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Data were collected through participant observation, a review of the literature, key informant interviews with health and social service personnel, and group discus sions and in-depth interviews with young women in Uzhhorod. Young women, age 18-30, were asked, “What do you consider to be the most serious health problems facing young women in Uzhhorod?” The first set of health problems listed by the respondents included a variety of illnesses associated with the proper function ing of the metabolic and endocrine systems. Most young women indicated that they suffer from stomach illnesses such as gastritis and ulcers, which they attrib ute to the drop in food consumption, the deterioration in the quality of the nutrients consumed, poor nutrition practices and stress. Many noted that women in Za karpattia suffer from problems associated with the im proper functioning of the thyroid gland. Iodine defi ciency is endemic in the Zakarpattia region and many women cite this lack of iodine, together with stress, as causes of increased thyroid problems. Other respon dents noted that women suffer from diabetes, which is difficult to control since many patients are unable to purchase glucometers to monitor their glucose levels or medications to keep their sugar levels under control. Iron-deficiency illnesses, including anemia, were also listed as a common woman’s health problem. Most of the respondents noted that there has been an increase in smoking and in the consumption of alcohol by women. This is especially a problem among young women. Although laws exist which make it ille gal to sell alcohol and tobacco products to people un der age 18, the laws are rarely enforced. I have ob served, on numerous occasions, children as young as 10-12, buying cigarettes and alcohol and have watched many young people under the age of 18 purchasing alcohol and being served alcohol in bars, cafes, and nightclubs. As noted by many of the respondents, “it’s all in the money.” As long as there is a paying customer, the products will be sold regardless of age or laws. A third set of health problems mentioned by the respondents included problems associated with sexual and reproductive health. In this realm, Ukraine is facing major public health challenges. The use of induced abortions to terminate unintended and un wanted pregnancies continues to be a widespread prac tice. Results from the 1999 Ukraine Reproductive Health Survey, funded by the United States Agency for International Development (USAID), indicate that there were more abortions than live births in Ukraine with rates in urban areas averaging 140 abortions per 100 live births. Almost all of the young women inter viewed in Uzhhorod, knew at least one woman, and often, several women, who had already had an abor tion. As noted in Women 2000, published by the Inter national Helsinki Federation for Human Rights (see http://www.ihf-hr.org), the high abortion rate is not caused by a short supply of contraceptives. It is caused by the high cost of these contraceptives (which are inaccessible for most people), by the lack of sexual education, and by acceptance of certain methods among the majority of the population. Respondents also indicated that many women suffer from yeast infections and inflammation of the ovaries (“zapalenja jajechnykiv”), which they claim is caused by catching a cold draft (“perestudzhenja”). Sexually transmitted infections (including syphilis, gonorrhea, chlamydia) are also on the rise. UNICEF statistics from 1999 indicate that the incidence of sexually transmitted infections in Ukraine, measured as newly registered cases of syphilis and gonorrhea, increased from 79 per 100,000 in 1991 to 208 per 100,000 in 1997. Ukraine is also considered the coun try in the Eurasia region most affected by HIV with the estimated number of carriers soaring from about 1500 in 1994 to some 110,000 in early 1998. Latest UN sta tistics estimate that there are nearly 500,000 people in Ukraine who are HIV-positive, approximately one per cent of the total adult population in Ukraine. Although intravenous drug use, primarily by adolescents and young adults, has been considered the primary route of HIV infection in the region, infection through sexual contact is on the rise, indicating that there is a need for increased awareness and acceptance of condom use. In interviews with gynecologists and women’s health personnel in Uzhhorod, it was discovered that a number of women, especially young women, suffer from ovarian cysts and irregular menstrual cycles. Cases of breast cancer and cervical cancer are also increasing, particularly in women over the age of 30. What is unfortunate is that many women with breast or cervical cancer are diagnosed at later stages since rou tine gynecological visits are not a common practice and breast self-examination information is rarely pro vided to women, especially outside of office visits. Mammogram services are also not readily available for most women in Ukraine, unless they live in Kyiv or other large cities that have mammography equipment. The young women interviewed in Uzhhorod were asked whether they had been to a gynecologist. Few of the young women interviewed had been to a gynecologist for a routine, preventive exam—those that had been to a gynecologist had gone because there was a problem. When asked about preventive health care, almost all of the young women interviewed indi cated that they go to a doctor only if there is a problem since “if it’s not broken, there’s no need to fix it.” Other women stated that “we are not accustomed to “НАШ Е Ж ИТТЯ”, ЧЕРВЕНЬ 2003 9
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