‘Non-essential’ shops and restaurants have been open for weeks in Armenia and Ukraine. Both countries eased their coronavirus lockdowns in May. But pregnant women continue to face restrictions, and have suffered other mistreatment, in contravention of World Health Organization (WHO) guidelines.
“I was crying all the time, and there was no one to hold my hand,” says A.H., who gave birth in April in Yerevan, Armenia’s capital. Like many other women in countries across Eurasia during the pandemic, she faced a strict hospital ban against visitors and was not allowed to have her partner or a relative with her.
Inside the hospital, A.H. says she was “forced to give birth by surgical C-section”. She describes being told that her cervix had not expanded enough for a vaginal birth – and that her requests to wait for this to change were dismissed. “You are not perceived as a woman. They treat you like a machine,” she concludes.
openDemocracy has found that women in most countries in the Eurasia region, including Armenia, Kazakhstan, Moldova and Ukraine, have faced bans on birth companions during the pandemic – contrary to WHO guidance as well as national regulations in each of these countries that encourage companions.
WHO says that women giving birth should be allowed companions of their choice and receive respectful treatment, clear communication and appropriate pain relief. Armenia’s guidelines add that moral and psychological support provided by companions can reduce labour times and the need for painkillers and surgery.
Armenia’s national lockdown was lifted more than a month ago. Since 4 May, all non-essential businesses have been allowed to reopen – and stay open despite rapidly rising COVID-19 infections, which have soared almost tenfold from 2,200 in early May to more than 20,000 to date.
Women giving birth in Armenia still face restrictions, however. This month, eight of Yerevan’s nine maternity hospitals confirmed to openDemocracy that companions have not been – and are still not allowed – to visit maternity wards before, during or after women give birth. The ninth hospital did not respond.
In mid-June, the health ministry also told openDemocracy that “to prevent the spread of the virus, the ministry offered health institutions [the possibility] to temporarily suspend visits”. It said that companions may be allowed if precautions are taken – but none of the hospitals we contacted in Yerevan offered this.
Meanwhile, three hospitals specified that women can have post-natal visits from other women if they pay for a private room (but men are still banned).
“My husband and I will handcuff ourselves together if doctors won’t allow him in”
Birth companions were also banned temporarily in Moldova to prevent the spread of coronavirus, while Kazakhstan’s ministry of health announced in March that “accompanied births will not be held, visits are prohibited”.
In Ukraine, when President Zelensky introduced the lockdown in his country in March, he encouraged young people to reproduce, saying: “No one has cancelled the demographic crisis in Ukraine. I think it's time to fight this crisis.” But again, women who have given birth in Ukraine describe being forced to do so alone.
“It’s very difficult when you’re alone,” says Olga Bardzii, aged 21, from the Ivano-Frankivsk region, who says she was also chastised and insulted by hospital staff for not bringing a baby bottle to the hospital.
“You have a catheter in you, the pain is hellish, you have a child on your chest… And they only tell you what a bad mother you are, because you didn't buy a bottle.”
The Ukranian government began to ease its lockdown at the end of May, but as in Armenia, women giving birth still face restrictions here too.
One woman recently launched an online petition calling on local maternity hospitals to let her partner join her when she gives birth. “My husband and I are ready to handcuff ourselves together if doctors won’t allow him in,” she told openDemocracy.
“Extra fuss – that's how they feel about it”
In other countries, including the UK and US, similar bans against birth companions, introduced by individual hospitals and health systems at the start of the pandemic, were the subject of significant local controversy and were reversed.
But in Eurasia, forcing women to give birth alone has deep roots. In the USSR, no relatives or partners were allowed to enter maternity wards. “Extra fuss – that's how they feel about it,” says Olga Gorbenko, co-founder of the Natural Rights Ukraine NGO, while “it is actually dangerous for a woman who gives birth to be alone.”
Anastasiya Salnykova, also a co-founder of this organisation, criticised president Zelensky’s call to “fight the demographic crisis” during COVID-19. It is based, she said, on “the premise that women have to give birth, as it is their function, no matter what the circumstances are”. She urged the government to focus on improving maternity care instead.
In Armenia, even before the pandemic, many women who wanted to have their partner or another companion with them while they gave birth would have struggled to do so. Despite government guidelines recognising the moral and psychological support provided by companions, they were only allowed into private rooms not public wards, and doctors could, at their discretion, refuse to let them in.
In Yerevan, several of the women that openDemocracy spoke to also described feeling disrespected, humiliated or endangered while in hospital – before and during COVID-19.
E.T., who gave birth in early May, described how “the doctor was shouting at me when I was in extreme pain.”
Another woman said that while maternity care is supposedly covered by the public health system, she had to pay some money to all the medical staff to be treated well when she had her first child, in 2014. “They were very kind to me, which I cannot say about the other woman in the room who hadn’t paid.”
Sona Burnazyan, a psychologist and founder of the online project Happy Delivery in Armenia, says that poorer women with less education are more likely to be treated disrespectfully – and may not speak up about it “because they are also treated disrespectfully in their families, where they always feel secondary”.
According to the most recent Armenian Demographic and Health Survey, 66% of women who gave birth in the country between 2010 and 2015 did not attend university, and about 40% had below-average living standards.
‘Poorer women are more likely to be treated disrespectfully’
But when women do speak up, they may find it makes things worse. This was J.Y.’s experience. She gave birth in April in a Yerevan hospital where she says she was not supported to breastfeed – also against WHO’s guidelines. As a result, “I did it wrong and my child went hungry for about three days.”
“Then the baby went into shock due to low blood sugar, ” she says. “I can't describe what I experienced in that moment, when my newborn was making unnatural movements in my arms.” When she asked for help, however, she says her doctor got angry and blamed her for the situation.
Yerevan obstetrician-gynaecologist Ani Gasparyan told me that disorganisation during the pandemic has left doctors overwhelmed, but that even before COVID-19, they were performing too many “additional responsibilities: giving psychological help, taking care of new mothers and newborns”.
Syuzan Muradyan, another obstetrician-gynaecologist, says the restrictions imposed by the health ministry were supposed to prevent the spread of COVID-19, but that their consequences for women have been overlooked.
“I want to ask my colleagues and some health workers to change their approach and attitude towards pregnant women,” Muradyan says, “as it is our duty to provide a positive emotional environment for our patients.”