It was one of the most horrifying targets of Russia’s war on Ukraine so far. Reports showed a pregnant woman on a stretcher, her face ashen with shock, legs smeared with blood and a hand holding her bump. Behind her, the bombed-out ruins of Mariupol’s maternity hospital. More than a dozen people, including women in labour, were injured in the attack in March 2022. The woman photographed, Iryna Kalinina, later died along with her unborn baby.
In the three years since then, maternity care in Ukraine has remained under constant attack, with more than 2,000 strikes on medical facilities, including 81 affecting maternal care and delivery rooms. Just last month, Diana Koshyk, seven months pregnant, was killed when a missile struck a maternity hospital in the eastern Dnipropetrovsk region.
Over the past month, the Guardian has visited three maternity hospitals on the frontline to witness how Russia’s full-scale invasion and attacks on healthcare facilities have taken away women’s fundamental right to a safe childbirth.
At each hospital, women and the staff working there face terrible danger: circling drones, artillery, ballistic missiles and the targeted degradation of healthcare infrastructure. They risk themselves to bring new life into a country where there are now three deaths for every birth.
Even with renewed hopes for an end to the war, Russia’s brutal tactics have fuelled a demographic crisis for Ukraine. Millions of women and children have fled the country, hundreds of thousands of people have been killed, and those women who remained have been left fearful of pregnancy and childbirth.
In 2024, Ukraine suffered the lowest birthrate in the world and the highest mortality rate, according to the CIA’s World Factbook.
Kharkiv
The hospital in Kharkiv delivered about 1,000 babies a year before Russia’s full-scale invasion in 2022. Last year, that figure fell to less than 440 – two-thirds of women of child-bearing age have fled the city. The figure would be even lower but more women are attending as other hospitals in the city stop operating.
Just five days before our arrival in late July, the maternity building of Kharkiv’s main hospital had been damaged in a drone strike. As the windows were blown in and glass sprayed across beds, the women – some pregnant, others with newborns and one in active labour – were rushed across the river to a perinatal centre for urgent medical care. All were suffering from shock, but the woman in labour needed an urgent caesarean section. Staff operated quickly and mother and baby survived.
Such bombardment has become all too common in Kharkiv, which has been under heavy and sustained attack since the first hours of the war. In June, the city was hit with the largest number of attacks since the full-scale invasion began. At the perinatal centre now taking care of women, doctors say they have delivered babies in the middle of air attacks, and carried out surgery while bouncing up and down from the impact of explosions.
The city itself is heavily scarred by war. Broken glass lines the pavements outside the hospital, while two buildings opposite lie derelict after suffering damage. The centre’s windows are filled with sandbags, their plastic panes crossed with tape to contain any breakage. Power cuts are routine, with caesareans having been carried out by torchlight in the past.
It is a lot of stress to contend with if you are pregnant. Doctors say they have seen medical complications and breakdowns – one new mother refused to take her child home after she learned her husband had been killed at the front. The hospital now employs a psychologist to help ease the fears of women who are reluctant to even come to the hospital due to the risk it could be hit.
When Olga Shevela, 30, went into labour, she had to travel to the hospital as Shahed drones buzzed above the road. “I was worried the hospital could be targeted, but I had no choice but to give birth,” she says, rocking one-day-old Zahar. They ended up in the hospital’s bomb shelter just hours after delivery as almost 20 explosions hit the city.
When the air raid sirens wail, women stream through corridors towards the shelter in varying states of health. It is too dangerous to take the lift in case the hospital is hit, so they contend with the stairs. Some are trailed by nurses steadying portable intravenous drips, others cradle tiny infants. Those in the late stages of labour, undergoing surgery or who are recovering from an operation are too fragile to move and have to stay behind.
Early in the war, births were improvised in what was then a dusty basement, but it has now been converted to include beds and a delivery room. It is not sterile enough for surgery but they can accommodate births and there are enough provisions for three days.
Dasha Borisenko, 32, has suffered two miscarriages and is now living full-time at the hospital to protect a high-risk pregnancy – she is not due until January. She was living in a village in the eastern Sumy region along the Russian border, which is now enduring some of the worst fighting. She has not seen her husband for two weeks because they are concerned about military recruitment teams on the roads.
“I really want to have a child but with this war, it is difficult to manage,” she says.
Sloviansk
Sloviansk’s population has halved since the invasion began, from more than 100,000 to about 53,000. Births at the hospital have dropped from more than 1,000 a year to about 550. The figure is kept higher because the hospital now takes patients from a broader area as other maternity facilities have become unavailable.
Liliia Eroshenko, 36, was at home and heavily pregnant in July when she heard that three Shahed drones had crashed into the main building of Sloviansk hospital. Eroshenko and her husband had delayed having a child for three years because they were waiting for the war to end, but with no sign of peace they “couldn’t wait for ever”.
