Operation Birth Rate: Limiting access to abortion in Russia is not a demographic solution but another problem

RU

History of abortion in the Soviet Union and Russia: criminal, legal, criminal again

Even in its today's state, Russia’s abortion legislation remains one of the most liberal in the world. According to Article 56 of the Federal Law “On the Fundamentals of Health Protection of Citizens in the Russian Federation,” “every woman decides independently on the issue of maternity” and has access to abortion at will for pregnancies up to 12 weeks gestation. Russia’s liberal abortion regulations mostly stem from Soviet legislation and late-Soviet practices.

In the 1920s, the young Soviet state became the first nation in the world to legalize abortion – only to criminalize it again in 1936 for almost 20 years, until its eventual legalization in 1955. The absence of sex education and the lack of quality and affordable contraception made abortion the main means of birth control for Soviet women. And they used it extensively: the USSR ranked first in the world by abortion rate, with an average of three or four abortions per woman.

As for post-Soviet Russia, researchers are convinced that its birth control policy has been inconsistent. In the 1990s, the state implemented the Family Planning program, aimed at “having only desirable and healthy children,” among other things. However, as early as the late 1990s, lawmakers shut down the program because they saw affordable contraception as a threat to depopulation. Under the new anti-abortion policy, the list of social indications for abortion shrank from 12 to four items in 2003. But the national policy did not take a U-turn until 2006, when Vladimir Putin highlighted the demographic problem.

The year 2007 saw the creation of “medical and social assistance offices” at maternity welfare clinics, with the mission of compelling women who come to the clinics for an abortion to carry the pregnancy to term. The list of medical indications for abortion was also reduced. Considering the bill “On the Fundamentals of Public Health Protection in the Russian Federation” in 2011, deputies proposed several restrictions, including the infamous initiatives to remove abortion from public healthcare services and ban the procedure in private clinics

The eventual compromise between the Ministry of Healthcare and abortion opponents was the introduction of the so-called “week of silence” – a compulsory pause between seeking an abortion and the procedure itself – and mandatory “counseling” with the true purpose of getting the woman to reconsider her choice.

Most recently, public calls to tighten birth control have been voiced by Russian Orthodox Church clerics and State Duma deputies, who urged to withdraw abortion from the list of public healthcare services but perform the procedure exclusively in public institutions. However, against the backdrop of a population decline and Russia's war in Ukraine, the number of anti-abortion initiatives has surged this year, causing concern among activists and healthcare professionals.

Anti-abortion policy radicalization

The summer and fall of 2023 saw several crucial developments: several regions restricted abortion in private clinics, the Republic of Mordovia and Tver Region banned “encouraging” abortion, and the federal government tightened control over drugs used for medical termination of pregnancy. However, many fear that the listed measures are only the first steps towards a new, more radical course aimed at forcing women to have more babies.

In early November, Crimea’s private clinics unanimously stopped providing abortion. Meanwhile, their colleagues in Kursk Region refused to administer abortion pills. Earlier, some of the private healthcare providers in Mordovia, Tatarstan, and Chelyabinsk Region also announced they were no longer offering pregnancy termination services. Kaliningrad Region plans to follow suit. Most likely, the initiative to ban abortions in private clinics is being lobbied by the Russian Orthodox Church.

Thus, Patriarch Kirill advocated the need to withdraw abortion from public healthcare services while banning the procedure in private clinics in May 2022 and January 2023. Last August, Rev. Fr. Fyodor Lukyanov, chair of the Patriarch’s Commission on Family and the Protection of Motherhood and Childhood, cited these two measures as “prerequisites for a turning point in the demographic situation.”

Currently, the Russian Orthodox Church officially views abortion as “the arbitrary taking of a human life tantamount to murder.” The ROC treats the fetus as a human being who has the right to human identity, life, and development, and has been demanding for years that these rights be enshrined in law. There is reason to believe that today the ROC is closer than ever to reforming abortion law.

Thus, the State Duma Committee on Health Protection held a round table in late October to discuss the ROC's proposals for legislative changes in pregnancy termination, including a reduction in the time limit for abortion at will from 12 to 8 weeks (from 22 to 12 weeks for rape survivors) and providing the right to decide on abortion to the parent or guardian of a pregnant minor or the spouse of an adult patient. It was also suggested that abortion should only be performed after an ultrasound scan during which the pregnant woman should hear the fetal heartbeat. After analyzing the panelists' comments, the Committee will propose changes to Article 56 of the Law on the Fundamentals of Health Protection in late November.

In August, Mordovian deputies passed a law “On Prohibition of Inducement to Artificial Termination of Pregnancy.” The law suggests fining doctors who coerce a patient into having an abortion “through persuasion, offers, bribery, deception” or “making other demands.” It's not considered inducement, however, if “a doctor informs a pregnant woman ... that there are medical indications for an artificial termination of pregnancy.”

In November, Tver Region adopted a similar law, also excluding the provision of information on medical and social indications from the definition of inducement to abortion. Patriarch Kirill has already supported the extension of these laws to the federal level.

