Contraceptive Use Increases in Russia
In a time of sweeping political and social change in Russia, AVSC International
has worked with reproductive health care providers to improve the quality
of services and to expand access to an array of contraceptive methods.
Nina Schwalbe, country advisor in AVSC's office in Ekaterinburg, Russia, is
enthusiastic about the program and praises the Russian government for its
commitment to increasing access to contraception and helping women avoid
A Change in Attitude
According to Schwalbe, the most exciting thing to come out of AVSC's work in
Russia is the change brought about by counseling training.
"There has been a change in people's attitudes," she explains. Doctors who
never spent any time developing interpersonal skills before training have
changed their beliefs after training from "the doctor should choose for the
patient" to "the client should choose for herself."
Participants have also reported a change in client satisfaction, even during the training sessions
themselves. Even though they received the service in a training setting with
three or four people watching, women who participated in IUD training came
out smiling and saying "I've never had such good care in my life...thank
Expanding Access to Methods
The goals of increasing access to and use of
a broader array of contraceptive methods is being gradually realized as well.
The most dramatic increase in use has been with the pill. In Russia, there
has been a bias against the pill for years. The biggest challenge for
reproductive health care providers was to dispel the myths surrounding it.
To counter these biases, AVSC's Russia program conducted seminars to educate
providers about the pill. Lower-dose pills are now available, and according
to Schwalbe, "People like them."
Sterilization in Russia
Female sterilization is also becoming more accepted
now. Although doctors once only considered sterilization as a way to prevent
high-risk pregnancies, there are fewer restrictions today.
According to Schwalbe, in the programs that AVSC supports, doctors who had never done minilaparotomy
procedures postpartum are "doing them every week now."
Vasectomy, on the other hand, is a method about which attitudes and acceptance do not appear
to be changing quickly. It is still virtually unavailable in Russia.
In addition to its work with contraceptive acceptance
and quality of care, AVSC's Russia program has undertaken a number of educational
The program has held reproductive health seminars for more than
1,500 health professionals and has trained 196 providers in counseling and
clinical skills. Activities have included contraceptive updates, IUD insertion
training, and surgical training for female sterilization.
In addition to conducting seminars and training, AVSC's Russia program has adapted a number
of materials that are distributed throughout Russia, including a cost-assessment
manual, a terms glossary, posters, and a family planning flip chart that
has been produced and distributed for use in counseling.
These educational activities and materials are key to increasing use of different contraceptive
methods. According to Schwalbe, family planning programs are often initially
met with skepticism in Russia, and many think the purpose of the programs
is to decrease the Russian birth rate. Once they understand that the purpose
is to improve women's health and reduce abortions, they become more receptive
to family planning.
A Confusing Time
Substantial progress has been made in increasing access
to, and the quality of, reproductive health care in Russia. However, the
same political and social changes that have made many of these exciting changes
possible have created a level of instability and disorder that seriously
undermines efforts to effect systematic change.
Right now everyone in Russia can still get health care of some kind, but the quality varies. Doctors'
salaries are low, and doctors are undervalued. The profit to be made performing
abortions still acts as a strong disincentive to providing family planning
services. The regions have little money for health; supplies are few and
equipment is deteriorating. Clinics run out of drugs, sutures, and antiseptics.
Clients may start on one type of pill only to return to the pharmacy and
find that it is out of stock.
"It's a confusing time," Schwalbe concedes, but she remains optimistic. The national and local governments have made a strong commitment to family planning. They
recognize that abortion is "an enormous drain on the system," both financially
and in terms of women's health. She is "very impressed" with their commitment
and confident that it will outlast the difficult times.
AVSC's work in Russia is primarily funded by the U.S. Agency for International
Margaret Schehl is a freelance editor/writer for AVSC International.