sponsored by the Harvard Ukrainian Research Institute, Dr. Oleh Wolowyna, sociologist and president of Informed Decisions, presented sobering demographic statistics, distilled from reports of Ukraine's Ministry of Statistics.

Dr. Wolowyna points to rapidly increasing rates of both infant and adult mortality in the past several years as the most significant figures to indicate a society under stress, along with the dramatic drop in total population, in life expectancy, and in the rate of birth.

Though numerous factors, such as immigration/emigration, political events, and man-made and natural disasters can influence changes in the demographics of a population, the current situation, in Dr. Wolowyna's opinion, is primarily a reflection of the current economic crisis.

The economic crisis, however, is not simply a consequence of several years of independence, according to Dr. Wolowyna, rather, it began decades ago. "The demographic crisis would have hit Ukraine regardless of the declaration of independence, since negative demographic trends were well in place prior to collapse of the Soviet Union," he said. Other former republics such as Russia, Belarus and Moldova are experiencing similar drastic changes among their population.

"People expected miracles with independence, which was unrealistic," continued Dr. Wolowyna, "since many basic political and economic changes will take 20 to 25 years." Nonetheless, certain steps in the direction of economic reform should have been taken that were not, "even within present constraints," and without some degree of economic recovery soon, Ukraine's demographic crisis will only deepen, he explained.

Population

Since 1993, Ukraine's population has dropped by 1.3 million, from 52.2 million to 50.9 (projected to the end of 1997). One of the reasons for this drop is seen in the ratio between deaths and births. In 1996 there were approximately 800,000 deaths and 500,000 births; the number of deaths exceeded the number of births by almost one-third.

Another reason for the population decrease is emigration; official Ukrainian statistics list that, for example, slightly less than 100,000 people emigrated from Ukraine in 1995. Dr. Wolowyna believes, based on other information and U.S. experience, that the figure is at least three times higher.

This precipitous decrease in total population, according to economists at the conference, is unheard of in developed countries and unprecedented during peacetime. Furthermore, Dr. Wolowyna projects that things will get worse before they get better: by 2010 Ukraine's population could drop to approximately 46 million, a decrease of almost 6 million people in 15 years.

Mortality

Infant mortality, defined as the number of infant deaths per 1,000 live births, is on the increase. In 1990 there were 12.8 infant deaths per 1,000 births; by 1995 the figure had risen to 14.7, about three times the average rate of developed countries.

Furthermore, in Ukraine, infants who die within the first week of life are considered to be "miscarriages," not infant deaths, and are not included in calculations of the infant mortality rate. Thus, using Western methods of calculation, the rate of infant mortality in Ukraine is actually higher. A colleague of Dr. Wolowyna's at the U.S. Bureau of the Census has made an adjustment for this difference in method and calculated that the infant mortality rate in Ukraine is probably closer to 22 infant deaths per 1,000 births.

The main reasons for infant deaths are an increase in "perinatal complications," problems arising from the birth - low birth weight, poor pre-natal nutrition and care, birth/pregnancy complications, premature birth - all indicative of a failing health care system, according to Dr. Wolowyna, and an increase in congenital disorders, a disturbing trend given the Chornobyl nuclear disaster and other environmental degradation.

Adult mortality also is on the increase, especially among men (a recent report from the Kyiv Oblast Department of Health Protection stated that last year in Kyiv Oblast, male deaths exceeded female deaths by a ratio of 6:1). The main cause of death in Ukraine, almost 60 percent, is "circulatory diseases" - stroke, heart attack, high blood pressure. Another cause is "violent death" - accidents, drownings, suicides, murders - a figure that has risen significantly since 1990, and yet another indicator, according to Mr. Wolowyna, of a society in distress.

Of the four Soviet republics often grouped together because of similar trends, Russia, Ukraine, Belarus and Moldova, only Russia has a higher rate of mortality than Ukraine.

