There are no medicines, but you give birth
In Russia, there is a widespread shortage of anti-Rh immunoglobulin. This is a drug that allows women with a negative Rh factor to give birth to a healthy child.
Ivanovo - Tbilisi - Rostov
Nadezhda (name changed) from the Rostov region is Rh negative, and her husband is Rh positive. Therefore, when she became pregnant, she had regular blood tests for antibodies. No antibodies appeared, but at 28 weeks of pregnancy, it was discovered that her baby was Rh positive.
At the antenatal clinic, Nadezhda received a free dose of Italian-made anti-Rh immunoglobulin. They also warned her that to avoid problems in future pregnancies, she needed to get another dose after giving birth. They explained that this was also free and routine, but she just needed to be monitored, as Rh incompatibility develops specifically during second and subsequent pregnancies.
Nadezhda was already expecting to give birth any day when news broke that Russia was experiencing a shortage of anti-Rhesus immunoglobulin. The Rostov Region wasn't on the list of "shortage" regions, but when she asked her doctor if the maternity hospital had any, he said, "First there were supply interruptions, and now there's none at all." Therefore, if possible, she needed to get it from somewhere.
A woman on the eve of giving birth is expected to laze around and think about pleasant things. Instead, Nadezhda, in a panic, began searching for the medication. It quickly became clear that neither her doctor husband's medical connections nor her pharmacy connections would help: there was no supply. An online search through pharmacy references revealed that immunoglobulin was unavailable in St. Petersburg, Krasnodar, Voronezh—or any other city where she had contacts who could urgently purchase and send the medication. It was also unavailable in any online pharmacies.
In Moscow, a single ampoule of Italian manufacture was found, priced at 33 rubles (before the immunoglobulin disappeared from sale, it cost around 6).
"We were willing to pay that amount, but we couldn't ship it to the Rostov region for several days—we were afraid we wouldn't make it in time," says Nadezhda. "And someone might simply not have the money—what then?"
With no time left, the search became international, involving friends living abroad. Fortunately, the immunoglobulin was eventually found in a Tbilisi pharmacy. A total of four people were involved in transporting it, passing the coveted ampoule back and forth and ultimately delivering it to Rostov.
The drug cost 6,800 rubles in Russian currency. Do you know who manufactured it? The Ivanovo Regional Blood Transfusion Station. This immunoglobulin has an interesting history.
"All I hear from everyone is, 'Have children! Have more children!'" Nadezhda complains. "But how can you give birth if you don't have the necessary medication?"
Let us remember that anti-Rhesus immunoglobulin is necessary for those women who, despite the risk of Rhesus conflict, decide to have a second, third, or fourth child.
The negative Rh factor is quite common: 15% of people have it.
The Ministry of Health is concerned
NotMoscow Wrote There are concerns about the problems with anti-Rhesus immunoglobulin in Russia. In late October and early November, social media posts in the Penza region began appearing from women seeking injections of "Human Anti-Rhesus Rho[D] Immunoglobulin"—the full official name of this medication.
“I would like to contact the Ministry of Health of the Penza Region
Why is anti-Rh immunoglobulin unavailable in city antenatal clinics, maternity hospitals, hospitals, and pharmacies? This medication is considered vital and is prescribed to all Rh-negative pregnant women from the 28th week. However, due to the unavailability of the drug, pregnant women are not receiving it, putting the life and health of their unborn child at risk. How can we expect an increase in the birth rate when this vital medication is unavailable in the region for six months?
Such a record left On October 31, user Lina Bakanova posted a message on the VKontakte page of Penza Governor Oleg Melnichenko.
"Unfortunately, Rh immunization cannot be performed today due to the temporary unavailability of this drug and its analogues both in state-run medical institutions in the Penza Region and throughout Russia. <…> Unfortunately, in 2024, a shortage of anti-Rhesus immunoglobulin production arose due to increased demand," the Penza Region Ministry of Health responded to Lina, assuring her that it fully shared her concerns.
The agency didn't explain why this sudden increase in demand arose. Are more Rh-negative women being born in the Penza region? Or have Rh-positive women in Penza suddenly started injecting themselves with immunoglobulin out of sheer spite?
