At many gynecology departments, where stocks of medicines have dwindled, women have the choice of paying a hard-currency or ruble "tip" to nurses or porters to provide anesthetics. The alternative is to go without any use of pain killers before their abortions.
"In some clinics you can't get anesthetics unless you buy it privately in the clinic", said Professor Giorgy Khodorovsky, chairman of the country's parliamentary committee on health care. "It is obviously a traumatic experience".
Anesthetics have joined the lack of medicines whose black-market prices rise in tandem with the fall in official supplies. As well as pain killers, children's medicines have become a highly valued commodity since the Chernobyl disaster.
"The situation is profitable for those who want to supply drugs", said Khodorovsky. "As you say in English, it can be arranged".
Abortion is still very much the leading, and occasionally fatal, form of contraception throughout the former Soviet Union. In Russia, where 4 million abortions are performed annually, 400 women die every year and another 800, 000 received "serious omplications" after the operation.
The mortality rate is caused, according to Olga Baran, senior gynecologist at Kiev's specialized abortion clinic, by rural doctor's lack of training.
Baran's clinic performs 60 abortions a day, four at a time in rooms screened from the main hall by glass tiles. Provided the fetus is under 12 weeks old, a women need only bring her passport and receive tests for AIDS and other sexual diseases to have the abortion.
Although the conditions are uncomfortable, anesthetic, at least here, is given as standard.
As a method of contraception, abortion's popularity with doctors is waning due to rising prices. After the series of price hikes this year, the Ukrainian state will spend upwards of 600 million rubles paying for state abortions.
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