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• Russia鈥檚 Battle around Reproductive Health and Women鈥檚 Rights

  The transcript has been lightly edited for clarity.

  Victoria Pardini: From the Kennan Institute, I am Victoria Pardini. 

  Nina Rozhanovskaya: And I am Nina Rozhanovskaya. And you鈥檙e listening to The Russia File.

  VP: In 1920, Soviet Russia became the first nation in the modern world to legalize abortion. Even though the Soviet stance on women鈥檚 reproductive rights varied throughout the 20th century, today Russian abortion legislation remains one of the most liberal in the world. However, authorities are now taking tentative steps to limit access to abortion and other aspects of reproductive health, ostensibly to combat the demographic crisis, which has been amplified by Russia鈥檚 full-scale invasion of Ukraine. Today, we will discuss the latest restrictions on reproductive rights in Russia, the rationale and driving forces behind them, and what this all means for Russian women and Russian society as a whole. 

  NR: And for that conversation, our first guest is Dr. Michele Rivkin-Fish, associate professor of anthropology at the University of North Carolina at Chapel Hill and expert on reproductive politics and health in Soviet and post-Soviet Russia. Michele, welcome to the program.

  Michele Rivkin-Fish: Thank you so much. It鈥檚 great to be here. 

  VP: So I鈥檒l just get right into it. To set the stage, can you provide a bit of background on the state of reproductive health legislation in Soviet and post-Soviet Russia and how you address that in your forthcoming book, Unmaking Russia鈥檚 Abortion Culture? 

  MRF: The history of reproductive policies in the Soviet and post-Soviet era is actually quite complicated because it doesn鈥檛 fit into our expectations regarding how ideas about terminating pregnancy and the controversies about this very common medical practice play out. They鈥檙e different from the US context. So as you said in the intro, abortion was first legalized at the very start of Soviet history in 1920 as part of a socialist vision to get women into the workforce. It was the first country in the world to legalize the procedure. But then in 1936, Stalin prohibited it in order to try to raise fertility.

  This didn鈥檛 work, not surprisingly, but instead led to huge rates of maternal mortality. Women went to all efforts to get abortions if they could not raise a child. These 18 years led to extreme hardship, and as soon as Stalin died, there was a move to make abortion legal again. However, contraceptives were not made widely available, in part because of a widespread deficit of consumer goods more generally, but also because there was a lingering ambivalence about getting women opportunities to prevent getting pregnant.

  What happened was the state realized that if abortion is not legal and available, women will go underground and get unsafe abortions. So the state made access to abortion in medical centers very, very widespread. But they didn鈥檛 make contraceptives available at nearly the [level of] demand. And so essentially, this policy led to abortion becoming the main form of fertility control. In the post-Stalin era, in the 1960s and 鈥�70s, there were over 200 abortions for every 100 live births. In other words, there were between three and four abortions, on average, per woman over the course of her reproductive lifetime. This was among the very highest in the world. 

  For everyday people, what that meant was that getting pregnant and then deciding, 鈥渄o we want to keep it or do we want to terminate?鈥� was a very routine experience. And this had enormous implications for how people thought about reproductive health and reproductive rights and questions of the morality or the significance of abortion. To put it very briefly, abortion for many women was experienced not as a choice or a form of empowerment, but as a symbol of the lack of choice. The lack of choice to have a child because of very difficult conditions; the lack of choice to not get pregnant, if one doesn鈥檛 want to be pregnant, and a kind of last resort. 

  It was not moralized in the way that we tend to recognize in the US, because in the atheistic Soviet Union, the embryo or the fetus was not seen as a human being. There was no notion of a soul. So it wasn鈥檛 described as a sin or as murder. But the state continually, basically, blamed women for rejecting motherhood and not caring about family life. 

  In the post-Soviet era, what started happening was almost as soon as the Soviet Union collapsed, and even beforehand, notions of abortion as a religious violation, as a sin, began to be heard in the public sphere. And an anti-abortion movement grew that pretty quickly took on religious overtones and came to take on the strategies and rhetoric of anti-abortion movements in the West. And these were helped by various anti-abortion movements in the West, from the Catholic Church to various evangelical churches. 

  The pro-choice movement had also attempted to contribute to the movements of maintaining access to abortion control and spreading contraceptive knowledge and family planning knowledge. And in fact, what my book traces is the history of the rise of family planning institutions and models of healthcare provision and thinking about getting pregnant in a timely and deliberate way. But the pro-choice rhetoric was met with some ambivalence because, again, as I said, the experience of routine abortions didn鈥檛 really fit the experience or the rhetoric of choice. 

  Over the last 10 years, the rhetoric of pro-choice has actually become more and more prevalent in Russia among those who want to retain the access to abortion. And it鈥檚 becoming talked about more and more as a woman鈥檚 right or a human right. But we have to recognize that there鈥檚 a widespread sense that abortion was part of the Soviet system and that moving away from the Soviet system and becoming a more moral society or a more liberal society is often associated with opposition to abortion.

