Choose Life, If You Can Afford It

In mid-January, Russia's health minister, Tatyana Golikova, said officials were trying to figure out how to reduce abortions there, citing 1.234 million abortions in 2008 compared with 1.714 million births. Her remarks came about a week before a UNICEF report showed that, although Russia's demographic decline seems to have slowed or stopped, the proportion of children in the population has steadily dropped, portending further crisis. This article originally appeared on 13 February 2001.

VLADIVOSTOK, Russia | The only Roman Catholic church in this Far Eastern seaport sits high on a hill at the end of a road half washed away by last summer's typhoons. But every month, 50 or 60 women trudge up to its Women's Support Center to take a free pregnancy test.

The church offers the tests as part of an anti-abortion program. But although Christina Pavlova counsels women here every day, few change their minds about abortion. Even when she spoke recently to a group of Catholic women about the church's position that life begins at conception, the reaction was hostile.

"It seemed they wanted to throw big stones at me," Pavlova said. "A lot of women have had such experiences [abortions] in life, and they can't accept that it's wrong."

While much has changed in Russia since the fall of the Soviet Union--raucous politics, a nascent independent press, fewer restrictions on believers--religious groups face an uphill battle in attempting to dissuade Russian women from using abortion as a form of contraception. In a land where the operation is free and the pill beyond the means of the average woman, abortion is so widely accepted that the issue sparks little of the sound and fury it generates in many other countries.

Russia has one of the world's highest abortion rates, with an annual figure of 57.3 abortions per 1,000 women of childbearing age, health officials say. That compares with figures of 14.5 in Japan and 26.4 in the United States, according to the most recent available data, said Rita Simon, a law professor at American University in Washington, D.C. and an expert in international women's issues. (In China, the abortion rate in recent decades has fluctuated between a low of 23.1 per 1,000 women in 1971 and a high of 61.5 in 1983).

"The big difference between Russia and the United States is that in the United States, most of the women who obtain abortions are unmarried," said Simon, who is the author of Abortion: Statutes, Policies, and Public Attitudes the World Over. "In Russia, most of them are married. There is great concern about families who simply feel they cannot afford to have another child."

Most families struggling to make ends meet also cannot afford the cost of contraceptives, said Tatyana Stankevich, chief gynecologist of the Far Eastern Primorye region, which is flanked by China, North Korea, and the Sea of Japan. Russia, and the Soviet Union before it, never put a high priority on women's health. Doctors denied painkillers to women in labor, and one gynecologist recalled a female colleague who used to slap women in the face if they screamed too much during delivery. Central planners saw no need to manufacture tampons, and the product was unavailable here until after the fall of communism. In such an environment, perhaps it is unsurprising that Russia still has no native contraceptive industry. And imports are expensive. In a place where even medical doctors at leading hospitals earn only $43 per month, contraceptives cost $10.80 per month. Even an intrauterine device will set a family back $14.28.

So it is not uncommon to meet women who have had five, six, even 10 abortions. Women who have repeated abortions risk infertility and other health problems, Stankevich said.

At the same time, many men--health officials included--are hostile to the idea of vasectomies, even in families that do not wish to have any more children. In a recent regional administration meeting on reproductive health, Vice Governor Alfred Gartman slept through most of the presentations, Stankevich said. But when the doctor recommended that health officials promote vasectomies, the vice governor snorted awake. "What is she talking about?" he raged, according to Stankevich. "You should stop even discussing it." 

FEW ALTERNATIVES

Despite the high numbers, abortions are falling as at least some women begin using contraceptives. In 1990, there were 199.6 abortions per 1,000 women of childbearing age--more than twice the current figure. Even so, the number of live births is falling rapidly in Russia, and the country's population is dropping. Twenty years ago, there were 48,000 births a year in the Primorye region--today the number has fallen to 17,000 per year.

Recently at City Maternity Hospital No. 3, which also performs abortions, most of the women terminating their pregnancies cited reasons familiar in more developed countries: They were single and young and did not think they could care for an infant. Marina is an 18-year-old student at a local college, and she and her boyfriend have been lovers for four years. Twenty-one weeks into her latest pregnancy, she had an abortion. A baby, she said, would be a hindrance to her studies.

"This one was a boy," she said. "I do feel sorry for him, and I think about him all the time, because we want to have a boy. My family would support me, but my parents don't even know that I'm here. The doctors tried to convince me to let him live, but I've made the decision."

Nadezhda, 18, from the village of Lesozavodsk, aborted a child at 28 weeks. She had wanted a baby, even though she was unmarried (in Russia there is no stigma attached to giving birth out of wedlock). But, she said, "I had an ultrasonic examination and the doctors told me that the baby was very deformed, so I had to have an immediate abortion. My family and my relatives were all ready to help me raise the child, but they sort of sighed with relief after that. It was not an immense tragedy for me. Since the doctors told me to do it, I did it."

Despite the high abortion rate, there are restrictions on the practice in Russia. Women must prove that they meet certain criteria, such as being unmarried or unemployed, or not having an apartment, said Lyudmila Tretinnik, deputy chief physician at Maternity Hospital No. 3. The hospital staff itself often tries to talk women out of having abortions. But doctors rarely make any headway.

"It is so seldom that we manage to convince a woman not to have an abortion, because usually those who end up here are very poor or not settled in life," Tretinnik said. "Sometimes they don't have enough money to support themselves, to say nothing of a baby."

Education on abortion and sexual health is also seriously lacking in Russia. Unlike in most Western countries, for example, there is no sex education in Russian schools. "We are ready to develop special programs for schools, but it is really difficult to squeeze into the school schedule," Stankevich said.

While health officials have been unable to provide reproductive education for schools, church groups have filled in the gap. The Women's Support Center teaches about the sanctity of life in schools, distributes postcards and posters, and produces a newsletter called "Accept Life." For those who say they can't afford to have another child, the Catholic Church can offer material assistance, Pavlova said.

Other religious groups--among them Baptists and Mormons--also proselytize against abortion. Spanish nuns and Korean pastors preach against the practice. And the Vladivostok Russian Orthodox bishop has opposed a more liberal Moscow patriarchy and has made statements opposing the termination of pregnancies.

Strikingly, in a place where abortion is so widely accepted, it is less politicized than elsewhere. Perhaps for that reason, doctors who perform abortions show a surprising openness to the anti-abortion message. Even Stankevich, the region's chief gynecologist, said an anti-abortion group convinced her not to perform abortions, though she believes in a woman's right to have one. "We watched this American movie about abortion, and indeed, you can see how the embryo resists death," she said. "I told myself: 'I will never perform another abortion in my entire life.' Two doctors immediately quit their jobs."

By contrast, in the United States--where abortion clinics must brave demonstrators, harassing phone calls, "wanted" posters targeting staff members and their families, and even occasional bombs and gunfire--doctors who perform the procedure are necessarily committed to a woman's right to an abortion.

Yet in Russia, if religious groups are seeing some small successes in reaching doctors, they have a long way to go before they change public opinion on abortion. Even Pavlova admits that.

Among the hundreds of women she encounters every year, Pavlova knows of only one she dissuaded from having an abortion: A 17-year-old girl in the northern port of Magadan read the Catholic Women's Support Center's newsletter and decided to go ahead and give birth to her child. "It's a long process," Pavlova said. "But I believe we will change people's minds."