Reproductive health and rights in Russia

“When the chemistry works... Gender relations and birth control in the age of The Pill”

November 28-29, 2013 Friedrich Schiller University,

Jena, Germany

Victoria Sakevich (Institute of Demography, Higher School of Economics, vsakevich@hse.ru) Boris Denisov (Lab of population economics and demography, Department of Economics, Moscow University, denisov@demography.ru)

outline:

•  demographic look at reproductive health •  data availability •  historical and contemporary situations •  reproductive rights in a pronatalist state

metrics and components:

•  infant and child mortality •  maternal mortality •  abortion •  contraception

RLMS-HSE data from the 10th (2001) and 19th (2010) rounds median ages are: menarche (13), the 1st coitus (18-19), menopause (48-49)

demographic view: •  From menarche to menopause a healthy

woman is fertile •  From age 15 to 49 a woman may have

(13x35) 455 cycles, i.e., 12740 days (pills) •  In a modern society she makes 1-3 live

births, which make her infertile just for 1-4 years, remaining time she somehow avoids an unwanted conception

LB -- live births (not averted, but occured) births averted due to:

DM -- delayed marriage (or other sexual abstinence) BF -- postpartum lactational amenorrhea (breastfeeding) IA -- induced abortions and miscarriages CC -- contraception (might be detailed by method)

Bongaarts, John A Framework for Analyzing the Proximate Determinants of Fertility Population and Development Review, Vol. 4, No. 1 (Mar., 1978), pp. 105-132

births averted:

data sources:

live births vital statistics, censuses, sample surveys

marriage vital statistics, censuses, sample surveys

breastfeeding sample and special surveys

abortions vital statistics, sample and special surveys

contraception vital statistics, sample and special surveys

data quality:

live births good

marriage good

breastfeeding unknown

abortions under discussion

contraception bad or at least scarce

what is under discussion?

•  Medical community consider abortion statistics in Russia incomplete, and provide its own estimates = reported x2-x4-x?.

•  It also provides no evidence or a verifiable argument to support this position.

•  Why do they do it?

early history:

•  before 1917 -- abortion was illegal, natural contraception •  1920 -- the first decriminalization of abortion •  1936 -- abortion ban + item#2 from Bakovka •  1955 -- the second decriminalization of abortion

main rule: 12 weeks (at a woman will) (item#1 = gas mask)

medium history :

1974 – Ministry of Health letter on hormonal contraception (harmful effects)

contemporary history: •  1987 -- wider availability of options = up to 28 weeks under a range of

non-medical conditions, wide introduction of IUD

•  1993 -- Peak of abortion and contraception liberties •  1998 -- political U-turn

•  2003 -- severe restriction of social indications (13->4)

•  2011 -- new (not so liberal to abortion) health law •  2012 -- Putin decree (only rape for social abortions, 4->1)

abortions’ dynamics:

trends of abortions’ dynamics:

inputs and outputs:

are these data complete?

•  There is evidence that abortion statistics is good enough

•  for the opposite the evidence is anecdotal or not transparent

evidence from the RLMS and other surveys:

Contraceptive revolution?

contraceptive prevalence: 47.8 per cent (Moscow, 1966), 59.4 (Russia, 2010), and TAR: 2.6-3.5 per woman (Moscow, 1966), 5.7 (Russia, 1966), and 0.9 (Russia, 2010)

why do they do it?

We guess the rationale behind the position of Russian medical community is as follows: 1.  it believes that it rules the public health, 2.  it does nothing to reduce abortion level -- thus,

it does not believe in its reduction.

it is misleading

•  Political parties use either faked data, or faith based goodwill speculations

to support their bills to restrict abortions. •  Decision making became irrational

I was not a particularly welcome visitor It is a remark, made by Margaret Sanger, a pioneer of global birth control movement, sex educator, and women's rights activist after her meeting with the officials of the Soviet ministry of health in 1934. The meeting revealed totally and strictly opposing views of Sanger on one hand and Soviet government on the other. Sanger was a neo-Malthusianists and look at a population problem from a human rights' perspective, paying more attention to means a person has to avoid unwanted pregnancy, on the contrary for the Soviet government each pregnancy was in demand. Over the past eighty years, this person-state opposition in Russia remained mostly in the same place.

Reproductive and sexual rights are not welcome in contemporary Russia

Since the end of the 1990s, the Russian government switched to archaic ideology in the area of reproductive health and rights, it neglects evidence-based arguments. An opposition is weak.

Resume:

• There is a demographic instrument capable of testing data consistency • There are data from various sources • Together the above confirms dramatic true decline in abortions, and thus improvement of reproductive health • Despite this evidence medical community provides government and society with wrong ideas, which are partially responsible for the archaization of public health policy

Acknowledgments

This study (research grant No 12-01-0076) was supported by The National Research University – Higher School of Economics’ Academic Fund Program in 2013 - 2014

Vielen Dank für Ihre Aufmerksamkeit

Thank you for your attention