  NR: That鈥檚 a very interesting point. And it鈥檚 also a very heartbreaking story that you tell, the whole historical background, and the fact that it was a lack of choice, not a choice in the Soviet times. But when we look at things the way they are today, what are the reproductive rights currently available to Russian women? 

  MRF: Yes. So, it鈥檚 interesting. On the one hand, according to the law, officially, women have the right to terminate a pregnancy through the first trimester, up through 12 weeks, on demand. They also have some very restricted rights to have an abortion in the second trimester, in the case of rape. And they have the right to have an abortion at any point along the pregnancy for medical reasons. However, in reality, there are more and more impediments put on at the clinic level and at the level of the local regions to try to prevent women from actually accessing abortion, even in the first trimester.

  Doctors can get bonuses by talking women out of having a termination. So if a woman comes to the prenatal clinic and says, 鈥淚 would like to terminate,鈥� and the doctor notes that, but then the woman does not terminate, the doctor gets a financial bonus. What I鈥檓 reading in the news is that some clinics are giving women the runaround so that they have to get more tests done and go to other clinics and redo the ultrasound. And these kinds of games that then delay the ability to get the termination within the first trimester, basically coercing the woman into keeping the pregnancy.

  There鈥檚 also a series of official barriers or techniques to try to convince women against getting an abortion. So there鈥檚 mandatory psychological counseling, which is actually not provided by psychologists or psychotherapists, as we would think of them, but they are people that are there to try to convince women not to have abortions. There鈥檚 a mandatory listening to the heartbeat and to see the ultrasound of the fetus. There鈥檚 also mandatory waiting periods.

  NR: So it鈥檚 all about biding time and also guilting women to make a different choice. But how recent are those things? 

  MRF: So, interestingly, there has been a creeping advancement of these impediments. In 2003 and then 2007, the list of criteria to get a second trimester abortion were first reduced. They had been quite expansive in the 1990s at the time of immense economic recession and hardship, and in the early 2000s and mid-2000s, the Ministry of Health started to reduce those social indicators. In 2011, there was a huge campaign to try to get abortion to be criminalized, and that did not succeed. However, that was at the point where the mandatory counseling and the heartbeat and the ultrasound were put into place and abortion services were prohibited from being advertised. So from 2011 on, things have really gotten much more practically difficult. 

  VP: Is that a federal policy? Is that specific to certain regions? 

  MRF: There are both federal mandates and regional policies. So at the federal level, that鈥檚 the counseling, the ultrasound, and the heartbeat, and the waiting periods. Those are federal. Regionally, more and more governors and local regional officials are putting into place restrictions, including things like getting permission from a priest, or if the woman is married, she may need to get her husband鈥檚 permission. Increasingly, some of the regions are taking the abortion procedure out of the compulsory health insurance program. 

  This goes back to some of the ways in which, even if there isn鈥檛 a federal prohibition against abortion, local regions and even the medical authorities in particular clinics are making decisions to appear to be respecting family values as the government defines them. So in October of 2023, nongovernmental medical clinics, meaning private clinics, stopped鈥攙oluntarily stopped鈥攑roviding abortions in the regions of Lipetsk, Kursk, Chelyabinsk, Nizhegorodskaya Oblast, Mordovia, and Tatarstan. And then in other regions there are fines that have been established for so-called coercing people into abortions, and those include Kaliningrad, Tver, Kursk, Pskov, Novgorod, and the Republic of Mordovia. So you鈥檙e seeing a lot of local changes that are happening, which of course can also be confusing for ordinary citizens who are not sure what information is available.

  There is an organization called Women for Life, which is a foundation. It appears to be a nongovernmental organization. But like so many nongovernmental organizations that are still able to function in Russia, they have the blessing of the state. And this Women for Life Foundation is actually funded by the state as well. And they have been undertaking a series of programs and campaigns to get local authorities to sign agreements and to promote these so-called traditional values through restricting abortion. And this led, for example, to the Tatarstan private clinics to refuse to provide abortions. And in Kaliningrad, the same, to only have abortions in state clinics. And other regions have officially signed agreements with the Women for Life Project, including the Republic of Komi, Arkhangelsk, Tambov, Tula, Novgorod, and Magadan.

  VP: You mentioned earlier about family planning, and I want to go back to that point. What is the situation with family planning services and access to that today? And, in addition, where does public opinion stand regarding abortions? And have there been changes, ebbs and flows, in public sentiment throughout the post-Soviet period? 

  MRF: I鈥檓 going to take the second question first, because it鈥檚 very interesting historically. So in the 1990s, as the Russian Orthodox Church was sort of beginning its revival, it was saying that abortion should be criminalized and the vast majority of Russians were opposed to the idea of criminalizing abortion. They remembered the 18 years during the Stalin era when women were dying or being harmed for life, even if they survived. But over the decades since, more and more people have come to see abortion through this lens and have been saying, 鈥淚 am opposed to abortion being widely available or even legal.鈥�

  About 60% of people were in favor of it staying legal. And younger people were more in favor of having it legal than older people. And women were more in favor of it being legal than men. So there is an understanding that people should have the right to do with their bodies what they want, that having a child is an extremely personal responsibility and people cannot be forced into this with any good kinds of results.

