MOSCOW -- On a recent Tuesday morning when Women's Health Service No. 15 in central Moscow held its regular abortion clinic, the waiting room was empty.
Ten years ago, it would have been crowded. But as the birth rate in Russia has plunged, so has the number of abortions -- from a high in 1988 of 4.6 million to 2.5 million in 1997.In Soviet times, abortion was the main means of birth control: The rule of thumb was almost two abortions for every live birth. That fact was one of the most shameful aspects of a medical system that routinely neglected its female patients.
With communism's collapse, birth control, once a subject that was considered vaguely indecent, became a matter of public discussion. Articles appeared in newspapers, gynecologists appeared on television talk shows, but most important, contraceptives, all imported from the West, appeared in pharmacies. In 1993, the Russian Health Ministry began a family planning program, opening more than 200 clinics around the country.
The government's efforts have been amplified by Western pharmaceutical companies. These firms' entry into the untapped Russian market has been accompanied by pamphlets, seminars, billboards and heavily discounted special offerings on contraceptives made available through women's health centers.
The results have been noteworthy, particularly against the backdrop of an otherwise crippled health system. Abortions, maternal mortality and infant mortality have all fallen.