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Analysis & Opinion
26.07.10 A Harmful Tradition
By Svetlana Kononova

Russian First Lady Svetlana Medvedeva’s Foundation of Social and Cultural Initiatives held a national “Week against Abortions” from July 8 to 15. The initiative brought together health workers, sociologists, psychologists and religious organizations to raise awareness about the dangers of abortion. But despite the efforts of such information campaigns, and even though contraception is widely available, Russia still has one of the highest abortion rates in the world. In 2009 alone, 1.16 million abortions were carried out - that’s 66.7 terminations per 100 births.

“In Russia, only eight to 15 percent of females of reproductive age use modern contraceptives, while 16 percent of women who are not planning to get pregnant do not use any contraception,” said Lidia Bardakova, the assistant representative of United Nations Population Fund (UNPFA) in Russia.

Large-scale research conducted by the Russian Ministry of Health and Social Development in cooperation with World Health Organization in 2008 to 2009 found that most Russians have a negative attitude to abortion from an ethical point of view, but consider it as a necessary measure of family planning.

Respondents said the main reasons for abortion were low living standards and economic problems, lack of knowledge about modern methods of family planning, limited access to contraceptives due to high costs and limited access to information sources (telephone helplines, free counseling etc).

“Russia still has high abortion rates for several reasons,” explained Doctor Lyubov Erofeeva, head of the Russian Association for Population and Development. “Firstly, Russians have a special mentality. They prefer to solve problems which already exist but do not make significant efforts to prevent trouble. Russia still has a so-called ‘culture of abortion’. Many women still believe it is easier to have an abortion once a year than to take care of contraception each month instead.”

This attitude might be explained by the history of abortions in Russia. The Soviet Union was the first country in the world to legalize abortions in 1920, but when Stalin came to power they were banned except in cases where there was a threat to the woman’s life. This led to a huge increase in back-street abortions and a connected rise in women’s deaths. In 1955 abortions were legalized again, and the Soviet Union soon had the highest abortion rates in the world.

“Abortion was the main method of family planning in Russia for many years because contraception was unavailable,” Erofeeva explained. “The situation improved in 1994 when the Federal Family Planning Program was approved, and family planning services with trained medical staff were established. But it takes a long time to persuade women to change their attitude toward abortion. Women should be well-informed and motivated to make a decision about using contraception.”

The second reason for Russia’s high abortion rates are myths about contraception, experts say. “Many women still have poor knowledge of modern contraception. They believe oral contraceptives could make them sterile in the future or change their appearance for the worse,” Erofeeva said, “Unfortunately, doctors who work in state health centers are often too busy to spend 20 minutes explaining to every woman how different contraceptives work and which contraceptive is the best choice for her. But even if medical staff do that, women often ignore their advice.”

Moreover, in some instances women avoid contraception for economic reasons. Unlike most European countries, in Russia contraception is not covered by mandatory state medical insurance. “In some regions women can earn no more than 8,000 to 10,000 rubles ($260 to 330) a month. How can they spend 600 rubles ($20) on contraception?” wrote a blogger, who goes by the nickname of ElenaM, in a discussion of abortions.

There is little research on abortions in Russia, but experts identify three main risk groups. Surprisingly, most abortions last year were had by married women aged from 20 to 32 who had already had a child.

The second group are young, single woman who avoid contraception deliberately. Russian search engines such as Yandex and Rambler return 400 to 500 links to the query “How to get pregnant by deceit.” Sometimes pregnancy is used as a way to stimulate marriage, but if the ploy fails – abortion is considered the only way out. Experts reckon some 20 percent of abortions are conducted in such circumstances.

The third group are teenagers aged between 16 and 17 who often do not understand they are pregnant until relatively late. They account for 10 percent of abortions. Lastly, there is a relatively small number of women who have abortions for medical reasons.

“Social status and level of education play an important role in the prevention of abortions. Well-educated and high-earning women are the most protected. They have enough knowledge of their reproductive health and they can afford to pay for private medical services. In contrast, low-income women are in a risk group,” Erofeeva said.
“One of the most vulnerable groups is teenagers,” Bardakova added, “According to recent data, 24 percent of girls and 44 percent of boys aged 15 in Russia are sexually active. These rates are similar to Western European countries. But while in the Netherlands – the country with the lowest rate of teenage abortions - 61 percent of sexually active teenagers use contraception, only 9 percent of their Russian peers practice safe sex.”

There is a growing sense among experts that state policy on abortion needs to change. “Reproductive health is the basis of demographic development for any country. Only a comprehensive approach to the problem and clear state strategy can improve the demographic situation in Russia. A strategy for reproductive health is an investment in the future of the country. Without it the demographic crisis cannot be solved,” Bardakova argued. The State Duma’s Public Health Committee is currently working on a draft law concerning “Protection of reproductive health,” but the date of its approval has not yet announced.

“While in Western Europe clinics perform non-surgical abortions and use pharmaceutical products to stop pregnancy (so called “medical abortion”), most Russian state health centers continue to conduct surgical abortions which lead to multiple health complications and put extra pressure on the public health services as well as on women’s finances. Non-surgical abortions are usually only available at private clinics. The only region in Russia where pharmaceutical abortions are available in the state health centers is the Kemerovo Oblast,” Erofeeva said.
“The treatment of post-abortion complications costs a lot. It would be better to spend this money on preventing unwanted pregnancies, including programs of sex education for teenagers,” she said.
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