  However, the family planning services have been really, in some ways, decimated. The Russian Association of Family Planning, which was founded in 1993, came under attack very quickly from conservatives who were worried that having family planning would lead to a drop in the birth rate, which is not true. But there was a kind of backlash against these institutions. And as early as 1998, federal funding was ended for family planning. Regional localities continued to fund it and there was some funding from abroad. But starting in 2014鈥�2015, this organization was branded a foreign agent and basically ceased to exist. 

  And what that organization had been doing was training physicians around the country to understand proper prescribing rules and techniques for oral contraceptives, knowing the latest about IUDs, and understanding the uses and how to properly ensure that people would be followed with some of these hormonal contraceptives or mechanical contraceptives. Without those organizations, it鈥檚 not clear to me that there is training for physicians anymore and I worry about that, because one of the problems that existed in the Soviet era was not only that people didn鈥檛 have access to contraceptives, but that physicians themselves didn鈥檛 know the proper use of them. In general, the term family planning has become a kind of obscenity in the minds of pronatalist and nationalist activists.

  NR: You鈥檝e mentioned the anti-abortion groups and organizations and primarily the Russian Orthodox Church. But what about the other flank? Are there still groups of activists who might exist in Russia and who might be able to actively oppose that crackdown?

  MRF: So, I believe that Russians will always find creative ways to pursue what they want. I have recently read about the Feminist Anti-War Resistance group, which had an activist infiltrate an online chat group that was run by an anti-abortion group called Women for Life and found out about how this [group] is operating to actually deceive women seeking abortions. 

  So there is a kind of underground movement to get women information and to understand what is actually their rights and how to go about getting what they want. But I can鈥檛 tell you how widespread or effective it is, because they鈥檙e really underground and I haven鈥檛 been able to get those insights right now. At the same time, I also believe that there are probably doctors who are doing the courageous work of trying to bypass this very repressive regime. Hopefully, we will be able to hear those stories. They鈥檙e trickling out a little bit. 

  NR: So, Michele, as you鈥檝e mentioned, abortion used to be the main form of fertility control in the Soviet Union, not necessarily by choice, but that was the Soviet reality. What does the situation look like now? 

  MRF: So, it鈥檚 fascinating to note that abortions have decreased every single year since 1990, and even before 1990, there were some substantial decreases as well. But if we take 1990 as a baseline, the reported number of abortions per live births was 206 abortions for every 100 live births. Now, that鈥檚 a reported number. There were many abortions that were not reported because they were done outside of the official recording. People wanted privacy; they paid under the table. But let鈥檚 just start with that number.

  So there鈥檚 more than twice as many abortions as births in 1990. Fast forward to 2010, and that number is 67. In these 20 years, you鈥檝e got a massive decrease and every single year you鈥檝e seen decreases and decreases. So by 2014, that number was down to 48 abortions per 100 live births. And in 2015, which is the last year that we have data that exclude the occupied territories, it was down to 44. Also, there are data that show that in various regions, such as the city of Moscow, the numbers are far, far lower. 

  So the family planning campaign and the efforts that were underway for decades to get people to have options to not get pregnant if they weren鈥檛 prepared to have a child have worked. And abortion has become a far more rare and kind of last resort when contraceptives don鈥檛 work.

  NR: This is quite interesting, because it does show that in a way, proponents of traditional values are fighting, well, if not an invisible and nonexistent, but at least a disappearing enemy. 

  VP: Michele, in addition to the restrictions on reproductive health, can you speak about how different regions are trying to encourage an increase in the birth rate through regional initiatives and pilot schemes? 

  MRF: Yes, and this is happening both from the federal level (encouraging regions) and from the ground up (in regions). So just recently, at the end of February, Putin announced new national projects to improve the standard of living. One of these national projects is called Family, and it aims to improve the standards of living for families with children and to raise fertility. The goal is to achieve a stable increase in fertility over the next six years by providing support for families with children. But moreover, the idea is that they want to make large, multi-child families the norm and life philosophy, in the words of the president. And they plan to do this both through educational systems and through supporting the regions economically to provide family support systems and reduce the poverty rates. 

  So one example is a federal entitlement payment established in January 2023 for families with low salaries. It鈥檚 means-targeted, and it starts from the time a woman is pregnant until the child reaches age 17. But regions with lower than average fertility are getting additional funding in order to raise their fertility. And since July 2023, each region was to establish a plan to raise fertility in its region. 

