Born During War: The Transformation of Neonatal Care in Ukraine
When we think about the impact of war on a country, we usually count the victims — diseased and injured people, property damage, and the destruction of infrastructure. However, war influences society much more deeply and complexly. Let us take just one area of healthcare — neonatology — and analyze the impact of war on it.
Beginning of the Crisis
From the beginning of the hybrid Russian-Ukrainian war, Ukraine started moving toward a demographic crisis. It did not begin in 2022, with the full-scale invasion and millions of refugees and internally displaced persons.
According to the State Statistics Service of Ukraine, more than 503,000 children were born in Ukraine in 2013. By 2021, that number had nearly halved to 273,772. In 2025, only 168,778 newborns had been registered. The sustained downward trend in birth rates poses significant systemic health risks.
The previous baby boom of 2009–2013 led to systemic changes in the provision of medical care for pregnant women, women in labor, postpartum women, and newborns in Ukraine. With the support of international technical assistance projects, a three-tier system of regionalized perinatal care was established, European protocols were adapted, and evidence-based practices were introduced in obstetric and neonatal care, infection control, and breastfeeding support. For each level of perinatal care, the scope of services, the list of specialists, indications for hospitalization, equipment requirements, and safety and quality indicators were defined.
It is precisely these past achievements that have helped maintain the accessibility, sustainability, and safety of perinatal care from February 2022 to the present, even though the past four years have been marked by difficult challenges, unpredictable choices, and unconventional managerial and medical decisions.
“Studies conducted by Ukrainian doctors and civil society organizations despite the war, along with data from Ukraine’s electronic health system, indicate a significant increase in the number of pregnant women with hypertensive disorders, gestational diabetes, infectious complications, exacerbations of chronic diseases, and advanced forms of cancer, particularly among women from de-occupied territories who, for a long time, had no access to either the public healthcare system or specialized obstetric and gynecological care,” points out Iryna Kondratova, Advisor to the Head of the National Health Service of Ukraine, Associate Professor of the Department of Pediatrics No. 1 and Neonatology at Kharkiv National Medical University, and a renowned Ukrainian neonatologist.
Premature Babies and Other Vulnerable Infants
All the previously mentioned factors have led to an increase in the number of newborns who were born prematurely, were ill at birth, or fell ill within the first 28 days of life, from 24,339 in 2021 to 36,761 in 2024.
Even Level III perinatal centers, where conditions for infant care in complex cases are optimal, faced a critical shortage in the early years of the war of bomb shelters equipped with oxygen systems, transport incubators and ventilators, as well as portable X-ray and ultrasound machines, open incubators, and mobile heat sources for infants.
In response to these new challenges, medical professionals and hospital executives had to reevaluate their equipment needs and adapt them to “military standards”: the equipment had to be as self-sufficient, multifunctional, mobile, and minimally invasive as possible.
To meet the needs of specialized medical facilities, several sources of aid are being utilized simultaneously, including governmental institutions, charitable foundations, international donors, and crowdfunding campaigns aimed at bringing about positive change in Ukraine’s neonatal field.
A number of meaningful initiatives and projects have been implemented to support the sector. One of them is First Breath, a comprehensive perinatal support program implemented by the charitable foundation ZDOROVI. The project is designed to strengthen — through the procurement of medications and equipment, internships for healthcare specialists, professional exchange visits between neonatologists from different countries, and advocacy efforts aimed at implementing European standards and protocols in neonatology — the capacity of Ukrainian perinatal centers to provide high-quality and consistent medical care, ensuring that every child, even those born prematurely, has a chance to survive and thrive.
As part of First Breath, a crowdfunding campaign titled “Help Premature Babies Take Their First Breath” was launched to raise funds for the purchase of the critical surfactant medication Curosurf, which is used in neonatal intensive care units. The campaign is still ongoing and can be supported financially.
Key Challenges for Ukrainian Neonatology
Among the key challenges faced by Ukrainian neonatology are the increasing incidence of infectious diseases among newborns, the growing need for antibiotics, and the rising number of cases of antibiotic resistance, all of which worsen neonatal care outcomes. Cases of pathology associated with placental abnormalities and intrauterine fetal hypoxia have also become more frequent.
According to the Ministry of Health of Ukraine, in October 2022, Ukraine launched a national program for expanded neonatal screening — a comprehensive examination of newborns for 21 congenital or hereditary diseases conducted in maternity hospitals within the first 48 hours of life. Over the course of three years, the program has performed more than half a million tests, identifying nearly 500 infants with rare (orphan) diseases, including 70 cases of spinal muscular atrophy.
