The MCAI Ukraine program

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Since February 2022, MCAI has been  supporting mothers, babies and their families in Ukraine, following the continued attempts by Russia to take over their country.

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Here is peer-reviewed publication published 1st February 2025 that summarises our latest work in Ukraine. Please click here for the main paper, here for Supplement 1 and here for Supplement 2

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Abstract A descriptive analysis of a medical humanitarian aid initiative for quality perinatal management in war-torn Ukraine.

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Background Russian’s invasion of Ukraine has seriously disrupted perinatal care. In a humanitarian initiative, emergency obstetric and neonatal equipment and drugs were provided by Maternal and Childhealth Advocacy International and distributed by Ukrainian partners to a selected 61 maternity hospitals throughout Ukraine. The programme included engaging mothers in labour to undertake fetal heart rate monitoring using a battery operated, portable, doppler ultrasound probe. This paper describes some characteristics of participants and analyses differences in fetal distress management and maternal / neonatal outcomes following different approaches to fetal health surveillance.

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Methods Data from 28,808 births were collected in specially developed database which contained information on maternal characteristics, course of pregnancy and childbirth, maternal and neonatal outcomes and donated drugs and equipment used. After informed consent, mothers (n = 13735) who agreed to use in labour fetal self-monitoring in addition to standard intrapartum fetal health surveillance, monitored and recorded fetal heart rate changes on a “contraction-by-contraction” basis into a special form. Data on maternal experience with self-monitoring were collected. Cases where fetal heart rate changes were identified (n = 1434) were extracted and analysed for differences in case management and maternal and neonatal outcomes in different approaches: joint monitoring (mother plus staff, n = 901) vs. staff only monitoring (n = 533) and different actors in case of joint monitoring (mothers, n = 512, vs. staff, n = 389).

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Results Vacuum assisted delivery was utilised in only < 2% cases. Caesarean section rate was 27%. Mothers reported their experience with self-monitoring as great or good in 79%. Preterm deliveries were less frequent where fetal monitoring was provided by both staff and mothers jointly. In the staff plus mother group, more often lateral tilt, intravenous fluid, spontaneous vaginal and vacuum assisted delivery and less often caesarean sections were undertaken even when fetal distress alone was an indication for operative delivery at term pregnancy.

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Conclusion Involvement of women may help to make delivery safer for mothers as complications may be recognized earlier and appropriately treated. Overall, the data shows that despite the full-scale war in Ukraine, it remained possible for high quality perinatal health care to continue.​​​​​

Abuse of Women and Children in Armed Conflict and Domestically: More Effective Safeguarding Systems Urgently Needed to Prevent these Crimes and Ensure Protection

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Please click here to read a PDF of this report from MCAI published (end February 2024) in the Medical Archives of the European Society of Medicine.  The Abstract follows below.

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ABSTRACT

Emergency medicine health workers have major roles in managing the clinical effects of armed conflict and domestic abuse on women and children. To safeguard vulnerable people from such criminal abuse, there is an urgent need for international and domestic action.

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International and national legal systems need to work more rapidly and efficiently with immediate power to protect against, and prevent, such abuse.

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Internationally, the current weakness of the United Nations Security Council to provide civilian protection, such as through UN troops on the ground and no-fly zones over conflict areas, and thereby minimise the effects of armed conflict on civilians, can, and has, largely resulted from self-serving, dangerous vetoes of the 5 permanent members with major conflicts of interest, in part related to their role in the manufacturing and global distribution of weapons.

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The International Court of Justice and the International Criminal Court have little immediate power to protect civilians affected by war crimes, including abuse, which breach the Geneva and other International Conventions. To date, the number of war criminals convicted by the International Criminal Court is incredibly small, and the long delay in the Courts’ decisions mean that the consequences of the war crimes sometimes continue for years.

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We describe new systems to better protect women and children from abuse in the home. We propose a new definition that separates ill treatment from criminal abuse that is undertaken for gain by perpetrators (who are often carers or intimate partners with antisocial personality disorders). Ill treatment undertaken within families experiencing adversity such as homelessness, poverty, displacement, and addiction requires compassion and socio-economic support. In contrast the crimes of abuse committed for gain require stronger forensic approaches investigated and addressed by special, inter-agency, forensic taskforce units led by senior experienced detectives in partnership with social, healthcare, and legal professionals.

We also discuss additional issues linked to abuse, such as the links between animal/pet abuse and human abuse, the need for better systems to prevent and protect children living in institutions, better regulation of social media to protect children from scenes of violence and sexual abuse, and gun control needed to protect children, especially in the USA.