Sunday, June 2, 2013

Which of vessels are communicating?

On May 28 and 29 I took part in two events:

  1. Partners' Forum on Russian Reproductive Health Survey (info about it lived short on Rosstat site, today it is already removed from news list) + I am going to write about partners separately, and
  2. Experts' round table at Gorbachov Fund “Demographic problems in the context of the modernization of Russian society”.

Many other people participated in the events, especially in Rosstat's one, probably more than one hundred, and only about twenty at Gorby fund. I talked on Current Russian Govt Approach to Reproductive Health. Certainly, I gave my own personal opinion and value judgments, and I am reproducing them below, presentation in Russian is here.

1. Complimentary part:
It was necessary to congratulate Rosstat for its 150th birthday (1863, Tsar-Liberator attempted to civilize Russia). Concerning the survey: Better late than never. The first RHS took place in El Salvador, 1975, Russia has experience of 1996 and 1999, when this methodology had been applied to estimate the efficiency of (breastfeeding promotion?) project. A unified program allows international comparisons of detailed indicators, which government statistics do not posses, albeit only 27 of about 80 sets of survey data are freely accessible from CDC site. However, most interesting for us data set (Ukraine, 1999 despite not very recent) is available. There is a large amount of new data that will give the opportunity to test some specific hypotheses (use of contraception+abortion culture).
Thanks for the survey, thank you for publishing the results, for the invitation to discuss.
Nikitina nodded, when I said about the possibility to work with data obtained in the Russian Federation. These data will also be available, thanks in advance.
Frankly speaking, I supposed, we are discussing a draft report, since there are a lot of stupid errors, mistypings, etc., but to our surprise the printed final version had been distributed. Thus the forum aim became unclear. I had supposed to speak about the text, since tables are not possible to comment. Results showed no significant discrepancies with what was previously known from other sources, and nothing counter-intuitive.

2. Scary reading:
Examples (section 11.3. Opinion about the risks ...)

  • Most of the women ... have no idea how dangerous are the use of injectable hormonal contraceptives or tubal ligation ...
  • Increasing knowledge about the dangers of abortion may contribute to the increased use of modern contraceptives.

It is a beloved horror story: Do not use these capitalist shit! From the same set of common arguments: pill use causes the mustache growth, breast cancer, and extra weight. As far as I understand, bureaucracy calls it: report agreed with the Ministry of Health. My suggestion was = remove it. And they did, removed by rephrasing, added a sheet of paper inside the book. They (organizers) also asked me to avoid speaking about it, they had removed the slide from my presentation sent beforehand. That made me redirect my speech from critics of MoH to critics of ideology of abortion perception (subj). inadequately considers fertility v abortion not abortion v contraception.

4. Abortion
It is likely the central theme of reproductive health domain in this country. Russia is remaining a leader, although births recently (five years ago) surpassed the number of abortions. It is interesting that the lag from two neighbor countries strangely coincides with changes in approach to reproductive health. The dynamics of reduction is not as favorable as it may seem, but the forum does not cover the issue with a particularly needed and inevitable section. However, the topic had been attached to the speech on fertility!!! made by Serbanescu. Despite I was invited to make a comment on contraception, this is not possible without concerning abortion. These are communicating vessels, not fertility and abortion.
Why we do not discuss abortion? The level of post-abortion complications in Russia is ten times higher than in the USA despite Russia has the longest history of legal abortion, 74 years. During this period MoH had been unable to train personnel to perform safe abortion. Why do we welcome them to a floor and reconcile anything with guys not knowing how to work properly.

5. More from the report:

  • section 7.3: This points to the need for education in this (family planning) regard.
  • section 9: This information can be used to effectively manage the system of family planning services, as well as monitoring and evaluating the effectiveness of the system.
  • section 9.3: We must carefully anticipate the needs for contraception in the future. This information will help policy makers and program planners to estimate the volume of the stocks to plan a budget.

Wow! Yyess. But what is it? My impression, – it is written about some other country, not about Russia. The authors probably borrowed the text from report on Kenya. Have we a system of family planning services? Or bodies responsible for this policy? Nobody have seen them.

Before moving on to the recommendations, I want to draw your attention to a couple of facts from the sources other than this report

6. Menarche and age at the first sex (data: RLMS-HSE, 19th round, 2010)
Median age at menarche is 13 years, i.e., a half of the girls starts to have a risk of pregnancy at about school's 7th degree, and by the end of the school a little less than half has already had a sexual experience (penetration).

7. The growth of HIV prevalence (data: Federal AIDS Center)
In 2012 Federal AIDS Center registered 62+ thousand new cases of HIV (in 2011 – 58+), about 20% of them was a result of heterosexual contact (since for about a half of new cases the transmission mode is unknown Federal AIDS Center prorates to 40%), thus one person a day in age group 15-20 is expected to be infected (my estimate;).
Condom prevents (hetero)sexual HIV-transmission, but MoH destroyed all HIV prevention programs.

8. Recommendations. Two parts: (1) concerning survey, (2) concerning policy.

  • open data for researchers +Another conference in a about a year after disclosure to discuss the results of independent researches
  • regular conduction of such a survey


  1. Introduction of sex education lessons in school, in particular, the use of contraception.
  2. Resumption of funding of the federal family planning program
  3. Renascence the full scale activities of Russian Association of Family Planning

Concerning policy recommendations can be combined into one: abandonment the obscurantist (Medvedev) modernization and return to the position that Russia held in the early wild 90's (before the Cairo conference)

I understand that the Ministry of Health does not need my nor any other recommendations, but I still hope the open data.

Next day after the partners forum in the news:
Measures that Ministry of Health is preparing to minimize fertility reduction are associated with a decrease in the number of abortions
Russian LJ about the event (and here)

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