As a study by Feminist Anti-War Resistance suggests, this and other anti-abortion initiatives are being promoted by the Women for Life Charitable Foundation, led by Natalia Moskvitina. The Foundation has been supporting Russia's population programs since 2016, obtaining the status of national project partner in 2021. As Moskvitina claims, the law furthers the interests of pregnant women and aims to protect them from threats and coercion. However, the sponsors of the law directly link it to Russia's demographic challenges.

Thus, Ivan Kapitonov, Chair of the Civic Chamber of the Republic of Mordovia, justified the need to adopt the law by “The demographic problem remaining one of the nation’s biggest challenges in the 21st century.” Meanwhile, Moskvitina points out the global nature of the population issue and the danger of indigenous populations being replaced through “massive migration” worldwide.

In addition, the Ministry of Healthcare added two medical abortion drugs, misoprostol and mifepristone, to the national list of controlled substances in September 2023. The order will take effect on September 1, 2024. Tatyana Butskaya, First Deputy Chair of the Committee on Family, Women's and Children's Affairs, explains tighter control by the need to trace “which pharmacy sold [the drug], which clinic administered [it],” and “whether all of the rules for supporting a woman in a situation of reproductive choice, including a week of silence and consultation with a psychologist, lawyer, and social worker, have been observed.”

The innovation also affects several emergency contraceptive pills (ECPs) that contain low-dose mifepristone. Whereas ECPs are considered to be prescription drugs, pharmacies often sell them without a prescription. Ahead of the possible innovation, a group of women's rights activists focusing on reproductive rights created the Emergency Contraception Storage Fund in July, engaging a network of female participants across the country. However, the Ministry of Healthcare assures that the placement of the two drugs on the list of controlled substances will not impact the availability of ECPs.

Reverting the population decline

“For Russia to be sovereign and strong, there must be more of us,” Vladimir Putin said in his annual address to the Federal Assembly in 2012. Russia's population has been declining since 2018 – primarily due to the low birth rate. The latter, in turn, was caused by the preceding demographic slump of the 1990s: this generation has now reached reproductive age, and it’s reflected in the number of births.

Another likely reason is Russia's second demographic transition which has been ongoing for over two decades and is characterized by a more responsible approach to the implications of sexual relations, better planning of parenthood, later marriages, and an increase in the average age of mothers.

Experts don't believe it will be possible to make an accurate conclusion about the true level of today’s fertility until today's childbearing age group reaches 40-50 years. In addition, experts note the possible role that maternity capital – a system of monetary incentives to young parents in Russia – has played in this process. The financial stimulation of childbearing triggered a shift in parenthood that led to an initial increase in births and an expected subsequent decline.

The Russian authorities seek to address the depopulation issue with a combination of consistent financial stimulation of childbearing and further restrictions on access to abortion. Paradoxically, even before access to induced termination of pregnancy in Russia became limited, the abortion rate had already been on a steady decline over the past three decades.

Studies show that Russia’s abortion rate showed a downward trend as early as the late 1980s, which accelerated in the mid-1990s and has never been reverted since. In 2015, the number of abortions per 100 births was less than one-fifth of that in 1993.

In 2021, the deputy minister of healthcare announced a one-third decrease in the abortion rate since 2016. From 2021 to 2022, the abortion rate slumped by 3.9%, with a 5.3% dip in the number of medical abortions at will. Russia has not topped the ranking of per capita abortion leaders for a while and even ranks below Sweden and the United States, according to demographer Alexei Raksha. Importantly, Russian statistics include not only induced abortions but also spontaneous abortions (miscarriages), thus overstating Russia's figures relative to other countries.

These changes have been made possible by the ongoing birth control revolution in post-Soviet Russia. Russian women are taking parenthood planning more and more seriously, increasingly relying on modern contraception.

The crucial consideration voiced by experts but ignored by the authorities is that restricting access to abortion to drive the birth rate is both ineffective and dangerous. The WHO agrees:

“Evidence shows that restricting access to abortions does not reduce the number of abortions; however, it does affect whether the abortions that women and girls attain are safe and dignified.

The proportion of unsafe abortions is significantly higher in countries with highly restrictive abortion laws than in countries with less restrictive laws.”

Victoria Sakevich, a senior researcher at Vishnevsky Institute of Demography and associate professor at the Department of Demography, Higher School of Economics, cites historical examples of countries that banned abortion: Nazi Germany, socialist Romania, Stalin's USSR, and modern Poland. The measure did not have positive demographic effects anywhere: “On the contrary, maternal mortality and even infanticide were on the rise.”

Adverse effects of prohibitive measures

Extant statistics indicate a significant decrease in the abortion rate in the first two years after its criminalization in the USSR in 1936, but the figures soon rebounded. As for the birth rate, the ban has only resulted in a short-lived spike: the criminalization of abortion came as a shock, but women adapted to the new context over time, and the average fertility rate did not change dramatically. Meanwhile, criminal abortion and self-abortion became business as usual, and the number of sepsis-related deaths among women quadrupled.

