Demographic crisis in Ukraine from the perspective of public health

Анотація

Aim - to analyze the transformation of the demographic situation in Ukraine in the pre-war period and after the onset of the war; to substantiate directions of state policy in the field of public health capable of reducing barriers to the realization of reproductive rights and contributing to the restoration of the population’s reproductive potential. The transformation of the demographic situation was analyzed with an emphasis on the loss of, and opportunities for restoring, the reproductive potential of the population. It was substantiated that the decline in the birth rate under wartime conditions is not an isolated behavioral phenomenon, but rather the result of interrelated factors: forced migration, destruction of the infrastructure of healthcare facilities, deterioration of access to sexual and reproductive health (SRH) services, psychosocial stress, gender-based violence (GBV), and worsening social determinants of health. It was shown that the demographic crisis is exacerbated by excess mortality and disability among men of working age, territorial separation of partners, a decline in the number of women of reproductive age, and reduced household capacity to realize reproductive plans, which creates long-term risks for the reproductive potential of the population. Based on a comparative analysis of the experience of France, Poland, and Israel, it was demonstrated that a positive demographic effect in post-crisis and post-war conditions is achieved not through isolated financial incentives, but through a coordinated package of intersectoral policies. Priorities for Ukraine were proposed: transition from a natalist model to a model focused on reducing barriers to conscious parenthood; ensuring continuity of SRH and perinatal medical services; integration of mental health into SRH pathways; strengthening the system of response to GBV; development of assisted reproductive technology programs, including services for male and female veterans; consideration of the environmental consequences of war and the impact of social determinants; and services to support families at the community level. Conclusions. From a public health perspective, sustainable demographic recovery is possible only through the combination of medical, social, housing, security, and economic interventions aimed not at mechanically stimulating birth rates, but at restoring the reproductive potential of the population. The authors declare no conflict of interest.

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