Sex and the Future of Russian Society

The prevailing Cold War perception of the Soviet Union and Russia was that of a very conservative, restrained society. In school, we were led to believe that this was simply a society of dark clad folks, mechanically going about their predetermined daily routines. They were not associated with images of promiscuity of any kind. Sex and Russia are terms not typically used together. Today's reality is much different and tragic.

As a result of 'freedom,' sex related magazines, and other products, are sold openly and it's not unusual to see couples 'making out' in public. Ironically, a park bench often provides more privacy than a crowded apartment shared with several family members. Adultery and prostitution fails to shock many people, anymore. The latter increased with economic crisis. Prostitution is legal and many young girls line up, after dark, to make a living as a part of the oldest profession.

Russia's young people face the same peer and media pressures as youth in the West. However, their parents, most of whom grew up during the Soviet era, are very uncomfortable and often unable to talk to their teenagers about sex, disease, abortion and so on. As a result, the incidence of venereal disease has sky rocketed since the end of the Soviet era. Between 1990 and 1998, the number of reported syphilis cases rose 50 times. Currently, according the the World Health Organization, there are roughly 262 known syphilis cases per every 100,000 people. The European average is about 3 in 100,000.

The main culprit, regarding venereal disease, is lack of sex and safe sex education. The Russian Orthodox Church, which has considerable influence where the government is concerned, has vocally opposed sex education in Russia's schools. The Church, naturally, insists on abstinence, thus education about disease and abortion are not needed. The resulting lack of knowledge is staggering. The use of contraceptives and/or protection, such as condoms, is extremely low. Abortions, however are shockingly high. On the average, a young Russian woman has anywhere between three and eight abortions. Part of the reason is; birth control is available but expensive; abortions are free.

With the constant rise in abortions and cases of HIV/AIDS and STDs in Russia, the debate over sex education in the schools has boiled over. Some oppose it altogether; namely the Church and old Communists. Those who support it are divided. One position is to teach it but offer abstinence as the one and only option. Others think sex ed programs should emphasize waiting to have sex, but should also include information on birth control . The debate is very heated and the result is no sex ed at all.

One hope is the offering of sex education through private organizations such as the 50 regional centers of the Moscow based Russian Family Planning Association. This non-profit group receives funding from the Russian government as well as the International Planned Parenthood Federation based in London, England. They provide information and conduct workshops, but emphasize the need for young people to discuss sexual issues with their parents. Other outside organizations, such as the Care for Health Campaign, bring education to Russia as a healthy alternative to abortion.

The high abortion rate in Russia is really nothing new. The Soviet Union ranked high in the frequency of abortion. Estimates indicate that the average Soviet woman had roughly three abortions during her child bearing years. The only forms of protection were low quality condoms. Poor education was and is the prime culprit with no more than 5% of Russia's schools offering any form of sex education. Abortions among teenaged girls is increasing. Clinics treating adolescent girls (ages 14-17) average 10 to 15 abortions a day and a patient's parents do not have to be informed. Sadly, 25 percent of girls under the age of 15 who have had an abortion will, eventually, become sterile.

	Some Facts from the National Center for Health Statistics
	1995: Abortion rate for Russian women, ages 15-49, was 6.76 percent, vs. 1.77 percent in the U.S. Of every three Russian pregnancies, two will end in abortion. In the U.S., this number is 1 in 3.
	Risk factors, during pregnancy, are much greater in Russia. Anemia is found in at least 20 percent of pregnant Russian women, vs. 2 percent in the U.S. The good news is, gestational diabetes is substantially less.
	Death rates for children and teenagers are higher in Russia. Accidental death rate for children 1-14 is roughly the same as for all causes of death among U.S. children of the same age. Drowning is the cause of a majority of these deaths.
	Diphtheria (ages birth to 14 yrs.) rose considerably in the early 1990s, peaking in 1994. In 1995, it decreased by 11 percent and has continued downward since. Hepatitis is much higher in Russia than the U.S., however, it declined 50 percent between 1990 and 1995. Syphilis, in Russia, is 30 times higher than the U.S., but U.S. gonorrhea cases number three times more than found in Russia.

HIV/AIDS came to Russia late, compared to the rest of the world. Being closed off to world and, thus, the so called Western problem, Soviet leaders figured their country was generally immune to the HIV/AIDS epidemic. This all changed when, in 1987, the first case of HIV was discovered. By 1989, 279 children in Rostov-on-Don, Elitsa, Volgograd and Krasnodar were reported to have contracted HIV through blood transfusions. Aware of the devastating effects of HIV elsewhere in the world, the government put in place nation wide involuntary HIV testing (1991). This program is still active today.

The statistics from Russia are growing. As of February 14, 2000, the total number of known HIV cases, since 1991, was 30,607, of which 715 were children. AIDS reported cases, since 1991, numbered 385 with 126 being children. Deaths from HIV totaled 494, 102 of which were children. AIDS deaths numbered 268 with 88 being children. Most of the cases are found in the Moscow region with Dagestan and St. Petersburg reporting the least.

