Be Fruitful And Multiply

MT
Andrei Malik, a logistics specialist from the Moscow suburb of Odintsovo, was shocked when he found out that he was going to become the father of three boys at once.

Doctors first insisted that his wife, Ludmila, was carrying twins, but an ultrasound at 22 weeks revealed that they were wrong.

"It was a shock. We had no children before, and now we had to start with three at once," Malik said.

As far as the couple knew, they did not have a family history of multiple births.

Experts say more triplets and quadruplets are being born in Russia than ever before. In 2006, 106 sets of triplets were born in the country, and in 2007 the number increased to 145, according to the number of birth certificates issued by the Social Insurance Foundation. In January this year, 18 sets of triplets were born, compared with 12 sets in January 2007. One set of quadruplets was born in Russia in all of 2007, but two sets were born this January alone.

One reason for the increase in multiple births in Russia could simply be an increase in birth rates in the country in general. Another cause could be the rise of fertility treatments as more and more women wait to have children.

The bureaucrats are happy -- the tendency is a plus for a country in a deep demographic crisis. Praise is lavished on parents of triplets and quadruplets, and a popular ad in the Moscow metro shows a young mother with three babies under the caption: "The country needs your records." Muscovite Varvara Artamkina, who gave birth to five girls in a London clinic last year, was met by Mayor Yury Luzhkov personally at the airport when she arrived home. Artamkina was forced to give birth in London after no local clinic would agree to oversee her pregnancy -- domestic doctors were sure it would result in the death of some of the children.

Today, parents of triplets in Moscow can receive up to 100,000 rubles as a one-time allowance at the time of their children's birth. The Maliks were not so lucky, however, since their sons were born in 2004, before these kinds of allowances increased so substantially and the "mother's capital" came into effect. This one-time payment of 250,000 rubles for the birth of a second child is intended to help the family pay for educational expenses, housing upgrades and other similar projects that would benefit the child or the family as a whole. It is deposited in a special account and cannot be accessed until the child is three.

In some cities, like Ufa, Voronezh, Kaliningrad and Kurgan, parents of triplets are usually awarded a three-room apartment. But this decision is up to the local administration. Moscow, which recorded 15 new sets of triplets in 2007 -- twice as many as in 2006, according to an Interfax report -- grants free apartments only to families with quintuplets.

The Maliks, who were living in a one-room apartment when their sons were born, were added to a list for housing upgrades, along with other families with several children. The list included more than 1,000 families.

"We were told that we did not deserve any special treatment, that we were like any other big family," Ludmila said. But she and her husband did not agree. "We said that we are different. It was not our choice to be a big family. We were not prepared."


Igor Tabakov / MT
The government is using ads like this to encourage people to have more children.


They wrote a letter to the head of their local administration asking for help, and they got lucky. In 2007, during the celebration of the 50th anniversary of Odintsovo, they moved into a new three-room apartment.

Unlike bureaucrats, doctors consider the increase in multiple births disturbing. Andrei Akopyan, the director of the National Center for Human Reproduction, said it is not typical and it is not the best-case scenario for the health of the women or their babies. A pregnancy involving multiple fetuses on average lasts from 28 to 29 weeks, while a pregnancy is only considered full term at 36 weeks. Women carrying a single fetus generally give birth after 36 to 42 weeks. The rate of miscarriage in pregnancies involving triplets is 16 percent, and the infant mortality rate in the early postnatal period is 15 percent. For pregnancies involving four or five embryos, the corresponding figures are 21 and 22 percent. And for women carrying six or more babies, the figures increase to 41 percent and 50 percent, according to the medical journal Reproductive Problems.

"It is natural for a human being to bear one child," Akopyan said.

Statistics from the World Health Organization show that the natural incidence of twins is one in 80 pregnancies, and for triplets, one in 8,000 pregnancies. Naturally occurring quadruplets are born only once in every 600,000 births. The likelihood of having a multiple birth increases if there is a family history. Age and ethnicity are less important factors, but younger women are less likely to have naturally occurring multiples, and they are very uncommon among Asian women. But the increase of fertility treatments, particularly in vitro fertilization, or IVF, has played a large role in increasing the number of multiple births. In the early 1980s, triplets occured in one out of every 6,400 pregnancies, but by the end of the 1990s, the frequency had increased to one set of triplets for every 1,300 births.

During IVF, several eggs are removed from the mother's body and fertilized via injection with sperm from the father. The new embryos are then transferred to the mother's body for normal development in the uterus.

"Doctors usually implant several fertilized ova to be sure that at least one would live," Akopyan said.

As technology developed and doctors became more skilled at the procedure, more of these implanted ova developed, resulting in multiple births. As a result, today many countries restrict the number of ova implanted during in vitro to two. In Russia, as well as in the United States, such restrictions are not in effect. In 2003, Ludmila Abakumova, a teacher from the Razdolnoye settlement in the Krasnodar region underwent IVF and became pregnant with quadruplets – three boys and a girl. Abakumova died while giving birth to them, and her daughter died shortly after birth. The three surviving boys had low birth weights and were often sick. Their father, Sergei Abakumov, had to leave his work on a collective farm and raise the children on his own.

Doctors sometimes offer a reduction in the number of embryos in order to increase the viability of the pregnancy and reduce health risks. This technique, however, has raised legal, ethical and religious issues. Artamkina, who refused the reduction offered to her in Russia, was given an award by Patriarch Alexy II.

About 5,000 children are born in Russia as a result of in vitro fertilization each year. It is not much -- in Belgium and the Netherlands, 3 percent of the entire population was conceived through IVF, and worldwide, more than 1 million children are born every year as a result of the procedure.

Regardless of the way families acquire triplets, quadruplets and even quintuplets, raising them is a challenge. Ludmila Malik said her first night at home with the babies was a real trial.

"I was breastfeeding the whole night, as they kept waking up one after another," she said.

Now her sons are in kindergarten. Although their teacher had some problems distinguishing them at first, now she knows for sure which one is Ivan, which is Daniil and which is Kirill. Malik says raising triplets is different from having twins -- they learn at an early age that when two of them are fighting for a toy, the third one can come in and take it.