Cradles and Conflicts: Is Ukraine Facing a Demographic Death Spiral?

On 25 September 2022 five civilians were killed and 32 badly injured by Russian shelling and missile strikes across Ukraine. On the same day, if the doctor’s calculations are correct, Maria Ridkokasha was conceived in the river city of Irpin in northern Ukraine.

It was, her mother said when she found out she was pregnant a few weeks later, a happy accident.

278 days later, on 2 July, 18 more civilian casualties were cut down by Russian weaponry across Ukraine. Two were killed and 16 were injured. And here, in Kyiv’s Maternity Hospital No 3, Maria was brought kicking into the world.  

A world that, unbeknownst to her, was at war.

Of course – for the moment – Maria remains oblivious to all this. The air raid sirens might wake her in the night but she is unaware her nation has been under attack for almost 500 days. That her life might be ended by a Russian Kh-101 cruise missile or a BM-21 launched rocket or an Iranian drone. A life precarious from the moment it began.

“It’s terrifying,” says her mother, Yulia, nestling Maria into the warmth of her neck. Standing in her bare feet in a night dress in her room on the maternity unit’s 5^th floor, she feels unbearably vulnerable. “We don’t think about going to Germany or Poland,” she says. 

But babies born into war are not the only strangeness to this maternity ward. The other is harder to put your finger on. Until that realisation: the silence.

There are no sharp reaches for breath as babies are pulled into this world. No urgent screaming of bairns. No swaddling cries. And in that moment, there seems nothing sadder to Ukraine than this – the noiseless maternity ward. A stillness that points towards something deep and dark: how the Russian invasion is threatening not just the living, but the yet-to-live.  

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“I think it’s a genocide,” says Dr Lyudmila V Manzhula, the doctor who eased Maria into this world. “100%.  This lower birth rate is because of the war and, in my opinion and in the opinion of many Ukrainians, it’s a form of a silent genocide.”

She lists the reasons. A lot of young women have decided not to have children; last year Dr Manzhula conducted many abortions as the threat of the Russians taking Kyiv seemed all too real.  Other women of reproductive age just left the country; these refugees have already found new boyfriends and husbands abroad and, yes, Dr Manzhula says, some of them have given birth.

“There is, of course, a happiness to this, but these babies could have been born in Ukraine.” Normally she sees around 3,600 babies born here a year.  “Last year, we saw a 50% drop – just 1,983. Before, we’d have 13, 14 births a day.  Now it’s as low as 5.” 

And, she says – her voice dropping – they’ve had cases where the mother has given birth but the father is out there, lying in a black earth grave.

“We have lost young, strong men who won’t be fathers because they’ve been killed. And other men too – if he’s had a spinal injury – he’ll come back an invalid, and he’s unlikely to find a partner.  Women want to have children with healthy, strong men who will grow up with their children.  Instead, there are men who are disabled who may end up alone.”

Sometimes she delivers a baby boy and the mother looks down at the bundle in their arms and then up at Dr Manzhula and they say: “he’ll finish this war.”

The obstetrician has seen patterns emerging.  “It might not be scientific,” she says, “but we’ve been seeing more boys. They say that when war descends, boys will be born.” And she’s noted more complications in pregnancies emerging from stress: knots in umbilical cords, high blood pressures. Women are often not coming in for their check-ups, so these things go untreated until the last minute. 

Throughout it all, too, is the great absence – less babies.  Less Ukrainians. 

As another obstetrician, Dr Malanchuk Oleg Borisovych, the Deputy Director of Kyiv’s maternity hospitals on Predslavynska Street, says, “at the beginning of the war, the birth level in Ukraine, especially in Kyiv, dropped by 70%. Today it is about 30% of the 2020 rate.”

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At 49 years old, Dr Malanchuk has been here since 1996 and in those years and he’s never seen anything like it. In 2005, 2006, that was a busy time, he says. When the first generation who had not been raised under Communism were starting to have families in their early twenties.  But that was then and this is now.

“The demographic state of Ukraine is definitely in decline,” Dr Malanchuk says, his office lined with dying orchids. Each of the plants was given by grateful mothers and fathers before the invasion. It’s hard not to see in their entropy a metaphor. He thinks that up to a quarter of the young women who have fled the nation will stay abroad. But of equal – perhaps greater concern – is the fact that a whole generation of young men are fighting, and with that will come injuries.

“These men might not be able to have a family,” he says. The sort of injuries that people rarely talk about in landmine-heavy conflicts – genitals shredded by upwards explosion – could be a cause of that.  “That’s why we are creating many rehabilitation centres for soldiers. That’s why we are starting to build up sperm banks.”

Other factors contribute. Women are giving birth later, and that invariably has had an impact on reproductive rates. But, for the most part, bringing a child into a nation at war weighs heavy on many women. They’ve had at least one baby born in a bomb shelter, and countless waters have broken as the sirens have blared high overhead down there in the depths.  

The threat is not imaginary. In March last year, Russian bombs were reported to have “completely destroyed” a children’s and maternity hospital in Mariupol. In total, there have been 29 direct strikes on hospitals, leading to 225 casualties, which include 107 civilians killed. There has been uncertainty around the precise number of maternity-hospital attacks due to inconsistent recording methods, though at least four are known to have occurred.

All these factors accumulate and, for those that make it their job to track the living and the dead, it feels apocalyptic.

Professor Ella Libanova, the Director of the National Academy of Science of Ukraine, has been in post over 20 years. She has long charted the slow and steady decline in the birth rate here in Ukraine. Since 1960, the population has not replenished itself but, she says, this war has brought a calamitous drop. 

By 2001, she tells you, Ukraine had the world’s lowest fertility rate, and even though it slightly improved following some modest government assistance to people with larger families, in 2019, Ukraine’s birth rate was still the lowest in Europe. 

She places the death rate surpassing the birth rate down to many factors. Men not getting old, for one – succumbing to alcoholism, poor diet, smoking, risk-taking. But on top of this decay came the war – mass migration, a drop off in marriages, stress, men dying at the frontline, civilians killed by Russian rockets.

The thing that worries her the most is the exodus of fertile Ukrainian women: “It will be a major problem if we can’t bring those women back.”

According to one paper released this month: “Ukrainian demographers are predicting that the Total Fertility Rate (TFR) will fall as low as 0.71 in 2023-24, the lowest ever recorded in the world.”

Such facts keep Professor Libanova awake at night, for her conclusion is bleak.

“I think that we are in a situation where Ukraine’s population might be in a death spiral,” she says.  “Even if victory is achieved the birth rate will not recover. If you had asked me about the crisis before the war, I’d have said it was deaths surpassing births. Now it’s migration and natality.”

Erich Maria Remarque, the German Great War novelist, talked about the lost generation, she says. She fears her country will suffer the same. And, even though she claims she is optimistic, it is hard to see any trace of hope in her Cassandra conclusion.

Back in Kyiv’s Maternity Hospital No 3, Maria sleeps on, unaware of how so great a nation’s hopes and futures rest on the future she represents. Unaware, too, of how little of that hope for the future there is to go around.

“I didn’t have another choice,” says Yulia, when she is asked why she decided to have her baby.  “God gave me this chance.”

It feels that God is handing out fewer and fewer such chances in Ukraine nowadays.