The futility and danger of restrictive policies are also highlighted by the contemporary example of Poland, which introduced a near-total ban on abortions in January 2021. Statistics suggest the ban has had no positive impact on the country's birth rate, which in recent years has been among the lowest in Europe. In addition, at least three women died due to a lack of medical care within two years of the ban. The primary cause of death was septic shock because doctors refused to perform an abortion while the fetus had a pulse.

Experts agree that if Russia were to severely restrict access to abortion in the modern context, one should not expect even a short surge in the birth rate. Rather, we should expect to see a surge in clandestine abortions and the illegal sale of medical abortion pills, with all ensuing risks to women's health and lives.

Any restrictive measures can only hurt women's reproductive health. Thus, private clinics refusing to provide abortions directly contributes to an increase in less safe procedures. Not only will there be fewer abortion options (private healthcare facilities now account for 15-20% of abortions in general and 30% if miscarriages are excluded), but there will also be fewer abortion methods available.

Victoria Sakevich notes that most private clinics offer medical abortion, which is considered to be the safest method. Meanwhile, around 50% of the abortions performed at public healthcare institutions were surgical until recently, despite curettage being considered less safe and recognized as outdated. As for medical abortions, they are rarely offered in public clinics due to their high cost.

Stricter regulation of medical abortion and emergency contraception drugs also exacerbates risks to women's health and lives, especially for the most vulnerable groups and women living in sparsely populated areas. Thus, lawyer Mari Davtyan, the head of the Center for the Protection of Victims of Domestic Violence, points out that the measure harms women living in rural areas.

Selling controlled substances suggests that the pharmacy has to obtain a license and follow a rigorous reporting procedure for each transaction involving such drugs. “It will become financially pointless for small pharmacies to store and offer such pills. Meanwhile, medical abortion, which is the safest method won't be available to small communities,” explains Davtyan.

Irina Fainman, the founder of the Emergency Contraception Storage Fund, also mentions the complicated access to emergency contraception for the most vulnerable:

“The problem is that emergency contraception only works if administered within 72 hours, 96 hours tops, depending on the drug, and its effectiveness is a downward slide. However, women now have to see the doctor for a prescription. Mind you, the need often arises after cases of sexual violence, in women who are in abusive relationships or belong to the most socially vulnerable groups such as migrants or refugees. Therefore, they don't always have the opportunity to see the doctor or get a prescription. It hurts precisely those who have survived some kind of violence, who have no money and find it difficult to seek medical advice.”

As for the Mordovian law “On Prohibition of Inducement to Artificial Termination of Pregnancy,” its definition of “inducement” does not exclude informing about rape as a social indication for abortion. That is, supporting a sexual violence survivor who has decided to have an abortion could potentially lead to administrative liability. As a result, the law may complicate access to information for pregnant women. Furthermore, the language of the law stigmatizes the choice to refrain from childbearing, attesting to the pro-life views of its sponsors:

“The Republic of Mordovia strives to create an information environment safe for families, fatherhood, motherhood, and childhood, prevents the spread of destructive ideologies, the planting of a system of ideas and values alien to the Russian people and destructive to Russian society, including the cultivation of selfishness, permissiveness, immorality, denial of the natural continuation of life, and the value of having many children.”

If greenlit, the initiatives voiced at the round table of the Duma Health Committee in late October hold only tragic ramifications for Russian women's health and lives. Reducing the time limit for abortions will further complicate access to the procedure, once again harming the most vulnerable. Those who fail to detect a pregnancy and seek medical attention in due time, making an allowance for the mandatory “week of silence,” are more likely to have a clandestine abortion or self-abortion, with all the resulting health and life risks. The suggestion of exposing the woman to the sound of the fetal heartbeat can be a real torture for those who already made the hard choice to have an abortion. Finally, mandatory consent from the spouse means depriving women of reproductive choice.

This measure would make a pregnant woman dependent on another person for her (and only her) health and life. It’s worth considering that pregnancy can occur as a result of sexualized marital violence, and since Russia still has no domestic abuse legislation, consent for the abortion would need to be obtained from the abuser himself.

As studies suggest, better access to family planning enables women to pursue education, build careers, and create stronger families, which has a positive impact on society as a whole. By contrast, if access to abortion is restricted, the time, effort, and money women spend seeking an alternative pregnancy termination option will primarily harm their families and the children they already have.

The situation looks particularly grim for low-income families. Last but not least, the complications and health problems women may face as a result of a later or less safe abortion create an additional burden on the healthcare system.

Besides, uninhibited access to abortion may contribute to lower crime rates in society. For example, a U.S. study exposed a correlation between the gradual legalization of abortion in the early 1970s and a drop in crime rates some 18 years later. In the 1990s, the lowest crime rates were found in states with the highest abortion rates in the 1970s and 1980s.

By contrast, restrictions may exacerbate social tensions. According to demographer Anatoly Vishnevsky, founder and first director of the Institute of Demography at the Higher School of Economics, criminalizing abortions turns women who terminate their pregnancies and those who help them into cirminals and leads to an increase in infanticide. A radical restriction of access to abortion will only exacerbate the already repressive atmosphere in society and will in no way contribute to its development.