  Now, the total fertility rate at the end of 2022 was 1.41. And so this would cover those regions that had lower than 1.41. But at the same time, Putin is trying to get all of the Russian Federation to have this cultural and psychological orientation towards multiple children. He wants three to four children per family. There鈥檚 a recognition from the center that some people are struggling and the state recognizing family values and saying, 鈥渨e鈥檙e going to put resources into families with children to reduce their poverty rate鈥� is a way of trying to garner legitimacy. 

  VP: It is a very interesting approach. I think it鈥檚 obviously more targeted and, in that way, might spark more birth, but it seems to be kind of a knowing ignorance [since] just throwing money at families does not necessitate a happy home or a happy childhood or a strong family.

  NR: And from what I saw in the statistics, those financial incentives seem to have an immediate effect that then dies out. Like there is a short-term increase and effect on people who actually wanted to have kids but didn鈥檛 feel confident enough in their financial security. And so they have the number of kids they would have [had] anyway. But then it doesn鈥檛 actually incentivize those who are not having kids for reasons other than finances. So in the long run, from what I read, those programs don鈥檛 actually increase the number of children in a nation.

  MRF: That鈥檚 correct. And demographers have shown this time and time again. Moreover, it doesn鈥檛 address any of the issues regarding women鈥檚 ability to combine work and family life, the need for quality childcare, the need for equality in the home as well. And this is a continuity with the past, that there is a kind of narrow focus on stimulating births rather than creating a more holistic opportunity and structure for caregiving and for wellness. And if you don鈥檛 have family planning in the mix, then people may not be able to conceive and bear children that they want at the time that鈥檚 appropriate for them. 

  VP: Going back to the family planning point and also going back to the dearth of information that exists: from what you can tell from your research and elsewhere, are there other sources [where] people can receive鈥攅ither anecdotally or in schools or in other kind of clubs or word of mouth or something鈥攈elp [in] family planning?

  MRF: So there has never been sex education as we know it in the Russian schools. There were some early attempts to try to create some curricula in the 鈥�90s, and they were squashed before they were started. The Internet is a very important resource and I think that to the extent that people have access to VPNs they鈥檙e able to get information; the question is people [who] don鈥檛 have access to VPNs.

  There was a clinic that I profiled, both in my first book and in my forthcoming book. They provided abortions, but their main focus was to get young people to prevent unwanted pregnancy, to preserve their health, and only have healthy pregnancies and avoid abortions and have healthy children. And this was led by a very open-minded obstetrician-gynecologist who was committed to young people. And he died in, I think it was, 2016, and he was appointed by the local region in St. Petersburg, the public health officials, and they replaced him with an Orthodox Church-observant doctor who then started to bring in the priests and bring in anti-abortion propaganda and to really stop offering open-minded, scientific-based education [to] the clients.

  VP: A lot of the conversation that we鈥檝e talked about has been in relation to the Russian Orthodox Church鈥檚 perspective on abortions and reproductive health. But we know that Russia is a multi-confessional [religiously pluralistic] country. What are, if at all, the responses from other faiths on the issues of reproductive health and abortion?

  MRF: So it seems that many of the local authorities throughout the country, including in the Muslim areas, are jumping on the bandwagon to promote so-called traditional values. And recently, President Putin was in Tatarstan and he was inaugurating the opening of a new perinatal center. And basically, he and the head of the Republic of Tatarstan were both agreeing on how births need to rise and traditional values need to be at the center of public policy. So we鈥檙e not seeing real differences in this. It actually seems to be a way in which people from diverse religious institutions are finding common ground. 

  NR: I was wondering: this emphasis on regional initiatives and 鈥渧oluntary鈥� decisions by private clinics, what is the rationale behind this approach? So is the federal government afraid of making the new restrictions a federal bill? Are they trying to shift responsibility? Are they doing that because the public, and they know it, is against the new restrictions? 

  MRF: This is an excellent question. The move to prohibit abortions from being provided by private clinics is an attempt to [exert] more control [over] what happens when a woman comes seeking an abortion. The doctors and the private clinics are incentivized by the payments that the women are paying for the abortion. In the state clinics, the doctors are incentivized not to give abortions, to hold back. And so that鈥檚 where the runaround is coming [from]. And I think the state believes that by pushing them through their channels of the state clinic, then they鈥檙e able to more effectively prevent the abortion from happening through these various strategies, both official and these unofficial tactics.

  NR: I know you鈥檝e mentioned that one of the results of this dynamic is the delays; that if a woman has to go through the state clinic, it might mean more effort to dissuade her and also longer wait times. But I also read that there is another aspect, and you can correct me if I鈥檓 wrong, but that private clinics tend to rely on the so-called medical or pharmaceutical abortion where a woman would be given a certain drug that would induce the process, while state clinics do tend to resort more to the surgical option. And one could argue that the surgical option has bigger health repercussions and consequences. Is that the case? 

