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Russia’s population is falling fast

Abortions, health problems causing demographic woes

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MOSCOW — Over the past six years, Dr. Irina Budnikova has examined thousands of Russian women who want to give birth but can't — women who have had six miscarriages, women whose ovaries atrophied before they turned 30, women so anemic that pregnancy made them faint daily.

These problems, she says, combined with Russia's still staggering abortion rate, are helping drive Russia's demographic decline.

"The population keeps getting sicker. That's one reason the birth rate is going down," she said, blaming widespread poverty, disintegrating health care, environmental hazards and poor nutrition.

Fertility problems are just one facet of a trend that deeply disturbs this bedraggled nation: Russia's population, currently around 145 million, is shriveling at a tempo unheard of in the modern era. At the current rate of decrease, demographers predict the world's largest country will have a population smaller than Japan's — 125 million — within 20 years.

President Vladimir Putin warned in his first state of the nation address last month, "If this continues, the survival of the nation will be in jeopardy."

Half of Russian men die before they can retire at age 60, as heart disease, alcoholism and smoking escalate unchecked. And Russian women aren't having children, or at least not enough. The country's birth rate has halved since 1988 to 1.3 children per woman, according to the Statistics Committee.

Most avoid childbirth by choice — either by not having children or by ending their pregnancies. Russia has the world's highest abortion rate, with two of three pregnancies ending in abortion.

Some women don't have that choice. Russia's Health Ministry and other experts estimate that 10 percent to 25 percent of Russian couples are infertile, and that many of them never turn to professionals for help.

And infant mortality is on the rise, a phenomenon extremely rare for an industrialized nation. Some obstetricians say one-tenth of Russian newborns die of infections.

"We have sick women, and they're having sick pregnancies," Budnikova said in her office at the city-funded Center for Family Planning and Reproduction in southern Moscow. She said the maternity ward used to handle 36 births a day when she started working there in 1994; now it handles just 10 daily.

In another wing of the clinic, Anya Morozova waited for an examination. Morozova, 18, is four months pregnant and juggling medications to protect her fetus from the herpes virus that she contracted last year.

"I didn't know much about women's health issues before I got pregnant," she said quietly, twirling her woven purse strap nervously.

Doctors at the clinic suggested one reason for increasing reproductive problems is that Russian women are having sex earlier, in their mid-teens. That gives a woman more chances to contract infections that could affect childbearing.

It also increases the chances that a woman will have more than one abortion before she has a baby. A history of multiple abortions can increase the risk of complications during pregnancy.

Though contraceptives are increasingly available in Russia, they are still mistrusted or misunderstood, and abortion remains the primary method of birth control. It is also free, unlike birth control, which is relatively expensive.

Dr. Andrei Akopian, a fertility specialist and director of the Republic Center for Human Reproduction, blamed a weak tradition of preventive health care and deteriorating food and water quality for the problems he encounters.

"Prevention is the number one priority," he said.

Government spending on medicine has shriveled in recent years, but the vast majority of the population still depends on public facilities. Women's clinics lay patients on tattered cots and use old, stiff speculums.

Doctors also say a legacy of Soviet environmental destruction has damaged the health of millions of Russians.

The government promised this spring to spend $125 million in the next two years on a program aimed at increasing the birth rate.

While birth rates are declining in most of Europe, it's happening faster in Russia and for different reasons.

Many potential Russian mothers are insecure about the future. Russia's economy has seen little but decline for the past decade. Paychecks and employment are no longer guaranteed.

Still, despite her health problems, Morozova is hopeful for her unborn child.

"I want all the best for my baby," she said. "Times are always tough. That's not enough of a reason not to have children."