Family planning in Russia in 1993-94: the role of NGOs in demonopolising population policy.
While official figures show a steady decline in the number of induced abortions performed annually in Russia, changes in regulations on the provision of abortion services and in the data collection system are likely responsible for the declining figures. For example, abortions performed in commercial health centers and in many state-supported medical units are not reported. Also there are no reliable figures on contraceptive usage in Russia or on other facets of family planning, and indeed Russian health care statistics in general are lacking. Thus, the 30% reduction in abortions reported from 1989 to 1993 was not accompanied by a similar increase in the use of modern contraceptives. Also, 26% of maternal mortality still results from induced abortions. However, during 1993-94, a significant amount of social attention was paid to the issue of family planning in Russia, and induced abortion was identified as a social priority and a health care problem. Also, many public groups are beginning to become involved in the formulation of a population policy in Russia. This has resulted in development of a grassroots approach instead of a hierarchical approach to FP. The most important new players in FP and population policy development are the Russian Orthodox Church with its anti-abortion lobby, commercial health care providers, new nongovernmental organizations, Western pharmaceutical companies, and international foundations and agencies. Several legislative initiatives have led to an increase in the number of officially registered sterilizations and to a proposal to remove abortion from the list of medical services covered by the state insurance program. The platform of some political parties would prohibit abortion. While the provision of FP and the problems associated with abortion have received priority attention, the concept of a human rights approach to FP is not developed in Russia. Russia completed its first demographic transition using the archaic technology of abortion and traditional contraception. A second transition will occur as the use of modern contraception instead of abortion increases.