As Ukraine’s birth rate plunges, here’s what one doctor is doing to reverse the trend

LVIV, Ukraine — As an OB-GYN doctor, Stefan Khmil has built a nearly 50-year career on helping women in Ukraine have children — an especially important job in Ukraine, the country with the lowest birth rate in all of Europe.

However, the last 2 1/2 years have been a particular challenge, as Russia’s full-scale invasion has upended everything.

Khmil says not only have doctors and patients been displaced because of the fighting, the conflict has also put the fundamental building blocks to make life at risk.

“Many of [the doctors] evacuated with sperm, eggs and equipment,” Khmil, 68, tells NPR. “So we helped them … to save it and not to lose everything.”

He brought some of those cryogenically frozen specimens to his two clinics in western Ukraine — one in the city of Ternopil and one in Lviv — so patients could continue their child-conceiving treatments, such as in vitro fertilization.

Soon, Khmil started thinking beyond what had already been harvested.

“I started thinking about what we need to do to preserve the biological material from our military, so we started offering to freeze the spermatozoa of men serving in the military for free,” he says.

A fighting chance

Dr. Khmil’s obstetrics clinic was the first of many across the country to make the move, saving Ukrainians thousands of U.S. dollars on the procedure.

In March, President Volodymyr Zelenskyy signed a law allowing soldiers to do just that — preserve their reproductive cells for free.

Khmil says that the worry isn’t just about death in combat. Factors such as stress, extreme weather and the use of chemicals and ammunition on the battlefield can all have a negative effect on sperm — even render a man infertile.

“We can give these men who are fighting the opportunity to have children after the war, during war, whenever they want,” Khmil says.

His clinics also offer the harvesting and freezing of military women’s eggs at no cost. Since Russia’s full-scale invasion in February 2022, Khmil has helped over 400 families and over 60 children be born.

Viktoriia Onyshchuk hopes to be one of those success stories.

The 34-year-old from the city of Kryvyi Rih, in central Ukraine, is a combat medic and drove hours from the front line to have her eggs harvested at Khmil’s Lviv clinic.

“I have been trying to have children since 2010,” she says.

Onyshchuk’s husband, Petro, who is also in the military, froze his sperm some time ago. But it’s taken months for her to find time to get away to have the operation, due to long rotations at the front.

In preparation for the surgery, Onyshchuk has been taking powerful hormone medications. The pills have caused her bloating, cramping and fatigue — all compounded by her job. But since a woman’s body typically only produces one egg per menstrual cycle; for a successful egg harvesting operation they need to get between six and eight, she says.

But Onyshchuk doesn’t mind. She says it’s a woman’s duty to give birth — especially now.

“We don’t know what will happen to our country,” she says. “And when peacetime comes, somebody will have to rebuild it.”

Population woes predate war

As Ukrainians try to conceive of life after war, concerns about who will be around to carry Ukraine into the future hang over the country like a pall.

But Ukraine’s demographic crisis far predates 2022. It actually began as soon as the country gained independence from the Soviet Union in 1991, when its population was estimated to be about 52 million.

Today, the United Nations says Ukraine’s population is a little under 38 million — a drop by almost a quarter in just 30 years.

Tymofii Brik, the rector of Kyiv School of Economics, says the reasons are a “little bit of everything.” Even long before the Russian invasion, Ukrainian men had some of the highest mortality rates in Europe, due to risky work and lifestyles, he says, only living to 65 years old, on average. Also, much of the population has simply left for better, higher-paying work and a safer life with a less aggressive neighbor.

Brik says, meanwhile, Ukraine is also experiencing the same downturn in birth rate as other modern, industrialized nations.

“When you have these kinds of societies, usually plans and ideas of your life also change,” he says. “In these societies, usually people do not plan to have a lot of kids.”

Ukraine’s Health Ministry says the country’s birth rate has been dropping since 2013. In 2023, the ministry reports, an average of about 16,100 children were born every month. Before the full-scale invasion, the number ranged from 21,000 to 23,000-per month.

Massimo Diana, the U.N. Population Fund representative in Ukraine, says that the country’s birth rates have dropped below one child per woman. Demographers say that’s far lower than “replacement level fertility” — which says the average number of children born per woman needs to be about 2.1 to maintain the population level. Any higher number would achieve population growth.

Russia’s full-scale invasion has displaced some 14 million Ukrainians with a little less than half still remaining outside of the country, according to the U.N. refugee agency.

So when the war ends, Brik says, Ukraine will have to work hard to make families feel safe and secure enough to not only have children — but to have more children than before.

Future Ukrainians

OBG-YN doctors across Ukraine are there to help the families who say they cannot wait for peace.

Svitlana Teleniuk and her husband, Bohdan Teleniuk, wanted more children even though they already had two boys. But when the full-scale invasion started, he went off to war and they never found the time.

“He was only home for a couple of days,” says Teleniuk, who is 48 and from Ternopil.

So they turned to Dr. Khmil, who froze Bohdan’s sperm in January 2023. Twins Angelina and Artur were born in February the following year.

But these babies will never meet their father, as Teleniuk found out she was pregnant just days after going to his funeral. Bohdan died on the front lines.

“The boy is an absolute copy of my husband, an identical copy,” she says, lovingly peering into Artur’s twinkling brown eyes, his chubby cheeks turning red with smiles.

Like so many other Ukrainian women, Teleniuk will raise the twins and her older son by herself now. She says she’s proud and wants to do it herself.

Khmil recognizes that life in Ukraine will likely not be easy for these mothers and their children born during war. But he sees his work — helping families have kids — as a way of doing his part to save his country.

“Russia is destroying the Ukrainian nation and killing Ukrainian people — we have to respond,” he says.

Polina Lytvynova and Hanna Palamarenko contributed to this story from Lviv and Ternopil, Ukraine.