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From Russia Without Love

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Recent legislation chipping away at reproductive options in Russia has uncomfortable similarities to struggles in legislatures around the United States. Russian women have been able to rely on legal abortion for decades. But in July, President Dmitri Medvedev signed into law measures that require advertisements for abortion to focus on alleged health risks. In mid-October a set of restrictions on reproductive choice -- a measure to cap abortions at 12 weeks and impose waiting periods, ultrasounds and counseling on those seeking abortion -- cleared two of the three legislative hurdles required before becoming law.

These steps are being advanced as panacea to Russia's dropping population figures, which some say are a result of the country's abortion rate, which at 73 per 100 births in 2009 is the highest in the world. However, the reality is that their effect will be largely on women's autonomy and rights, with no guarantee that the decline in population will reverse.

Russia's high abortion rate can be partially explained by the fact that Russian women's overall reproductive choices are curtailed, despite easy availability of abortion.

Reproductive choice is curiously lopsided in Russia, where contraception has always been harder to come by than safe abortion. Historically, the medical establishment, political authorities and religious forces asserted that contraception is a Western imposition, a danger to women's health and a threat to the social fabric. The Soviet system rightly saw that modern contraceptive methods promoted individual women's autonomy, and preferred to keep reproductive health care in the hands of state medical providers. Birth control pills, IUDs and condoms were of poor quality and hard to access.

Russia's artificially narrow selection of family-planning options may be unique, but some things hold true the world over. Women benefit from more reproductive choice, not less. A 1999 study showed that when women did have access to birth control, Russia's abortion rates declined. According to a Reuters report published on November 8, "With the arrival to the market of modern methods of contraception in the 1990s, abortion rates fell by almost a third but have since dropped more slowly." The same report pointed to the lack of state funding for family planning programs since the debt crisis of 1998 as one of the factors contributing to the low rates of contraceptive usage.

Another universal truth is that health care serves women best when it focuses on women. But doctors have tended to give patients negative information about contraception, in part because the Russian system does not adequately reimburse for contraceptive counseling. Disturbingly, the recent legislation requiring doctors to share skewed information about abortion dangers continues the tradition of political agendas and faulty science getting in between Russian women and the care they need.

If Russia is serious about reversing population decline, it should be serious about reducing maternal and infant mortality rates -- among the highest in Europe. A 2005 study from the British Medical Journal traced factors contributing to these trends and found a bureaucracy-heavy health-care system not designed to meet women's reproductive health needs.

Women's and children's health tends to go hand-in-hand. Russia still has far to go in closing the gender wage gap and in meeting the need for child care and early-childhood education. These are the very factors women consider when making childbearing decisions. A survey conducted in 1994 during the Russian economic crisis found that a lack of confidence in the future was correlated with a reluctance to have children. Population growth can be encouraged by non-coercive policies that provide the health care, paternal leave, child care and other supports women want for their families.

Making improvements in women's opportunities has proved to increase birth rates, as happened in Russia during the 1980s when public service benefits were extended to larger families. However, the results of coercive pronatalist policies have also been bitterly proven. Under Ceausescu, Romanian women had no reproductive choice -- the resulting high rates of later abortion and maternal death punished women, as well as the many children who were undervalued or unwanted.

As a Catholic, I recognize that the Catholic hierarchy plays a significant role in promoting restrictions on abortion -- and contraception. In Russia, the Orthodox Church has been supporting recent legislation designed to reduce abortion access. But the dynamic remains the same. These forces weave a tale full of dangers and prohibitions about reproductive choice that have little to do with the real problems and solutions that ought to concern society.

Our research shows that religious leaders do not accurately reflect the needs of their faithful. Reuters quoted one feminist as saying, "Why should a priest decide what I do with my body?" Luckily, public policy and public health have no need for such intermediaries. Policymakers must rise above religious pressure and the temptation to promote quick fixes to long-term problems. Thankfully, proposed legislation that would have required a husband's consent for a married woman seeking an abortion or parental consent for women under 18, as well an amendment to strike abortion from the national health plan were dropped after proving unpopular in the polls.

There is no easy answer to demographic decline, and making abortion the scapegoat for decades of neglect to women's well-being will not help. Building a stronger society that supports women and children is the long, slow, sure road to a thriving Russia.