  MRF: Sort of. What鈥檚 going on is that, starting in September of this year, of 2024, medical abortion drugs will be classified as restricted medications, which I think will mean that probably only state doctors will be able to prescribe them and they鈥檒l be limited in their accessibility. This is a problem because the medical abortion, where you take pills, is a very private experience. Women can do it in their own home. It鈥檚 safe, and it also allows women to avoid the punitive or rude behavior or the judgment of the physicians or the clinic staff. The vacuum aspiration abortion method, which is one of the more invasive forms, when it鈥檚 done correctly, it is a very safe procedure. But this issue of privacy and comfort, that鈥檚 what I think medical abortions can provide. So the degree to which those are going to be accessible, starting in September, is going to be something to keep our eyes on. 

  The question that I have that I think is worth watching for is whether abortion will be taken out of the compulsory insurance system federally or not, and whether there will be increasing efforts to restrict, even at the first trimester. I don鈥檛 know that a full-on ban is going to happen. You never know, of course. But I think they鈥檝e actually found what seems to be, unfortunately, a very effective way of, on the one hand, we鈥檙e going to bring you in here saying that you have the right, but actually we鈥檙e going to make it really, really difficult for you to get it. And then, well, it just won鈥檛 happen. So I鈥檓 not sure that it鈥檚 going to be criminalized. This kind of situation may continue.

  NR: So that鈥檚 why it鈥檚 all being done in this underhanded manner. We are not going to ban abortions outright. We aren鈥檛 going to follow the Polish example, where that bill brought a million people into the streets. We鈥檒l just make it extremely difficult. So it鈥檚 not banned; it鈥檚 legal. And there isn鈥檛 any public debate, because a ban would encourage a public debate.

  MRF: There was a debate that emerged in 2011 and again in 2015. And I want to say that this was an extremely momentous set of events for me, as someone who鈥檚 been observing the reproductive politics in Russia for a long time. In 2011, when the first really expansive bill to prohibit abortion was made public, the Russian Association of Population and Development鈥攚hich was the new name of the Russian Association of Family Planning鈥攐rganized a coalition of grassroots feminists and their own network of colleagues to go out on the street and demand abortion stay legal. They did so both with the notion that it would protect women鈥檚 health from illegal abortions and it would ensure that children who are born are born wanted, that they wouldn鈥檛 be given up to orphanages and they wouldn鈥檛 live in a situation where they were resented by their parents. 

  In 2015, again, another proposal to ban abortion became very widely known about and discussed. And again, the same coalition came out and said, give women the right to have their own choice. Then they started to use some of the pro-choice language, along with their slogan that had been used in 2011, which was 鈥淔ight Abortion, Not Women.鈥� So they were saying at that point, 鈥渨e don鈥檛 want routine abortions, but don鈥檛 punish women; get people contraceptives.鈥�

  And this 鈥淔ight Abortion, Not Women鈥� slogan was fascinating to me, because it seemed to really epitomize how the debate didn鈥檛 follow the Western model of anti-abortion or pro-choice. It was its own version, responding to the lack of alternatives. But when the Family Russian Association of Population and Development was called a foreign agent and it ceased to exist, these feminist groups also eventually ended up having to be very careful and even to go, now, underground since 2022.

  So there was a debate and that debate was started and there [were] some very interesting ways that people were conceptualizing: What is the role of the state? What does it mean to have bodily autonomy? What does it mean to demand choice? These were questions that many Russian people were starting to debate publicly and in their personal lives, but that has been squashed with the more repressive turn of events.

  NR: You did mention increasing the demographic strength of Russia as a motivation behind some of these restrictions. And obviously many people in the Russian elite probably think that we need more soldiers, if not now, then in the future. If, say, you are a major proponent of 鈥渢raditional values,鈥� you might probably be willing to use the war and its demands in your rhetoric to get more people in power on your side in your pronatalist campaign.

  MRF: Well, what鈥檚 interesting is that from the early Soviet era, the question of demographics has been central to reproductive politics. This is another way that it really differs from the West. So even in the 1920s, there was concern that if you have legal abortion, the birth rate might go down. After the Stalin ban ended in the 1950s, there was a huge concern to replace the losses from WWII鈥擬ie Nakachi鈥檚 book, Replacing the Dead, right? There was a real hope to promote births. And so, the demographic issue has long been cited overtly as why the state or experts want to reduce or limit abortions in order to promote higher fertility. This, of course, is a fallacy, because you can prevent unwanted pregnancy without lowering the birth rate.

  In societies where the birth rate is already quite low鈥擱ussia has had a very low birth rate for decades鈥攔eplacing abortion with contraception is only changing the means of low fertility. It鈥檚 not going to lower fertility more, but the people [who] are thinking about raising fertility are constantly thinking you get someone pregnant and then you convince them to have the baby even if they don鈥檛 want it. Just try to get them, somehow, to continue that pregnancy. 

  Now, where the war has made a difference is that the war has created a notion that the society is vulnerable and that the society needs to kind of promote a patriotic mobilization in all spheres. I think that it鈥檚 the religion, the religious argument, for abortion as sinful and as somehow a kind of transgression that is working on top of the demographic argument. 

