Russian Family Planning Association    by Elena Chernomazova

I n 1994, implementation of the Federal Family Planning Program began in Russia. The Program pursued the goal of reducing artificial abortion and improving women's reproduction health with promotion and free distribution of contraceptives and regular medical examination of women of fertile age. Many believed this program to be among the most successful targeted federal programs. Four years into its implementation and abortion rate have decreased by 25% (from 3,440,000 cases in 1992 to 2,650,000 cases in 1996). Under this program, the federal government funded the purchase of new equipment for, and the introduction of new medical technologies to, clinics throughout the country that would support more effective and safe treatment modes (including laparoscopy instead of conventional surgical intervention).  Here we describe the Federal Family Planning Program in the past tense, because from the beginning of this year it is no longer covered by the federal government budget. Initiated by President, the Family Planning Program was excluded from the 1998 federal budget largely as the result of public campaign deployed by Pro-life Movement and lobby activities of legislators supporting this movement. The same reasons effectively suspend the draft "On reproductive rights and guarantees of their execution" which was first introduced to the State Duma last year. At first hearing, after extensive debate the draft was suspended as requiring some improvements; since then it was never heard again, and chances that legislators will address it soon are narrow, since they are entirely engrossed in crisis-related agenda.

Meanwhile, Pro-life and its allies keep on attacking Russian Family Planning Association (RFPA) which initiated the reproductive rights draft. For example, at "Peaceful Family World" Congress that took place in May of this year, Pro-life associates ominously described International Federation of Family Planning (IFFP) (of which RFPA is an active member) as an evil monster aspiring to "get hold of the entire planet with its tentacles" and having declared "demographic war" to Russia. They even "quoted" as if from IFFP strategic plans which, they stated, were to reduce Russian population to be as low as 80 million people after 20-30 years of RFPA activities. Of course, statements of this type, would always fail to name actual explanations why Russian population has steadily decreased in recent years: shorter life expectancy; low birth rate due to downward phase of demographic cycle induced by the World War II; grave overall economic situation making married couples to postpone babies in hope for better times; and so forth. The only reason why Russians decrease in number, "pro-lifers" believe, is RFPA activities in sexual education and contraception promotion.

Lene Thomas, Director of IFFP European Bureau, at one of her public speeches, emphasizes that Pro-life activism is the "indicator of IFFP and RFPA effectiveness. The Pro-life movement that eventually gained strength both in Europe and in Russia is, in fact, not the movement for life, but rather the movement against choice, and this difference should sink deeply into everyone's mind. Information they spread about IFFP and RFPA is either incorrect or deliberately distorted". And Inga Grebesheva, General Director of Russian Family Planning Association, believes that "reckless pro-lifers' propaganda is Russia bears the semblance of abundantly prepaid and thoroughly preplanned campaign".

It did not take long for the wave of aggressive opposition between RFPA and Pro-life to burst down to the regional level. Ivanovo legislators' approval of the law 'On Family Planning' gave rise to a violent storm of publications in regional press. RFPA Ivanovo branch managed to convince local legislators that, since the Federal Family Planning Program no longer existed, they should pass analogous regional act and budget expenses. Positive outcomes of federal program implementation looked impressive, and legislators were ready to approve its regional substitute, when, as if on someone's direction, local press was full of critical and merely affronting publications about RFPA. Former RFPA's allies in anti-abortion crusade (seniors' clubs, Orthodox church and others) turned into RFPA's unrestricted opponents literally overnight. Of course, this campaign was coordinated and pursued the goal to torpedo the regional family planning act. Legislators, however, would not give up in face of severe public pressure and passed the law. Unfortunately, the problem of budgeting family planning activities with local funds stays unresolved.

Overall RFPA strategy for today is to pass regional acts that would allow for family planning financing by local governments with as many regional legislatures as possible. Economic crisis and fierce opposition, however, make this task look rather like a long-term goal with no definite timeframe and schedule.

With government financing gone, RFPA did not curtailed its major activities. First of all, the Association enjoys IFFP coverage. International Federation finances RFPA projects in support of human rights, reproductive rights, the right of choice and reproductive health. Along with IFFP-sponsored activities, RFPA implements projects sponsored by World Health Organization, United Nations, British KNOW-HOW Fund. The project of opening three health and education centers was supported by the European Community. Therefore, RFPA opponents have nothing to worry about any more: Russian tax-payers no longer finance "systematic genocide of the Russian nation" (pro-lifers' designation for family planning).

Among RFPA priorities, public education and information services are salient. "We publish literature for both nurses and physicians and general public. Materials for wide circulation are always approved at the Ministry of Health and pilot-tested for people's reaction to them before we actually start their large-scale dissemination," says Inga Grebesheva. Every individual is entitled to reliable and complete information on his or her reproductive health. RFPA publishes brochures and books on such issues as contraceptive methods; physical changes teenagers experience in maturation period; personal hygiene. Unfortunately, all these materials are circulated in deficient numbers of copies. For instance, freshly published brochure on impregnation prevention after abortion and birth will be available to every hundredth woman of fertile age only, while repeated abortion rate is above 50% today.  Another concern of RFPA is the lack of money for centralized purchase of contraceptives. With the Federal Family Planning Program in place, contraceptives were purchased with federal allocations to abortion-reduction component of the program. Today this reserve is no longer available, and RFPA specialists will have to apply for these funds to federal and regional government agencies in the role of solicitors and with highly doubtful chances to get what they ask.

At the same time, reproductive health of Russian population was far from satisfactory even before the crisis, and one can only guess what reproductive health outcomes will be in the ongoing period of total poverty. V. I. Kulakova, RFPA President, believes that "expectations for the nearest future include abortion rate increase, newborn health deterioration, upsurge of sexually transmitted diseases, growing number of sterile couples - that is, overall deterioration of reproductive health of the nation in every component."
All members of the Association unanimously believe that "reproductive health of the nation is the problem of strategic importance." In the country where artificial abortion is still the prevalent tool of birth control and occurrence of sexually transmitted diseases is unacceptably high, reproductive health needs to be addressed in coordinated and steadfast manner. "Otherwise, birth rate will be driven close to zero in ten years with nationwide infertility."
It would be better for Russian parliament, administration and public to understand it and place reproductive health among national priorities, so it be addressed accordingly. A single public organization- even with access to so much resources as RFPA has- is incapable to solve all problems that affect reproductive health status of the nation so large as Russia is.
We have only to wait in hope for public attention to be finally drawn to national-scale reproductive health problems. Maybe, then RFPA activities will receive objective appraisal. In this connection, the role of mass media should be emphasized: the best journalists can do for national reproductive health is to describe it in unbiased and objective manner.