Вплив факторів навколишнього середовища, включно з COVID-19, на репродуктивне здоров’я жінок-біженок та внутрішньо переміщених жінок через війну в Україні

Objective of the study: to assess the impact of environmental factors, namely the war in Ukraine and the COVID-19 pandemic, on the reproductive health of refugee and internally displaced women, taking into account the roles of chronic stress and restricted access to healthcare.Materials and methods. The study included 100 Ukrainian women aged 18–49 who experienced displacement between 2022 and 2024 years. Study participants were stratified into two groups: Group 1 (n = 50) included women who were directly located in active combat zones (e.g., along the frontlines); Group 2 (n = 50) comprised those who were preemptively displaced or relocated from areas without active combat. Quantitative measures, including menstrual cycle disturbances, pregnancy complications, and contraceptive use, were obtained via structured questionnaires supplemented by mental health assessments (depression, anxiety, post-traumatic stress disorder). In-depth qualitative interviews explored barriers to healthcare access, levels of chronic stress, and the influence of the COVID-19 pandemic on daily life among refugee and internally displaced women.Results. Women who remained in active combat zones exhibited a higher prevalence of menstrual cycle disturbances (55% vs. 24%), pregnancy complications (18% vs. 8%), and unmet contraceptive needs (40% vs. 20%) compared to those relocated prior to hostilities. Mental health indicators were also significantly worse: depression (66% vs. 30%), anxiety (60% vs. 26%), and post-traumatic stress disorder symptoms (76% vs. 36%). Logistic regression analysis confirmed significant associations between chronic stress and adverse reproductive health outcomes (adjusted OR = 3.2) as well as poor mental health outcomes (adjusted OR = 4.5). Additionally, low COVID-19 vaccination coverage (30% vs. 50%) and limited access to healthcare services further exacerbated the vulnerability of these populations.Conclusions. The research demonstrated the profound impact of both the war in Ukraine and the COVID-19 pandemic on reproductive and mental health among refugee and internally displaced women. These findings underscore the urgent need to improve healthcare access, implement gender-sensitive humanitarian interventions, launch targeted vaccination programs, and provide comprehensive support to mitigate chronic stress and facilitate health restoration in vulnerable groups.