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.

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