Health Policy and Planning Advance Access originally published online on February 13, 2007
Health Policy and Planning 2007 22(2):83-94; doi:10.1093/heapol/czm003
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Women's reproductive health needs in Russia: what can we learn from an intervention to improve post-abortion care?
1International Services, American Red Cross National Headquarters, 2025 E Street NW, Washington DC 20006, USA.
2Harvard Center for Population and Development Studies, Cambridge, MA, USA.
3Research Centre of Obstetrics, Gynecology and Perinatology, Moscow, Russia.
4John Snow, Inc., Moscow, Russia.
5State Research Centre for Preventive Medicine, Moscow, Russia.
* Corresponding author. International Services, American Red Cross National Headquarters, 2025 E Street NW, Washington DC 20006, USA. Tel: +1 202 303 5259; Fax: +1 202 303 0053. E-mail: davidpa{at}usa.redcross.org
It has been well documented that abortion is a common means of controlling fertility in Russia. Women undergo repeat abortions throughout their reproductive lives, but recent studies of abortion trends in the Russian Federation suggest that abortion rates are on the decline, use of modern contraceptives is increasing, and women dislike abortion as a method of fertility control. Using data collected during 1999–2003 in women's health facilities in three Russian cities, this paper reports the results of an evaluation of interventions to improve post-abortion care, which show an impressive increase in post-abortion contraceptive counselling but no reduction in the rate at which women present at clinics for repeat abortions. The findings indicate a discrepancy between women's stated preferences for modern medical contraceptive methods and their abortion-seeking behaviour. Further exploration of these data suggests that certain women resort to abortion with greater frequency than others, and points to the need for a more focused investigation of these women. These results indicate the complexities associated with changing what has been a relatively common and long-standing practice, and have implications for improving reproductive health services. Meeting the reproductive health needs of Russian women requires not only improved provider and client knowledge but may also demand a more focused delivery of client-centred care than may be the case in other settings.
Key Words: Reproductive health policy, abortion, post-abortion care, Russia, contraceptive counselling, family planning programmes
This study was completed while the corresponding author was Senior Evaluation Advisor with John Snow, Inc., 44 Farnsworth Street, Boston, MA, USA.
Accepted for publication 1 December 2006.