Russia Tackles Its High Abortion Rate

Tatiana was four months pregnant when she realized that she was expecting again. But with two children, a husband and two parents already living in the family’s cramped apartment, the 35-year-old felt she had no choice: She decided to have her fourth abortion.

The procedure was “a nightmare,” she said. The doctor didn’t realize she was pregnant with twins. Tatiana spent a week in bed with a fever before the second, dead fetus was suddenly expelled. “It was like a horror movie,” she said. “I was screaming at the top of my lungs.”

An emergency room doctor stopped the bleeding. Later, he had a terse message for her: “You cannot afford to have another abortion.”

For the first time, Tatiana, now 42, may not have a choice. In an attempt to curb what is probably the world’s highest abortion rate in a country facing a drastically shrinking population, the Russian government has issued new regulations that sharply limit women’s options for terminating pregnancies past 12 weeks.

Reversing decades of public health policy under which Russian women had free, easy access to abortions more than five months into their pregnancies, the Council of Ministers last month eliminated two-thirds of the “social” conditions under which a woman can terminate an advanced pregnancy.

No longer can she elect to abort between 12 and 22 weeks simply because she is not married; because she doesn’t have a big enough apartment; because she already has three or more children; or because she or her husband is unemployed, of low income or divorcing.

Under the new restrictions, abortions at these midterm stages can be performed only if the woman was raped or imprisoned, if her husband dies or becomes disabled during pregnancy, or if a court determines she is not fit to be a parent.

Abortions before 12 weeks -- the majority of the roughly 2 million procedures performed in Russia last year -- remain freely available and, as before, pregnancies advanced beyond 22 weeks can be terminated only for medical reasons.

Last week, parliament considered proposals for an even wider rollback that would require psychological counseling and limit abortions past 12 weeks to cases of rape and unfit parents, including conditions of alcoholism and child abuse. That is considerably stricter than in the United States, where in most cases second-trimester abortions are restricted only by laws intended to protect the mother’s health.

There does not appear to be majority legislative support in Russia for those tighter restrictions, or for a bill under consideration that would declare that fetuses of viable age -- roughly 20 weeks -- would have full rights to life and medical care. The proposal would, in effect, ban all late-term abortions and require women to nurture unwanted fetuses.

But Alexander V. Chuev, a religious conservative legislator who has led the antiabortion move in parliament, said the number of supporters has grown each time the abortion rollbacks have been discussed. “This is only the first step,” he said this week.

At play is the increasing discomfort with the number of abortions performed in Russia. Even with about half the population of the United States, the country saw nearly twice as many abortions last year. And official statistics count only the number of procedures formed in state health clinics. It is possible, some doctors say, that as many as 4 million abortions are performed each year, compared with about 1.3 million in the U.S.

The number is jarring at a time when Russia faces a near-crisis of demographics. With death rates rising and low birthrates continuing, some experts predict that in 50 years the country’s population, now 145 million, could shrink by a third. Currently, there are almost twice as many abortions as births.

“The question is pretty simple. We are just diminishing. According to state statistics, in the first six months of this year, the Russian population decreased by 450,000 people,” Chuev said. “This is explained not only by the fact that half of first marriages and 70% of second marriages end in divorce. It is also explained by the tremendous number of abortions.”

Many public health officials are skeptical that the tightened restrictions will have much statistical effect. More than 93% of abortions are performed before the 12th week and will be unaffected by the changes.

Only 2.4% fall under the category of “social” reasons subject to the new restrictions, said Vladimir N. Serov, deputy director of Moscow’s Scientific Center for Obstetrics, Gynecology and Perinatology.

“Many of these ‘social’ reasons can be covered by medical reasons,” he said. “For instance, a girl of 13 gets pregnant. She will have an abortion for medical reasons. A woman who gets pregnant close to menopause, she is in a state of acute stress. We need to help her.”

Serov and other doctors have complained that the lack of government funding for contraceptive programs probably accounts for Russia’s high abortion rate.

Birth control pills are expensive, and parliament a few years ago eliminated funding for a nationwide network of family planning centers.

“Why should doctors be left to resolve the issue of the deplorable state of women in our country?” Serov said. “We need to work in two directions: first, to decrease the number of abortions, and also to improve the quality of health. We need to be going into the schools to explain contraception to children, because their parents are not prepared to deal with it.”

Russia had the most liberal abortion laws in the world in the years after the 1917 Bolshevik Revolution, but the practice was nearly banned in 1936 when Josef Stalin decided that the country needed more Russians in the military and in factories.

The ban was lifted after Stalin’s death in 1953, and the wide-ranging list of “social” justifications for midterm abortions was adopted. After that, the number of abortions skyrocketed.

By 1990, the abortion rate among women of reproductive age was 110 per 1,000 (compared with slightly less than 30 in the U.S.). A public education effort through the early 1990s reduced the number of abortions by 30% but still left Russia officially tied with Romania for the highest rate in the world.

In a country where it is not uncommon to find women who have had a dozen or more abortions, there has been surprisingly little public debate on the new regulations.

Many women say they would be happy to help the state produce more children if economic conditions made it easier to raise families. They ask how large families living in two-room apartments can find space for new children, and how families can afford as much as 500 rubles a month for oral contraception (about $16) when 45 million families have monthly incomes of 3,000 rubles or less (about $100).

“The problem of abortion should be addressed by educating families on what are the consequences of abortion,” said Yekatarina Vasilyeva, 26, who had two abortions as a teenager. “When I was younger, I felt ashamed to tell my mom I was having a sex life. I had no knowledge whatsoever about how condoms worked or what birth control pills were all about. I felt embarrassed even to ask these questions.”

Olga Alyokhina, 36, is married and pregnant with a child she wants very much, but she’s facing potential difficulties because of the two abortions she underwent when she was younger. At the time, she said, she didn’t think she had a choice.

“My financial status was shaky. I had just gotten a job and I had no way to be dealing with a baby. There was just no way. I thought that an abortion was a way out,” she said. “In the condition I’m in now, I feel really horrified to remember all those moments. I don’t understand how I had the guts and stupidity to do those things.

“But I do believe social conditions have changed drastically. It’s not only me. You go out on the street now and you see pregnant women all over the place. Living conditions are going up. One of my friends has decided to have a second child, even though she and her husband are over 30 now. I guess people have more confidence.”