  ***

  VP: Abortion and contraception are not the only aspects of reproductive health sparking heated public debate. Though they assist rather than prevent pregnancies, surrogacy and in vitro fertilization tend to cause controversy in the Russian context as well. In the second part of this episode, we鈥檒l discuss the Russian approach to these reproductive practices with Dr. Nataliya Shok and chat with her more about how reproductive health is discussed on the ground. 

  NR: Dr. Shok is a public policy fellow at the Kennan Institute. She holds two PhD degrees鈥攊n political science and in the history of medicine鈥攁nd conducts interdisciplinary research on public health and science policies. Nataliya, thank you for joining us today.

  Nataliya Shok: Thank you. I鈥檓 happy to be here today.

  VP: So let鈥檚 start off with just setting a stage question. What are the new initiatives in the Russian reproductive health system and why might one consider them problematic? 

  NS: Yeah, thank you, Victoria. It鈥檚 actually a very good, and a huge, question. And currently there are a few initiatives on reproductive health in Russia that mostly focus on women鈥檚 reproductive health. And it is a triangle: abortion, IVF, and surrogacy. And all these medical practices contribute and are seen by Russian authorities as an important part of the demographic policy; and the place of that triangle in the state policy has changed within [the last] two decades, following the changes of Russian domestic and foreign policy towards more securitization. 

  There are three main tendencies that have become publicly evident first amid the COVID-19 pandemic and are developing now amidst that devastating war in Ukraine. The first tendency is an extreme inconsistency in state and regional reproductive policies, including the special limitations for the private clinic practices. Abortion is a big example of that. 

  The second tendency: because reproductive health is envisioned by the state as a national security matter, the whole medical practice has become a matter of restrictive legal reform and growing risks of criminal liability for medical personnel. The most recent case is when a team of six highly skilled professional physicians, gynecologists and reproductive health professionals, received a sentence of a total 90 years in prison because of an accusation [of] child trafficking through the surrogacy practice that is legal in Russia.

  And the third tendency: the growing role of non-state actors and media in domestic public policy on health with a big focus on a conservative narrative of traditional values. To name a few of them: it鈥檚 the Russian Orthodox Church and some pro-life, state-funded NGOs that more often present themselves as Orthodox. And unfortunately, Russian women as well as Russian physicians are deprived of their agency in reproductive matters and are the object rather than the subject of the governmental demographic and reproductive policies, which is a huge issue. Therefore, public debates on reproduction illustrate the deep gap between state reproductive policy and the reproductive strategies of Russians themselves.

  NR: There is a lot to unwrap here, and it鈥檚 clearly a very complicated, interconnected issue. So let me first ask specifically about surrogacy, because you鈥檝e mentioned that it is legal and yet there are people persecuted for assisting in surrogacy. We know why people might object to abortion for moral reasons. But surrogacy is a way to have children. And the Russian state is clearly very keen on Russian women having more children. So what is the problem with surrogacy currently?

  NS: The problem around surrogacy started in the early months of the COVID-19 pandemic. I posted a Russia File post on that in 2021, describing in detail what happened and why surrogacy was seen as problematic. Basically, what happened, [is] the children born after surrogacy programs were found in a Russian flat in the Moscow region where they lived because it was in strict lockdown. It was not possible for them to get to their genetic parents. And they had been waiting for the changes in COVID restrictive policies, and somehow the situation had become a case of criminal liability. And the whole public policy campaign around this case had become focused on the child trafficking. 

  Nobody really knows what was the reasoning for this accusation. But the precedent has been created, and surrogacy practices that were legal, and that are still legal, are restricted. The government of the Russian Federation issued a new amendment for healthcare legislation regarding surrogacy. So they obliged all parents using a surrogacy program to confirm their relationship with a child carried by a surrogate mother through a DNA test. That was the first amendment, and also the second amendment, that happened: they tried to limit the availability of the service to foreigners.

  Also, they limited the practice of oocytes donations. So basically, a Russian woman [who] wants to go through the surrogacy program should have her own oocytes. If she doesn鈥檛 have her own oocytes, she is not eligible to be a part of this procedure. That鈥檚 why another tendency is growing in Russia: couples who have infertility problems, especially on the side of women [who] don鈥檛 have their own oocytes (which is a very typical problem for very severe gynecological problems among women), they have to travel to countries with their own biological materials to be able to perform surrogacy programs abroad. Professional associations of reproductive health physicians have already posted a lot of statements against this initiative, trying to push it back, to get all those surrogacy services back into the healthcare system of [the] Russian Federation. Unfortunately, the situation is still not resolved. 

  VP: I鈥檓 curious also, as we discuss other ways of having a child with surrogacy and IVF and the new preclusions that are being put upon this way of having children, who are the actors promoting and proposing new restrictions, and how does it tie into this emerging and growing tide of traditional values that鈥檚 present in Russia? 