They were fearful that the maternity building – a short walk from the main hospital – would be the next Russian target. Four days after the bombardment, the maternity unit has so far been spared and Eroshenko is tending to her two-day-old daughter, Milana, who wriggles in a box in front of her.
With the future of the city so uncertain, she is now considering fleeing to the west of the country, but worries that nowhere in Ukraine is safe. One of her biggest fears is that her husband will be mobilised.
“There is no safe place left in Sloviansk,” she says. “We hear explosions every day.”
In the same room as Eroshenko, Vitalii Chernetskyi, 31, cradles his two-day-old daughter, Daria. Blinded in one eye, he is on indefinite leave after being injured at the front while his wife was pregnant. “Children are our happiness – they should be born,” he says.
The hospital building that was hit now lies in ruins – burnt out, partially collapsed, with huge twists of metal roofing flung metres away. Diggers were clearing away rubble and glass when the Guardian visited, as artillery shelling boomed in the distance.
The maternity unit is the last one to remain functional in Ukrainian-held Donbas, the colloquial term used to describe the eastern industrial heartlands of Donetsk and Luhansk that have been partially occupied since 2014. All the others have either closed, been destroyed or are under occupation.
Lying less than 20 miles from a shifting frontline, women travel from as far as 100 miles away to give birth here. They face drones, artillery, missiles and reconnaissance sabotage groups. People try to avoid public spaces due to regular attacks and endure routine electricity cuts as well as espionage – an alleged Russian agent was detained in Sloviansk during our visit for collecting information about Ukraine’s military.
The maternity hospital has lost several members of staff to attacks on the city, while midwives say there are more premature births and a rise in cancers, especially of the uterus. “We saw the same jump after 2014,” says Valentyna Hlushchenko, 62, director of obstetrics and gynaecology.
“Women breathe in particles in the air from the daily explosions,” she says. “They also wait too long to ask for help when something is wrong.”
Kherson
The population in the city was 280,000 before the invasion and less than quarter of its residents remain. Its maternity unit used to handle 1,500 to 2,000 births a year, but now only sees about 120. About 100 people have been killed and 1,100 injured in the city this year.
In a windowless underground maternity hospital in Kherson, Kateryna Osetsymska, 35, is sitting in bed in a spotted hospital gown, her face wet with tears. Outside, heavy booms sound as explosives are fired back and forth across the river – with Russian forces about half a mile away.
Osetsymska was admitted a week ago for her safety. She is 33 weeks pregnant and considered high risk – doctors say there are some complications with her uterus. “I’m certain it’s because of stress,” she says.
Since the start of the full-scale invasion the city of Kherson, in southern Ukraine, has been attacked with everything from tanks to guided aerial bombs, drones and multilaunch rocket systems. The city’s maternity hospital No 2 has been damaged five times and now operates underground in a state-of-the-art basement refurbishment that includes delivery, surgery and recovery rooms.
The day before the Guardian’s visit, explosives dropped by a remotely guided “first-person view” (FPV) drone narrowly missed the hospital and hit the car park. “Kherson doesn’t have a medical facility that has been hit less than four or five times,” says the head of obstetrics, Petro Marenkovskyi. “We are 100% confident Russia is targeting us deliberately.”
The city’s proximity to Russian forces means there is little chance of a siren warning before an explosion. Artillery or mortar fire hits just three seconds after launch and if people hear a Russian fighter jet is in the sky, they only have five minutes to find somewhere to hide from guided aerial bombs.
Residents are stalked by FPV drones that drop explosives with chilling precision, often hitting civilians. Doctors say they face extreme risk even coming to work; we are warned that a Russian reconnaissance drone is flying above the hospital during our visit.
The constant stress, says the head of obstetrics in Kherson, means higher risk of miscarriages, more haemorrhages and an increased rate of surgical intervention. Things were worse during almost nine months of occupation in 2022 when people hid in their houses and women went without medical care; a steep rise in stillbirths followed.
Osetsymska says she was pregnant with her youngest child during the occupation and unable to travel from her village, with no access to doctors or medical care. “You can’t erase the horrible stuff we have been through with this war.
“But my big hope is that my baby will live, and that they get a chance to enjoy childhood,” she says.
Quick Guide
Contact us about this story
Show
The best public interest journalism relies on first-hand accounts from people in the know.
If you have something to share on this subject you can contact us confidentially using the following methods.
Secure Messaging in the Guardian app
The Guardian app has a tool to send tips about stories. Messages are end to end encrypted and concealed within the routine activity that every Guardian mobile app performs. This prevents an observer from knowing that you are communicating with us at all, let alone what is being said.
If you don’t already have the Guardian app, download it (iOS/Android) and go to the menu. Select ‘Secure Messaging’.
SecureDrop, instant messengers, email, telephone and post
If you can safely use the tor network without being observed or monitored you can send messages and documents to the Guardian via our SecureDrop platform.
Finally, our guide at theguardian.com/tips lists several ways to contact us securely, and discusses the pros and cons of each.