Getting abortion pills into Ukraine during a war meant having to be creative

Transcript

STEVE INSKEEP, HOST:

This story takes us to the early days of the Russian invasion of Ukraine and a covert effort to resupply Ukrainian doctors with abortion pills. The story comes from our podcast, Rough Translation. Because of the secrecy of the doctor's mission and because of medical privacy, most of the people in this story are referred to by just one name or, in one case, no name at all. Here is Rough Translation host Gregory Warner and reporter Katz Laszlo.

GREGORY WARNER, BYLINE: When Katz and I arrived in Ukraine this past October, everyone told us, if you're doing a story about abortion, you have to talk to Galina Maistruk.

GALINA MAISTRUK: Yeah, I know. I know. You sent me so many messages, just like lovers in previous times. Yeah.

KATZ LASZLO, BYLINE: We met Maistruk at her office in Kyiv. Her organization is the Ukrainian partner for International Planned Parenthood.

MAISTRUK: I'm an OB-GYN.

LASZLO: Maistruk has been practicing medicine for four decades, and abortion has been legal for her whole career. And 10 years ago, abortion pills came on the market. But when Russia invaded in Feb. 2022...

MAISTRUK: We have no air connection. We have no ship connection. All the pharmacies were in collapse.

WARNER: So by mid-April, about seven weeks after the Russian invasion...

MAISTRUK: No. No. No pills at all.

LASZLO: This doctor in Kyiv - her first name is Olha - said that in the early months of the invasion, three to five times more women were showing up in her office and asking for abortion pills.

OLHA: (Through interpreter) We realized that women would come and come and come, and there are going to be more and more of them. But the pills, there's not going to be more of them.

WARNER: But what those doctors did not know was that tens of thousands of abortion pills were making their way to Ukraine, donated by a major supplier of those pills.

LASZLO: Are you comfortable with us calling you supplier?

SUPPLIER: Yeah, why not?

WARNER: We agreed not to use the supplier's name because of the way he got the pills into Ukraine - by land across Poland. And in Poland, abortion is highly restricted. It is illegal to give anyone abortion pills.

SUPPLIER: I didn't want the Polish customs to find any mifepristone.

WARNER: Mifepristone is one of the drugs in the medical abortion kit. The other drug is misoprostol.

SUPPLIER: If these pills are labeled misoprostol and mifepristone, it's a big problem.

WARNER: The supplier's solution was to take the medicine out of its packaging. So imagine a bunch of plastic bags with 75,000 unmarked, loose pills inside them. And because you need multiple pills for an abortion, that's enough for about 15,000 abortions. One of the volunteers who ferried the pills across Poland was a Ukrainian woman named Yevgenia.

YEVGENIA: It looks like a drugs packing. I don't want to touch it.

WARNER: Yevgenia has an NGO that delivers medical supplies. If she got arrested in Poland for carrying these pills, her charity work could be jeopardized.

YEVGENIA: I'm definitely not against abortion, but it was like, why we should bring it in this amount?

WARNER: Did Ukraine really need this many abortion pills? After Yevgenia made it over the border, she started calling doctors. One of those doctors - Galina Maistruk.

MAISTRUK: Connection with Yevgenia was like magic situation.

WARNER: We talked to some of those doctors that received the pills, and we heard stories of patients where the war had come into their lives, changed their environment, their living situation, their relationships, their income. And they came to ask for these pills.

LASZLO: One doctor we met, Valentyna, told us about this woman who had come to her from the east, from the city of Slovyansk.

VALENTYNA: She told me I had, in Slovyansk, everything. I had two flats. I had house near seaside. I had two restaurants. Now I am (non-English language spoken).

WARNER: Now I'm a bum.

VALENTYNA: Now I am (non-English language spoken). I don't know what I should do with my child.

LASZLO: She said, I already have a child to take care of, and I just lost my house. I lost my money.

VALENTYNA: I should be healthy, strong and to have time and energy for my one child.

WARNER: We also heard stories about the use of these pills that went beyond abortion.

LASZLO: And that revelation, it started with Dr. Oksana. Her hospital is in Lviv, near the train station. And she sees local patients and also patients who've fled fighting in the east.

OKSANA: (Through interpreter) And these are a lot more complicated cases, more complications with pregnancies and more issues with pregnancy. Everyone is in a lot of stress.

LASZLO: Just because of the stress, like, there's more complications, like miscarriage and stuff like that?

OKSANA: (Through interpreter) Yeah, that's right. Difficult to estimate, but I think it's, like, one-third more than it was before.

DIANA: When the war start, we have a lot of complications of pregnancy.

LASZLO: This is Diana. She's a gynecologist in Kharkiv, really close to the frontlines. And she described having a day where...

DIANA: All women get to our hospital by ambulance with bleedings.

LASZLO: Every single woman that came in was hemorrhaging. When doctors see these complications happening, they can reach for these pills because it's really dangerous if a miscarriage doesn't complete. Like, if anything is left in your womb, then you can get pretty serious infections. So you take the pills, and then those pills make sure that your uterus is completely cleared out. In the case of bleeding, you don't actually need both pills. Doctors would just go for misoprostol. That's the pill that causes the contractions. And so when you have that contraction, it clamps down on the blood vessels and essentially, it stops the bleeding.

WARNER: When these pills were being smuggled across Poland and Yevgenia, the volunteer we heard from before, first saw these unmarked bags of loose pills, she wondered, did Ukraine really need this many abortion pills?

LASZLO: The answer was yes, because those pills address so many reproductive concerns beyond abortion.

WARNER: And for all the risk that people took to smuggle these pills into Ukraine, all the concerns they had over being arrested because of Polish abortion laws, many of these pills were used to help women safely give birth and to deal with the complications of pregnancy.

LASZLO: In a war as existential as the one in Ukraine, where stress is high, even in relatively peaceful areas of the country, even a normal pregnancy is far from normal.

INSKEEP: Reporter Katz Laszlo and Rough Translation host Gregory Warner. Their story was told with help from WNYC's Radiolab. To hear the full story of the smuggled pills and how war is complicating the debate over abortion rights in Ukraine, check out NPR's really awesome Rough Translation podcast.

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