All premature babies and infants with conditions identified during the perinatal period require follow-up care and long-term monitoring, as well as assessment of the risk of developmental disorders and rehabilitation needs. Unfortunately, this area is very difficult to implement during wartime, so only one-third of at-risk children receive follow-up rehabilitation during the first three years of life.
Ukrainian healthcare professionals and parent organizations are trying to develop evidence-based practices for follow-up care, functional assessment, and developmental evaluation of infants, but they face numerous challenges, including a severe shortage of nurses, physical therapists, and speech therapists, as well as the inability to obtain permission from rights holders to use the world-renowned standardized assessment tool for infant and toddler development — the Bayley Scales of Infant and Toddler Development — in Ukraine.
Among the less obvious but significant medium- and long-term issues are the decline in the proportion of partner-assisted births and cases in which infants requiring intensive care are separated from their mothers due to the need to ensure safe conditions for their care.
A study on the quality of women’s postpartum recovery conducted in Ukraine between 2024 and 2025 indicates that women have become more emotionally vulnerable: 58% experienced anxiety and fear, 60% had difficulty concentrating and making decisions, 35% experienced despair and depression, and sleep disturbances became a common problem affecting nearly 90% of women in the postpartum period during the war.
More than half of new mothers were unable to seek psychological support from specialists, and 47% noted that their psychological state and emotions affected their ability to care for their newborn child.
Transformation Brings Hope Despite the War
The impact of war on healthcare in every affected country is deep and complex. Even areas significantly removed from direct war trauma frequently suffer from the consequences of armed conflict. By 2026, Ukraine had entered a deep demographic crisis, and overcoming this crisis will require a comprehensive approach, years of effort, and millions of dollars from both Ukrainian society and the international community.
However, the positive changes in neonatal care in Ukraine are distinct:
- In 2025, the Center for Public Health of the Ministry of Health of Ukraine launched an initiative aimed at raising awareness among primary care professionals about breastfeeding support, as well as training and research on barriers to implementing child-friendly practices in pilot medical facilities at the community level.
- In 2025, the Ministry of Health of Ukraine approved the Procedure for the Provision of Medical Care on Follow-Up Monitoring of Newborns and Children Under Four Years of Age at Risk of Developmental Delays and/or Chronic Diseases.
- From January 1, 2026, Ukraine updated its National Immunization Schedule, including vaccinations for newborns.
- In 2026, the Unified Clinical Protocol “Initial, resuscitation and post-resuscitation care for newborns in Ukraine” was updated and approved.
- In 2026, Ukraine expanded state support for families, including a significant increase in childbirth benefits.
- The United Nations Children’s Fund (UNICEF), in partnership with the Ministry of Health of Ukraine and the National Health Service of Ukraine (NHSU), is implementing an in-depth certification course on breastfeeding support for doctors, nurses, and midwives.
- The United Nations Children’s Fund (UNICEF), in partnership with the Ministry of Health of Ukraine, the National Health Service of Ukraine, and the NGO “Early Birds,” is implementing on the NHSU Academy Platform a series of training webinars on introducing a system for the long-term follow-up of children at risk of developmental disorders in Ukraine.
“War makes you understand much more deeply the value of each new life. Through all the pain, fatigue, loss, and constant challenges, Ukrainian doctors, medical teams, and families work miracles every day for the first breaths, first days, and future of our children — our future generations.
For ZDOROVI, it is important that even in such difficult conditions, pediatric intensive care in Ukraine does not stop developing: specialists are being trained, hospitals are evolving, and new partnerships and solutions are emerging to help save the lives of Ukraine’s smallest patients. We truly look to the future with hope,” outlines Nataliia Tulinova, CEO and Foundress of ZDOROVI, a Ukrainian charitable foundation working in healthcare.
ZDOROVI expresses our gratitude to Iryna Kondratova for providing expert commentary and materials used in the preparation of this article.
Dr. Iryna Kondratova is a renowned Ukrainian neonatologist, Advisor to the Head of the National Health Service of Ukraine, Associate Professor at the Department of Pediatrics No. 1 and Neonatology at Kharkiv National Medical University, Candidate of Medical Sciences.
In 2022, she appeared on the cover of Time Magazine and was included in the BBC’s list of 100 Most Influential Women for her leadership and dedication to neonatal care during the war.
In March 2022, former footballer and UNICEF Goodwill Ambassador David Beckham, for one day, handed over his Instagram and Facebook accounts to Dr. Iryna Kondratova to help raise funds for Ukrainian newborns and increase international awareness of the impact of war on babies. At that time, she was the head of the Kharkiv Regional Perinatal Center in Ukraine.