In 1999, there were 15,652 cases of HIV reported. This number is four times greater than the same statistic for 1998 and 1.4 times greater than the period of 1987 - 1988. The numbers for January through mid-February, 2000, were not encouraging. There were 4,264 new cases of HIV reported. The area with the highest incident of new HIV cases is Moscow oblast with the second highest area being the Irkutsk region. These two regions, combined, produce roughly 70 percent of all new HIV cases in Russia today. (source Russian Federal Ministry of Health; Department of HIV/AIDS Prevention)

Safe Sex Campaign in Moscow was initiated in June of 1997. It was aimed at young people (ages 15 - 25) and provided information on contraceptives and sexually transmitted diseases (STDs). With no nation wide sex education in the schools, this was virtually the only resource of this nature. The occurrence of STDs has increased roughly 60 times since 1990. A March, 2000, survey of Moscow youth shows that information and knowledge are the key to reducing these numbers but that misconceptions still are prevalent. For example, 29 percent of those surveyed thought that eating from the same plate put one at risk of HIV. Ninety-three percent of those responding to this survey said they would support sex education in the schools.

Obviously, abstinence is the only 100 percent way to not come in contact with a STD or HIV. But, as in the U.S. and most other countries, this concept a very unrealistic. The key points of the Safe Sex Campaign were the use of condoms and the reduction of multiple or frequently different partners. This is a common message in the west and by no means unique to Moscow.

Support for the Safe Sex Campaign came in the form of the equivalent of roughly $9 million in tv, radio, metro and magazine advertisements in Moscow. Additionally, over 800,000 pamphlets have been handed out in night clubs as well as in clinics. The Campaign has been adopted in other regions of Russia.

The reasons for high abortion rates in Russia are fairly obvious. First, if condoms are unaffordable and abortions are free, abortion becomes birth control. Health risk factors for pregnant women are greater. With at least 20 percent, that we know of, diagnosed with anemia, many abort because they believe that they, nor their baby, would make it safely to term. Those who already have HIV are likely to abort, as well.

Economics are a reality when it comes to pregnancy. Many women and couples will choose abortion because they cannot afford to support and raise a child. Many who don't believe in abortion for religious reasons or think they can figure out a way to care for a child will deliver, only to place their baby up for adoption. Most of these infants and children are adopted by non-Russian families, primarily in the United States. This leads to a whole other issue regarding adoption procedures, laws and Russia's feeling that its children and future is being systematically exported.

According to a recent report from the World Health Organization, Russia ranks 69th in the world in terms of quality of health and healthcare. The bad economy has led to pollution, poor eating habits and increase of diseases such as tuberculosis. Over one-third of Russian infants come into the world with some sort of health problem. The WHO states that a country's health is in serious danger if the annual per capita consumption of alcohol exceeds 8 liters. Russia's per capita consumption (mainly vodka) is roughly 16.5 liters. Russian male life expectancy has dropped from 63.8 years in 1990 to 59.8 years. Female life expectancy has gone from 74.2 years in 1990 to 72.2 years.

Decreased births is more of a problem, regarding population growth, than the shortened life expectancies. In order to sustain a population, women would need to bear at least two children each. Russia's birthrate in 1998 was 1.24 children per woman. It dropped in 1999 to only 1.17. This does not take into account the number of children leaving Russia due to foreign adoption. Russia has invested some $125 million into Children of Russia, a program aimed at improving health care for children and mothers.

Even with improved health care, many Russian couples do not see a light at the end of the long, economic crisis tunnel. Abortion in Russia should not be seen as a product of a society that cares little for children or family. Nothing could be further from the truth. When a women or couple choose abortion or adoption, it is a very sad time. Couples who choose adoption hope their child will be adopted by a Russian family - far too often, this is not the case and their child is whisked away to some other country where he/she will be well cared for but not raised with Russian traditions. The loss of Russian children, whether by abortion or adoption, is having visible effects on the population and society.

The need for information, education and the ability to make informed decisions regarding one's sexual activity, disease risk, pregnancy and abortion is nothing unique to Russia. These are issues faced by all peoples and societies. What is problematic is the availability of information and the manner in which is is disbursed. In reality, there are considerable misconceptions and lack of knowledge when it comes to birth control, STDs and HIV/AIDS. The result in a continued increase in pregnancy and abortion, as well as, disease.

The most recent figures show that the population problem in Russia is not improving. From January through November, 2001, the population dropped by 781,800 people (5%) and total population was 144 million. During the same period in 2000, population dropped by 678,100. According to the State Statistics Committee, the number of deaths is 170% greater than the number of births.

In today's Russia, the number of deaths per day is not equaled by the number of births. In fact, there are about 180,000 deaths a month in Russia and only 100,000 births. At the same time, the infant mortality rate is higher than that of many third world countries. In the past eight years, Russia's population has dropped by 8 million people to a current count of ca. 145 million. President Putin, in his last state of the nation address, expressed his concern that, in 15 years, Russia could be a nation of only 22 million unless dramatic measures are taken now.