Abortion restrictions in Russia spark outrage as the country takes a conservative turn

TALLINN, Estonia (AP) — Despite its last-minute scheduling, the meeting at a bookstore in Russia’s westernmost city of Kaliningrad still drew about 60 people, with many outraged by a lawmaker’s efforts to ban abortions in local private clinics.

The weeknight turnout surprised and heartened Dasha Yakovleva, one of the organizers, amid recent crackdowns on political activism under President Vladimir Putin.

“Right now, there is no room for political action in Russia. The only place left is our kitchens," Yakovleva, co-founder of the Feminitive Community women’s group, told The Associated Press. "And here, it was a public place, well-known in Kaliningrad, and everyone spoke out openly about how they see this measure, why they think it’s unjustified, inappropriate.”

Although abortion is still legal and widely available in Russia, recent attempts to restrict it have touched a nerve across the increasingly conservative country. Activists are urging supporters to make official complaints, circulating online petitions and even staging small protests.

A ‘GRADUAL EROSION’ OF ABORTION ACCESS

While only a proposal for now in Kaliningrad, private clinics elsewhere have begun to stop providing abortions. Nationwide, the Health Ministry has drawn up talking points for doctors to discourage women from terminating their pregnancies, and new regulations soon will make many emergency contraceptives virtually unavailable and drive up the cost of others.

“It’s clear that there is a gradual erosion of abortion access and rights in Russia, and this is similar to what has taken place in the U.S.,” said Michele Rivkin-Fish, an anthropologist at the University of North Carolina at Chapel Hill.

Last year's U.S. Supreme Court decision rescinding a five-decade-old right to abortion has reshaped American abortion policy, shifting power to states. About half of U.S. states have adopted bans or major restrictions, although not all are being enforced due to legal challenges.

In the Soviet Union, abortion laws meant that some women had the procedure multiple times due to difficulties in obtaining contraceptives.

After the USSR's collapse, government and health experts promoted family planning and birth control, sending abortion rates falling. At the same time, laws allowed women to terminate a pregnancy up until 12 weeks without any conditions; and until 22 weeks for many “social reasons,” like divorce, unemployment or income.

That changed under Putin, who has forged a powerful alliance with the Russian Orthodox Church, promoting “traditional values” and seeking to boost population growth. Health Minister Mikhail Murashko has condemned women for prioritizing education and career over childbearing.

WAITING PERIODS, CONSULTS, APPROVAL BY A PRIEST

Over the decades, the number of abortions in Russia fell from 4.1 million in 1990 to 517,000 in 2021.

Only in instances of rape is an abortion legally allowed between 12 and 22 weeks. Some regions hold “Days of Silence,” when public clinics don't provide them. Women must wait 48 hours or even a week -– depending on what stage of pregnancy -– between their first appointment and the abortion, in case they reconsider. They also are offered psychological consultations designed to discourage abortions, according to state-issued guidelines reviewed by AP.

Health authorities have introduced an online “motivational questionnaire” outlining state support if women continue the pregnancy, according to a state clinic gynecologist who was not authorized to comment publicly and spoke on condition of anonymity.

She said the waiting periods were psychologically hard for some of her patients. “During that week (of waiting), she might start getting nauseous and experience other symptoms of pregnancy," she added. "They don't understand the point.”

State clinics in one region referred women to a priest before getting an abortion. Authorities maintained the consultation was voluntary, but some women told the media they had to get a priest to sign off to get an abortion.

RESTRICTING ABORTION PILLS

The anti-abortion push comes as Russian women appear to be in no rush to have more children amid the war in Ukraine and economic uncertainty. Sales of abortion pills in 2022 were up 60%, according to Nikolay Bespalov, development director of the RNC Pharma analytical company. They fell 35% this year, still higher than pre-2022 levels. Sales of contraceptive medications also have been rising in 2022-23, he said.

A recent Health Ministry decree restricted circulation of abortion pills, used to terminate pregnancies in the first trimester. The decree puts mifepristone and misoprostol, used in the pills, on a registry of controlled substances requiring strict record-keeping and storage.