  NS: Because the whole healthcare system in Russia is very different comparing to the system, for example, in the United States; it鈥檚 very difficult to explain why all those reproductive health things are so inconsistent. Every case in the triangle I have already mentioned should be considered separately. In the case of abortion, it was always considered as guaranteed by the state. And interestingly, since the early 2000s, the Russian Orthodox Church has become vocal on the matter of both abortion and IVF in their [Basis of the] Social Concept. Back then, nobody actually paid attention to this document. It was just rhetoric of the Russian Orthodox Church for Orthodox community.

  However, probably in the early 2010s, the Russian Orthodox Church involvement has become more evident. They started to present these ideas, meaning more conservative ideas towards abortion and IVF, in public. And what started to happen in the mid-2010s, they initiated the campaign against abortion first. They basically tried to say that abortion, according to their opinion, should be excluded from the state medical insurance programs because they were concerned that the Russian Orthodox community, specifically Russian Orthodox taxpayers, should not fund such federal guaranteed state health insurance programs.

  They didn鈥檛 succeed and neither the State Duma nor the medical community supported them. Therefore, they started doing another thing, and this started to happen last year, in November 2023, when Patriarch Kirill [asked] the State Duma to pass a federal law prohibiting inducing women to have an abortion and excluding this medical procedure from private clinic service. Five years earlier, the patriarch demanded the opposite: to exclude abortion from the state-funded, free-of-charge medical insurance system. What made him do so? He pointed, in his letter, to the State Duma in 2023. He said that abortion is a matter of national security. 

  Basically, the whole idea of traditional values can be seen as a part of the moral mobilization of Russian society when the country is at war. And if we look at the reproductive health initiatives, including increasing criminal liability for physicians, all those regional and federal restrictions, as a part of a bigger mobilization, social mobilization campaign for Russian society, where women should be also mobilized as a part of this kind of wartime narrative, then it鈥檚 clear that women鈥檚 rights and freedoms are not a part of this agenda.

  NR: This is extremely interesting. I guess if you are not following the rhetoric and this dynamic very closely, you might miss this rather curious switch in strategy. 

  NS: I must say that the whole idea of the military strategy for the state鈥攖hat it is at war鈥攗ndermines all directions of state politics, including both domestic and foreign. So it doesn鈥檛 mean that healthcare should be kind of diminished or cut extremely. It only means that the whole narrative, in all areas of state policy, should be subordinated to the military political goals of the state. And on the domestic level of such subordination, that means that we have to create the space and environment around certain issues that are considered vitally important for the state鈥檚 national security interest. We should put them into the narrative of the moral mobilization of the society. That means that everyone should feel that he is a part of this patriotic movement, whether this person wants it or not. 

  VP: That鈥檚 a really important reframing that I hadn鈥檛 really considered in the context of this conversation. To that end, I鈥檓 also curious: if this is the policy, what does opposition to this policy look like?

  NS: Yeah, it鈥檚 a good question, especially paying attention to the recent evidence on any kind of protest that happened in Russia since the war started. Drawing lessons from history, in the case of reproductive health, physicians themselves always had agency in the Soviet Union and in Russia. I鈥檝e worked extensively in Soviet archives, mostly focusing on the Ministry of Health of the Soviet Union. And there was an attempt from physicians in 1934鈥�1935 to create a longer list, when Stalin decided that he wanted to ban abortion. They tried to create a longer list of medical conditions that could have helped them to keep abortion available for women. And actually, they didn鈥檛 succeed. And Stalin himself cut this list, because he understood what they were trying to do. But at least there was an attempt that is evident in archives. 

  Today, of course, the same agency physicians might have鈥攁nd they have already published a lot of statements, specifically [from] professional associations of reproductive health professionals鈥攖hey published several statements regarding why they think those [new] legal initiatives, including [restriction of] surrogacy and IVF, should not be [put in] place. In the case of abortion, the situation is quite different, because, of course, many physicians, they think that it鈥檚 not the best practice for women, in terms of their health and in terms of [future] pregnancies. So I don鈥檛 think, here, we might have physicians鈥� support, as it used to be with Stalin鈥檚 case. 

  I must say that probably there should be more female agency in this. But now, looking back from 2024, I understand that in the mid-2000s the Russian women鈥檚 movement had started experiencing big pressure. And today, we could hardly say that there is any chance for women in Russia to become strong opponents, or at least pose some issues in front of the state or [in front of] any kind of political authority in Russia fighting for their rights. Also, because the most vocal proponents of traditional values are also women in Russia. 

  NR: Thank you for bringing this up. That鈥檚 indeed an interesting point. I mean, both the point about the agency of physicians, because I think it is sometimes overlooked in the whole debate, but also thank you for bringing up the women who oppose, publicly, reproductive rights and work towards restricting them. It might be very sincere, but it also might be part of a strategy. And still certain male actors have definitely much more power on this issue and all the others. And we know that Russian President Vladimir Putin announced that this year, 2024, is the year of the family. So my question was whether he voiced any of his own takes or opinions about reproductive rights, whether he speaks about it in public.