Birth rate

Fertility in Ukraine is quickly approaching the lowest level in the world. For demographers, Total Fertility Rate (TFR), a rate by which a population replaces itself, is considered to be 2.1 - that is two children per couple - roughly one child to "replace" each parent. In Ukraine, the TFR in 1995 was 1.4. Dr. Wolowyna believes that since then, the rate has dropped to 1.3.

The lowest registered TFR, or replacement birth rate, in the world in 1995 was 1.1, in the tiny island republic of San Marino. In short, the low rate in Ukraine means that the population is not replacing itself. This downward trend is also reflected in Ukraine's crude birth rate: the number of births per thousand of population, which has dropped from approximately12.5 per 1,000 in 1990 to approximately 9.5 per 1,000 in 1995.

Reasons offered for this low rate in Ukraine include: a decrease in the over-all number of pregnancies as more women actively choose not to get pregnant; a rate of male infertility that reportedly is the highest in the world (attributed by the Ukrainian Ministry of Health to exposure to environmental hazards, such as the Chornobyl clean-up); an increase in the number of pregnancies that miscarry. However, the most alarming statistic is the number of abortions: more than 715,000 reported in 1995.

Dr. Wolowyna believes these numbers indicate that abortion is being used as a primary form of birth control, and that couples choose not to have children for economic reasons such as the inability to support more than one child, the fear of an ill child and consequent expenses, and competing economic responsibilities such as aging parents or a sickly spouse. As a result, fertility rates will probably not increase without economic improvement.

The average number of abortions per woman, over her lifetime, is five. Not only does this dramatically impact the birth rate, it results in significant health problems for the woman.

Though Dr. Wolowyna did not speak to this topic, The Weekly staff did its own math: the combined number of pregnancies terminated by miscarriage (relying on Ukrainian health reports), number of pregnancies terminated by abortion (Ukraine's Ministry of Statistics) and pregnancies that ended with infant death (revised U.S. Bureau of the Census figures) resulted in the termination of approximately 750,000 pregnancies in 1995.

Life expectancy

Not only are more men dying, they are dying younger. In 1990, life expectancy for men was 66, for women, 75. By 1995, life expectancy for men had dropped to 62 (the official retirement age for men is 60), for women, life expectancy dropped to 73. This trend is reflected throughout the former Soviet republics: in 1995, in Russia life expectancy was 59 for men, 72 for women; in Belarus, 64 for men, 72 for women. By comparison, in the United States life expectancy was 72 for men, 76 for women.

Implications

According to Dr. Wolowyna, a below-replacement rate of birth is not necessarily bad. Unlike in Ukraine, a low replacement birth rate in the West is the result of economic strength, not weakness; the mothers and children are generally healthy and demographic changes are gradual.

Moreover, in Ukraine, children's first few years, the most critical in a child's development, increasingly are filled with stress - poor nutrition, poor health care, family tension - which are all indicator for stunted mental and physical development in the future.

A lowered birth rate has implications also for the future labor force. If the economy does improve, there will probably be a shortage of workers. Growing Western economies solved this type of economic problem in part by relying on immigrant and migrant labor, which then often resulted in social tensions. The most probable source of immigrant and migrant labor for Ukraine is the populations of the Central Asian republics.

The difference in life expectancy in Ukraine between men and women is 11 years; given that a woman is generally a few years younger than her spouse, she can expect to be widowed for 15 to 20 years of their life.

Ukraine's population graph for the 20th century looks like a mountain range, periods of peaks, between periods of population drops, in the mid-1920s, 1930s and 1940s, and consequent lowered birth rate "echoes" through the 1960s. The current population drop will "echo" into the 21st century, since fewer people today means that 20 to 25 years later there will probably be fewer births.

According to Dr. Wolowyna, statisticians and demographers in Ukraine have estimated that between 1929 and 1959, the potential loss (those who could have been born but were not) to the population of Ukraine was 14.6 million. This came on top of the actual loss of tens of millions of lives due to wars, the Great Famine, and political purges.

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