For hospitals and clinics, where the pills are usually dispensed, the move will add more paperwork but not much else, said Dr. Yekaterina Hivrich, head of gynecology at Lahta Clinic, a private clinic in St. Petersburg.

But it will affect the availability of emergency contraceptives, sometimes known as morning-after pills, which are taken within days of unprotected sex to prevent pregnancy. Three out of six brands available in Russia contain mifepristone in a lower dose, meaning they'll be severely restricted once the decree takes effect Sept. 1, 2024.

They will require a special prescription, and not all pharmacies will stock them, said Irina Fainman, an activist in the northern region of Karelia, adding that getting a prescription takes time that women might not have when they need the pills.

The Health Ministry did not respond to questions on whether it will exclude morning-after pills in the decree. Officials earlier promised it won't affect those pills, but some pharmacies already list those with mifepristone as available only under strict prescription conditions.

After the restrictions were announced, Fainman said she and other activists stocked up on the pills to distribute in case of shortages.

Sales of emergency contraceptives soared 71% through August 2023, over the same period last year, according to Bespalov. Those containing mifepristone account for about half the market. New measures likely will increase the cost of unrestricted medications and possibly lead to short-term shortages.

ABORTION BANS IN PRIVATE CLINICS

Senior lawmaker Pyotr Tolstoy said that by spring, lawmakers would strive to adopt a nationwide ban on abortion in private clinics, where about 20% took place in recent years, according to state statistics.

Conservative lawmakers failed to enact such a ban before, but the Health Ministry now says it is ready to consider it.

To Irina Volynets, an abortion opponent and children's rights ombudswoman in the Tatarstan region, “it gives hope that this procedure will be taken out of private clinics” eventually. She also wants increased state support for women with children as an incentive for boosting birthrates.

Regional authorities have tried to get private clinics to stop offering abortions, with varying success. Kaliningrad is mulling a region-wide ban. In Tatarstan, about a third of all private clinics no longer provide them, officials said. In the Chelyabinsk region in the Urals, three clinics agreed to halt them.

“It’s important to understand that the pressure on women will be growing” even in the absence of a total ban, said Kaliningrad psychotherapist and activist Lina Zharin, who helped organize the recent bookstore meeting. An online petition against the ban in Kaliningrad has gathered nearly 27,000 signatures.

PRESSURED TO GIVE BIRTH

In seven other regions, the Health Ministry is using another pilot project: having gynecologists try to get women to reconsider having an abortion.

A document obtained by AP and cited by other media outlines language doctors are told to use, including saying pregnancy is “a beautiful and natural condition for every woman,” while an abortion is “harmful to your health and a risk of developing complications.”

Natalya Moskvitina, founder of Women For Life, which aids women who decide against abortion, said she helped develop the instructions and is introducing similar scripts for doctors in several regions.

Moskvitina made headlines in August after the region of Mordovia adopted a law she helped draft to ban “encouraging” abortions. At least one other region is considering a similar ban. Her program, which instructs doctors to congratulate women on being pregnant and gives baby-themed presents and information on support resources, has driven the abortion rate down 40% in Mordovia, she and local officials said.

For women with doubts about abortion, such conversations might indeed help them reach a decision but for others, they could be deeply uncomfortable.

Olga Mindolina was contemplating an abortion in 2020, traumatized by an earlier, difficult pregnancy. But when a doctor in a state clinic in the western city of Voronezh asked her what she wanted to do, she said she didn’t know -– and was told, “In this case, you should give birth.”

A clinic psychologist told her that women sometimes regret abortion, advising her to talk to her husband. A lawyer also told her about state benefits she could get if she gave birth. Mindolina decided to continue the pregnancy.

Anastasia, a Muscovite who sought an abortion in 2020, said it “wasn’t very pleasant” when a doctor urged her to change her mind.

“I simply don’t want any children,” she told AP, asking that her last name not be used for fear of reprisals.

Dr. Lyubov Yeroveyeva, a gynecologist who spearheaded family planning projects in the 1990s, believes the key is preventing unwanted pregnancies with education about birth control and making contraceptives widely available.

Instead of talking a woman out of an abortion, authorities should “do everything so she doesn't have to seek one,” she said.