Some Women Have as Many as 20 : Health Effect of Abortions Alarms Soviet Authorities

Medical officials are increasingly concerned over the adverse effects of the estimated 10 million or more abortions performed in the Soviet Union every year.

It is not uncommon for a Soviet woman to have four or five abortions, and a few women have as many as 20 in state-run clinics.

The lack of safe and effective contraceptives, together with a strong desire by city dwellers to limit the size of their families, have combined to raise the Soviet abortion rate.

The government, conscious of the dwindling birthrate among ethnic Russians, has a policy of discouraging abortion, but it remains the primary method of birth control here. Abortions are legal in the first three months of pregnancy, but there is a rule prohibiting more than one every six months.

Clinics charge five rubles (about $6.50) for the procedure, which is available throughout the country although the demand is greatest in Moscow, Leningrad and other large cities. There are reports that doctors charge up to 50 rubles (about $65) for performing abortions privately, with anesthetic that is not available otherwise.

“The Russian woman, forced to work to support her family, sees childbirth as one of the few burdens she can still control,” said William A. Knaus, an American doctor who wrote a book entitled “Inside Russian Medicine.” Knaus estimated that Soviet doctors performed 16 million abortions in 1980, about 10 times as many as were performed in the United States.

The subject of abortion, taboo in the general press, has been raised in medical journals, especially by Soviet Public Health.

There are an average of 2.08 abortions for every child born in the Soviet Union, according to A.A. Popov, a Moscow specialist in medical demography. (In the United States, by comparison, there are about two live births for every abortion).

Another article, in the Medical Gazette last Sept. 27, reported that the number of births rose to 5.4 million in 1984--indicating that nearly 11 million abortions were performed that year, according to the Soviets’ own calculations.

Until recently, Popov said, there was no verified data on the role of abortion and contraception in preventing births.

Leads Contraception

Now, he added, it is clear that “abortion continues to lead contraception by a wide margin in the structure of birth control. . . . The advantage becomes even greater if one counts not only the abortions performed in medical institutions but also those done elsewhere, of which there are a good many, according to some data.”

At one clinic on a state farm in Kazakhstan, doctors said they become concerned about the health of a woman after she has had three or four abortions.

Obstetrical and gynecological hospitals may spend up to half of their budgeted funds either performing abortions or treating complications resulting from legal and illegal operations, Popov said.

“It is well known that the current abortion rate is a major factor in determining the incidence of gynecological diseases and childless marriages, infant mortality, miscarriages and child morbidity,” he added. “Lowering the abortion rate would have a colossal effect on public health.”

Each abortion requires an average 2.5 visits to a medical office, he said, and costs the state from 35 to 92.6 rubles ($45 to $120).

Rejects Restriction

Popov rejected the idea of restricting abortions, contending that Soviet history and the experience of other Communist countries in Europe show that this approach does not work.

The Soviet Union outlawed abortions from the time of the revolution in 1917 until 1920, then forbade them again from 1936 to 1955.

Popov said that a ban on abortions in Romania in 1966 led to a temporary doubling of the birthrate for one or two years, followed by a decline to prior levels by 1972. At the same time, he said, the number of deaths from illegal abortions skyrocketed by almost 400%.

He concluded that providing “up-to-date, highly effective contraceptives” is the only way to lower the abortion rate permanently. This was confirmed by results in Byelorussia, Tatar Autonomous Republic and Altaisky Territory in Siberia following widespread introduction of intrauterine devices (IUDs), he said.

In Moscow, one-third of the women polled in a special study said they prefer abortion to contraceptives, but this reflects disappointment with the availability and quality of contraceptive products, he said.

Pharmacies satisfy only 26% of the demand for contraceptives, he said. (Soviet citizens reported recently that contraceptives seemed to have disappeared from pharmacy shelves without explanation.)

Disillusionment Told

“For many women, abortion is a forced step taken either out of disillusionment with contraceptives or because of the objective impossibility of using highly effective methods of contraception,” Popov concluded.

Many, if not most, abortions are performed on married women, Soviet studies have indicated. For example, research done in the Magadan region in the Soviet Far East in 1970-71 showed that 78% of all pregnancies were aborted and 95% of the women having abortions were married.

In another study in Leningrad, 82% of the women seeking abortions were married. A 1978 survey in Moscow indicated that 10% of the women who were polled had had five or more abortions each.

A 1981 study of 4,000 women in Minsk indicated that multiple abortions were common, and about one of every six women had at least five abortions in her lifetime.

Writing in the Medical Gazette, A. Antonov said the birthrate has fallen below the replacement level in the Russian Republic, the Ukraine, Byelorussia and the Soviet republics of Estonia, Lithuania and Latvia.

Below Replacement Rate

“In the European part of the country, most people want to have just two children,” Antonov wrote. The average number of children born per woman fell from 2.39 in 1970 to 2.29 in 1983, he said, while the figure for urban women fell below 2.0.

Demographers calculate that 2.6 children must be born for each married couple to keep the population at its present level--about 270 million.

At the same time, the birthrate is increasing in Central Asia, where the heavily Muslim and largely rural population is known for large families and disdain for abortion.

Antonov urged special incentives to encourage families--presumably those in the European part of the Soviet Union--to have three or four children each. “This is a long and difficult business,” he said, “but there is hardly any other road to success.”