Russia-Maternity, Infant Care, and Birth Control

Some of the same factors shortening the lives of adults cause needless premature deaths of newborns in Russia. Poor overall health care and lack of medicines, especially in rural areas, reduce infants' survival chances. In Russia an estimated 40 to 50 percent of infant deaths are caused by respiratory failure, infectious and parasitic diseases, accidents, injuries, and trauma. For developed countries, this share ranges between 4 and 17 percent.

Infant mortality rates vary considerably by region. Central and northern European Russia's rates have been more in line with West European rates. In the intermediate category are the Urals, western Siberia, and the Volga Basin. The highest rates are found in the North Caucasus, eastern Siberia, and the Far East. Several autonomous republics, including Kalmykia, Chechnya, Ingushetia, Dagestan, and Tyva, consistently record the highest rates in the Russian Federation. In these areas, social and economic underdevelopment, poor health care, and environmental degradation have had an impact on the health of mothers and newborns.

Unwanted pregnancies are common because of the limited availability and substandard quality of contraceptives and a reluctance to discuss sexual issues openly at home or to provide sex education at school. No social stigma is attached to children born out of wedlock, and unmarried mothers receive maternity benefits. Medical care for expectant mothers is among the least adequate aspects of the country's generally substandard system of health care. A high percentage of pregnant women suffer from anemia and poor diets--factors that have a negative effect on their babies' birth weight and general health.

In the mid-1990s, modern forms of contraception are unavailable or unknown to most Russian women. The Soviet Union legalized abortion for medical reasons in 1955 and overall in 1968. But information about Western advances in birth control--and all modern means of birth control--was systematically kept from the public throughout the remaining Soviet decades. As a result of that policy, today's Russian gynecologists lack the training to advise women on contraception, and public knowledge of the subject remains incomplete or simply mistaken. Even in Moscow in the mid-1990s, most contraceptives were paid for by voluntary funds and international charities. In the early 1990s, an estimated 22 percent of women of childbearing age were using contraceptives; the percentage was much lower in rural areas.

Abortion remains the most widely practiced form of birth control in Russia. In 1995 some 225 abortions were performed for every 100 live births, up from a rate of 196 per 100 in 1991. According to one study, 14 percent of the women in Russia with sixteen or more years of school had undergone eight to ten abortions. The conditions under which abortions are performed often are primitive. Moreover, it is estimated that nearly three-quarters of abortions take place after the first trimester of pregnancy, involving substantially greater maternal risk than those performed earlier. The number of abortions is much higher among Russian women than among Muslims and other minority groups, however. Statistically, the higher her social status and the extent of her Russification, the more likely a Muslim woman is to seek an abortion.

Infant and child health in Russia is significantly worse than in other industrialized countries. According to official statistics, only one child in five is born healthy. The inability of more than half of all new mothers to breast-feed, mainly because of poor diet, further undermines infants' health in a country where diets generally are unbalanced. Another problem is that most women of childbearing age are employed and thus must place their young children in day care centers, where they often contract contagious diseases. Illnesses such as cholera, typhoid fever, diphtheria, pertussis, and poliomyelitis, which have been virtually eradicated in other advanced industrial societies, are widespread among Russia's children. Vaccines are scarce. Even when immunizations are available, parents often refuse them for their children because they fear infection from dirty needles.

Alcohol, Narcotics, and Tobacco

Russia's rate of alcohol consumption, traditionally among the highest in the world and rising significantly in the 1990s, is a major contributor to the country's health crisis, as well as to low job productivity. Rated as Russia's third most critical health problem after cardiovascular diseases and cancer, alcoholism has reached epidemic proportions, particularly among males. In the twentieth century, periodic government campaigns against alcohol consumption have resulted in thousands of deaths from the consumption of alcohol surrogates. The latest such campaign was undertaken from 1985 to 1988, during the regime of Mikhail S. Gorbachev (in office 1985-91). Although some authorities credited reduced alcohol consumption with a concurrent drop in Russia's mortality rate, by 1987 the production of samogon (home-brewed liquor) had become a large-scale industry that provided alcohol to Russians while depriving the state of tax revenue. When restrictions were eased in 1988, alcohol consumption exceeded the pre-1985 level. According to one study, between 1987 and 1992 annual per capita consumption rose from about eleven liters of pure alcohol to fourteen liters in 1992; current consumption is estimated at about fifteen liters. (According to World Health Organization standards, consumption of eight liters per year is likely to cause major medical problems.)

A 1995 Russian study found that regular drunkenness affected between 25 and 60 percent of blue-collar workers and 21 percent of white-collar workers, with the highest incidence found in rural areas. Because alcohol remains cheap relative to food and other items, and because it is available in most places day and night, unemployed people are especially prone to drunkenness and alcohol poisoning. In 1994 some 53,000 people died of alcohol poisoning, an increase of about 36,000 since 1991. If vodka is unavailable or unaffordable, Russians sometimes imbibe various combinations of dangerous substances. The Russian media often report poisonings that result from consumption of homemade alcohol substitutes. Production of often-substandard alcohol has become a widespread criminal activity in the 1990s, further endangering consumers. Alcohol consumption among pregnant women is partly responsible for Russia's rise in infant mortality, birth defects, and childhood disease and abnormalities.

Smoking, a widespread habit, especially among women and teenagers, compounds Russia's health crisis. Chain-smoking is endemic in Russia; in 1996 an estimated 55 percent of Russians were regular smokers, and health authorities believed that the figure was rising. However, rather than urge patients to quit, doctors often recommend the purchase of American cigarettes, which are more expensive but have less tar and nicotine than Russian brands. When import restrictions ended in the early 1990s, the American cigarette industry found a large new market in Russia. A modest government antismoking campaign paralleling Gorbachev's anti-alcohol campaign in the late 1980s had little effect. In January 1996, cigarette advertising in the print media was prohibited, and smoking in theaters and workplaces generally was restricted to designated locations.

The increasing incidence of drug abuse was belatedly acknowledged by the Russian government as a public health problem. In 1995 an estimated 2 million Russians used narcotics, more than twenty times the total recorded ten years earlier in the entire Soviet Union, with the number of users increasing 50 percent every year in the mid-1990s. In the Soviet era, drugs were viewed officially as a capitalist vice, but that attitude disappeared soon after the Soviet Union dissolved. Russia legalized drug use (but not possession or sale) in 1991. According to experts, laws against possession are not dissuasive. Narcotics use has spread to new elements of society in recent years, including alcoholics seeking a new means of escape. Russian experts rate the new class of Russian businesspeople as the group with the highest percentage of drug users; for them, success often includes the ability to purchase the most expensive narcotic. The drug scene, once dominated by students and intellectuals, now includes large numbers of housewives and workers. Synthetic drugs now are manufactured in small laboratories by professional chemists; some are easily fabricated by amateurs as well. Legally produced drugs often are stolen and move into the black market (see The Crime Wave of the 1990s, ch. 10).

Medical treatment and educational programs now include hot lines in major cities and walk-in clinics that provide advice and treatment on an anonymous basis. Some schoolteachers have begun class discussions of drug-related issues and have distributed antidrug literature to students. Nevertheless, Russia's drug problem remains largely intractable. Many addicts overdose, and some who cannot afford heroin inject themselves with other substances that cause illness or death.

Data as of July 1996