Four anti-Rhesus immunoglobulin preparations are used in Russia, three of which are produced abroad, accounting for 95,7% of the Russian market. A Russian preparation from the Ivanovo Regional Blood Transfusion Station accounts for 4,3%. Source: Kommersant
A week later, after publications in Kommersant, the problem has become a national concern. News reports have surfaced of drug shortages in "some other regions," including St. Petersburg, the Yaroslavl Region, Krasnoyarsk Krai, and annexed Crimea.
And the Penza Ministry of Health, which a week ago reported a "temporary absence" of anti-Rhesus immunoglobulin "both in state medical institutions of the Penza region and throughout Russia," has suddenly backtracked.
"Penza Oblast Denies Reports of Shortage of Drug for Pregnant Women" — a news article with this headline appeared TASS reported the same day as Kommersant's publication. "Currently, the region's immunoglobulin supply is sufficient for a month's supply; the drug is being purchased through direct contracts," the agency quotes the regional Ministry of Health as saying, after suddenly ceasing to worry.
According to the Penza Ministry of Health, "women requiring immunoglobulin are under special monitoring by the administration of medical institutions to ensure timely and targeted assistance." To verify this, NeMoskva tried to contact Lina Bakanova, but she did not respond to our message.
Suppliers reported a reduction in imports of anti-Rhesus immunoglobulin for pregnant women as early as early August 2024. Thus, in the first half of 2024, deliveries of the drug to Russia decreased by more than 70% compared to the same period in 2023. calculated According to experts from the analytical company RNC Pharma, one reason is global—the shortage of blood plasma, from which immunoglobulin is produced. The second is specifically Russian: the drug is on the list of essential drugs (VED), so its price is fixed and suppliers are unable to raise tariffs. Therefore, with increased production costs, they are not interested in supplying Russia.
Antibodies attack
What is Rh incompatibility? And how does it pose a threat to a woman and her unborn child? NeMoskva asked doctors of various specialties about this.
Transfusion specialist of the highest category:
— As a rule, nothing serious happens to the patient with Rh incompatibility. But for the child, especially the second and subsequent children, there can be serious problems. The fact is that Rh-positive blood is dominant. Therefore, if the mother has Rh-negative blood and the father has Rh-positive blood, the child will usually have Rh-positive blood, which causes the mother to develop anti-Rh antibodies. Immunoglobulin is administered precisely to remove the anti-Rh antibodies developed during the first pregnancy. If immunoglobulin is not administered, the anti-Rh antibodies remain. And as soon as the child's blood is formed, these anti-Rh antibodies will attack the child's Rh-positive red blood cells. If immunoglobulin is administered, the mother will no longer have anti-Rh antibodies.
Typically, the first child is born healthy. However, during pregnancies with a second or third child, the administration of anti-Rh antibodies is necessary to neutralize existing anti-Rh antibodies. Even if a woman has not given birth but has had an abortion, she may still have anti-Rh antibodies. What happens to the baby when these antibodies attack? Red blood cells are destroyed, bilirubin levels rise, and jaundice begins already in the womb. Brain damage is possible. In these cases, plasmapheresis or other extracorporeal blood purification methods are used, but they are not always effective. Therefore, if an Rh-negative woman was pregnant with an Rh-positive child, anti-Rh immunoglobulin must be administered to neutralize existing antibodies.
Obstetrician-gynecologist:
If the baby has a positive Rh factor from the father, the mother's Rh-negative body perceives the pregnancy as a foreign phenomenon. Antibodies begin to appear early in pregnancy, so when a woman with a negative Rh factor registers with us, we monitor these Rh antibodies monthly. If they are not detected, this means everything is normal with the pregnancy. There are two possible outcomes: either the baby also has a negative blood type, like the mother, or the body has accepted the pregnancy and everything is proceeding normally. To protect the existing pregnancy, anti-Rh immunoglobulin is administered between the 28th and 32nd weeks. And to prevent Rh incompatibility in future pregnancies, it is administered within 72 hours after birth.
The story we began this article with had a happy ending: Nadezhda gave birth to a healthy daughter. She received an injection of anti-Rh immunoglobulin on time, so if she has any more children, they won't be at risk of Rh incompatibility.
We don't know how many children will be born with the disease in the coming months due to a lack of anti-Rh immunoglobulin. We don't know how many women will abandon their second or third pregnancies for the same reason.
