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. Last Updated: 07/27/2016

Russia: A Risky Place to Be Pregnant

More than 50 women die from pregnancy-related complications for every 100,000 live births in Russia, up to 10 times as many as in leading industrialized countries, Health Ministry and World Bank officials said.


Largely to blame for the disparity, they said, were unsafe abortion practices and Russia's towering rate of abortions: two for every live birth.


Dina Zelinskaya, the Health Ministry's top official for maternal and child health, said that in 1993 for every 100,000 live births there were 51.6 maternal mortalities, counting all deaths that occur during pregnancy, childbirth, or abortion."It is a heavy statistic for us," she said in a recent interview.


The Russian rate is two to five times higher than in Western Europe, which ranges from 10 to 25 deaths per 100,000 live births, and more than 10 times higher than in Canada (four per 100,000) and Japan (4.5 per 100,000), said Chantal Worzala, of the World Bank's population, health and nutrition department.


The rate in Russia is also twice that of Malaysia, according to 1988 World Bank statistics, and comparable to the rates in Panama and Venezuela.


Up to 30 percent of Russia's 800 maternal deaths last year were caused by abortion complications, such as uterine infections and bleeding, according to Zelinskaya. She also blamed a lack of proper drugs and equipment.


Most of Russia's 3 million yearly abortions are performed without single-use sterile instruments, she said, and most patients receive only primitive anesthesia -- or none at all.


This is not just painful but dangerous, Zelinskaya said, because if the patient squirms from the pain it increases the risk of surgical mistakes.


Most abortion-related deaths in the former Soviet Union involve abortions done outside the public-health sector, said Dr. Mark Belsey, program manager for maternal and child health and family planning at the World Health Organization in Geneva.


He said that while state abortion clinics under the Soviet regime were relatively safe, the quality of care "left a great deal to be desired. Sometimes it was a lack of equipment or anesthesia, sometimes a lack of general respect for women's dignity."


Because of abusive treatment and lack of modern methods at state abortion clinics, Belsey said, "women are pushed into the private sector, which is sometimes qualified -- even more qualified than the public sector -- but also sometimes completely unqualified, and therefore unsafe."


Many women turn to private doctors because they offer vacuum-aspiration abortion, a procedure dominant in industrialized countries. The method is simpler and safer than that used at state clinics in the former Soviet Union, which involves scraping out the uterus with a metal instrument. But some private-sector abortions are done without sterile equipment, or by people without medical training, causing many complications.


Officials agreed that no matter what the conditions, a high number of abortion-related deaths is inevitable in a country where abortion is still the main form of birth control. "It's not because abortions are so dangerous," said Worzala. "It's because there are so many abortions."


Abortion was the only readily available form of birth control under the Soviet Union, which produced few contraceptive devices. Therefore Russian women still have "a casual attitude toward abortion," Zelinskaya said.


She said a federal family-planning program inaugurated this summer to make contraceptives more available and encourage Russians to use them has had some success. Three percent of women are now using birth-control pills.


"But we can't even talk about a decrease in abortions when we are still doing 3 million a year," she said. "We realize that women are not going to change right away, and we need to make abortions safer."


The risk of death in childbirth is also high in Russia because maternity wards lack blood supplies, drugs, and equipment, and are "not well prepared to deal with complications," Worzala said.


Zelinskaya says the government will soon launch a program called "Safe Motherhood," which will:


?Create maternity centers that are specially equipped to deal with premature births and other complications.


?Retrain nurses, to "raise the prestige" of the profession, improve the treatment of patients, and free up doctors. Women report being insulted, neglected and even given injections to halt midnight labor artificially so that doctors can sleep until morning.


?Increase funds for prenatal care and educational programs to encourage open discussion of pregnancy, long a taboo subject even within the family.