. Last Updated: 07/27/2016

Abortion Rate Falls, New Rules Mulled

All too often, by the time a patient reached Patimat Abakarova's clinic it was too late: She was pregnant and seeking an urgent way out. Nowadays the women come seeking advice on how not to get pregnant.

Abortion, once the country's primary means of birth control, is in steady decline, but the rate is still staggering: For every 10 births there are about 13 abortions, compared with roughly three in the United States.

"There are so many methods of birth control available now ... methods that not only prevent pregnancy but can help ease other medical problems," Abakarova said.

The Health Ministry has proposed scaling back the liberal policy whereby women can cite a wide range of nonmedical reasons -- being unmarried, poor, already raising three kids -- to obtain an abortion well into the second trimester of pregnancy. The plan would still guarantee abortions in the first 12 weeks of pregnancy to anyone. But after that, most women -- including rape victims -- would be turned away.

"Abortion should never in any society be the primary method of birth control," said Vladimir Kulakov, a leading gynecologist and head of the Scientific Center for Obstetrics and Gynecology, linked to the women's clinic where Abakarova works.

During the Soviet era, women had limited options for avoiding pregnancy. Men regarded Soviet-produced condoms as uncomfortable and unreliable. Doctors were leery of prescribing oral contraceptives.

Abortion was outlawed by Josef Stalin for 19 years as he sought to boost the birthrate. It was reinstated in 1955, after his death, and became widely available even in small towns.

Abortions skyrocketed in the chaos that followed the collapse of the Soviet Union, when jobs and the social net evaporated overnight, often hitting women hardest.

Four years of economic growth have taken some of the financial bite out of starting a family. Birthrates are climbing, albeit slowly. Last year, there were 9.8 births for every 1,000 people compared to 9.1 the year before, according to government statistics. But demographers still predict that by 2050, the world's largest country will have a population comparable to just over a quarter of the United States'.

Occasional efforts by nationalist politicians to outlaw abortion have gotten nowhere, while the latest limited measure has won tentative support, including from many women's groups. The proposal, still in a draft stage, would have to be formally adopted by President Vladimir Putin's government.

Under the proposed new rules, after the first 12 weeks of pregnancy abortions would be limited to women whose husbands died or were severely injured and those who choose abortion after being legally stripped of their parental rights in connection with previous children.

Today, all major birth control methods are easily available at the corner pharmacy, often without prescription, and advertisements abound for clinics offering pills known in some places as RU-486, which can cause an abortion if taken in early pregnancy. "Young people are more literate and informed about birth control," said Tatyana Lobova, who runs a city-funded family planning clinic in Moscow. "But not everybody and not everywhere."

Irina Sigratovskaya, 22 and newly married, said her husband wants to stop using condoms now that they are married. They would like to have children, but not yet. "I'm working all the time. He's working all the time," she said, sitting in a clinic and flipping through a pamphlet that promises happiness, health and love for those choosing an oral contraceptive.

Across town, at the women's clinic where Abakarova works, patients ranging in age from 15 to 30 shuffle about, their high heels covered in the center's mandatory blue slip-ons. To fight sexually transmitted diseases, Abakarova encourages her patients to use a condom as well as oral contraceptives. "I would say that certainly the majority are no longer choosing abortion," she said.