  NS: In December [of] 2023, Putin gave his public comment that, I鈥檓 quoting here, 鈥渨e must [respect] women鈥檚 rights and freedoms.鈥� That was a direct citation. Also, he highlighted that it doesn鈥檛 look [like], on the federal level, [there鈥檚] going to be an abortion ban, because he compared the abortion ban with the anti-alcohol campaign in 1980s that led to increased mortality due to poisoning. He called basically for more careful actions on the federal level against abortion. Unfortunately, I cannot recall his comments on either surrogacy or IVF procedures. Basically, those two practices are more aligned [with] the main direction of Russian strategy in demographics. So the more IVF, the more children, the better. But of course, the problem here that we must consider is the whole understanding of the role of criminal liability, that it鈥檚 increasing in medicine as well as in many other areas of professional practice in Russia. 

  I think the most important takeaway from the conversation we had today is the complexity of Russian reproductive health policies, its inconsistency, and its huge dependency on the bigger military political narrative of the Russian authorities. It is a reality that we must face and probably try to help those who remain in the country to find a way to keep the availability of reproductive health for women [in] place.

  VP: I think that you鈥檝e really given us just a lot of information to work with and a lot of nuance that we hadn鈥檛 really considered. 

  ***

  VP: Let鈥檚 close this discussion with some remarks from Michele. Women鈥檚 health and reproductive rights seems to be a major issue on many nations鈥� agendas right now. What are the international implications of the Russian government鈥檚 latest attempts to further legislate reproductive health, if you look at them not just as a domestic policy, but also part of a larger geopolitical strategy?

  MRF: So this is a fascinating issue. From the very beginning of the 1990s and continuing until today, Russian attempts to limit access to abortion and to oppose family planning have been inspired by the tactics of the Western anti-abortion movement. They鈥檙e taking, oftentimes, the same tactics and just bringing them to Russia. 

  I think if you look at Poland and Hungary and you look at Russia, you鈥檙e seeing a reaction against gender equality鈥攕uch as it existed in the socialist system, which, of course, was a problematic and incomplete form of gender equality, but at some level, women had access to economic independence from husbands, and that was a form of gender equality that these post-socialist countries are really trying to undo and undo at the cultural level鈥攕o a vision of a woman as subordinated to her husband in the family, giving birth to many children is a kind of recreation of a populist patriarchal system. And so I think this case of abortion and reproductive politics is a very important example of how conservative, so-called 鈥渇amily values鈥� organizing and campaigns are happening transglobally. 

  NR: We started this conversation by mentioning your upcoming book. And to conclude, I would like to go back to that, and ask you to tell us a bit more. 

  MRF: So what the book does, is it traces the efforts of medical experts, demographers, and some other activists to make the case that contraceptives will be a healthier way to address fertility control than abortion, that it will lead to actually stronger family values, that contraceptives will not reduce the birth rate, but will strengthen society from the level of women鈥檚 health to children who are wanted to an overall happier and healthier society. 

  And the fact that it was a pretty moderate liberal movement and not a radical feminist movement for a long time made me think it was going to succeed in the Russian context, because it was speaking to the concerns of ordinary people there and the fact that, actually, it was still, nonetheless, attacked and made into an object of extreme derision and backlash by nationalists really raises some interesting questions. Why is family planning or women鈥檚 control over their bodies so much an issue of antagonism and hostility by populists and pronatalists and conservatives? And it really raises the issue that this is about a bigger system of control, of control over intimate life, family life, and women鈥檚 bodies. 

  NR: And as far as I know, the book is coming out later this year in English.

  MRF: It鈥檒l be coming out in June with Vanderbilt University Press. And then I guess, probably within the next year, a Russian translation with Academic Studies Press. 

  NR: Well, I鈥檓 sure, Victoria, we鈥檒l agree that we both very much look forward to reading that.

  VP: We鈥檙e both going to be picking up a copy and we鈥檙e looking forward to what is an increasingly critically important discussion in Russia and in many flashpoint countries currently. 

  NR: Michele, thank you for joining us today for this conversation. It was fascinating, and we both learned a lot. 

  MRF: Thank you both so much. 

  NR: So, Victoria, we've just had two extremely insightful conversations. What did you take away from them? 

  VP: I think both conversations provided a lot of nuance for us. The current debate about reproductive rights in Russia can't be separated from its historical context, which is noticeably different from that of other countries. But tamping down on these rights is part of a larger global trend.

  NR: I do agree with this point. And the Russian government's rather frantic attempts to combat the demographic crisis does seem to coincide with a more global conservative backlash against gender equality. And so, while Russian abortion legislation remains one of the most liberal in the world, how these freedoms will look in the future is indeed uncertain. 

  VP: In any case, we at the Kennan Institute will continue to follow these developments, just like we follow other developments in Russian foreign and domestic policy. We will continue to bring you high-quality expertise in the form of our blogs, podcasts, and other events. 

  NR: So thank you for listening, and we look forward to having you with us on the next episode of The Russia File.