Doctors evaluated measures to stimulate the birth rate

The majority of physicians surveyed by the professional service “Doctor’s Handbook” have a negative attitude towards the initiatives to increase the birth rate proposed by the Ministry of Health and the State Duma. In particular, 59% of respondents were against restrictions on the free sale of abortion drugs. Doctors believe that this will lead to an increase in criminal abortions, a surge in “medical tourism” and a large percentage of child abandonment. The expert of the Ministry of Health points out that medical abortions should be performed only under the supervision of a doctor, so the restrictions are “justified and aimed at preserving the health of women.”

As Kommersant told, in mid-July, the Ministry of Health decided to update the list of medicines subject to subject-quantitative accounting. Among other things, the agency wants to add drugs for medical abortion: mifepristone and misoprostol. This happened against the backdrop of a United Russia discussion about ways to improve demographics in the country and a statement by Health Minister Mikhail Murashko about the need for “strict control” of such drugs. It is expected that the document will come into force from April 2024. In addition, the agency promises to consider the proposal of a number of deputies to ban abortions in private clinics.

The professional service “Doctor’s Handbook” interviewed 1.6 thousand doctors about their attitude towards such initiatives to increase the birth rate. As the study showed, the majority of respondents (60%) generally negatively assess such measures. The second most popular answer (23%) is a neutral attitude, since such an initiative will never be fully implemented.

In other matters, 45% of doctors believe that only the woman’s opinion should be decisive in relation to abortion, another 33% – that it should be the couple’s decision. As for the means of postcoital (emergency) contraception, 50% of doctors here are in favor of the free choice of a woman, 33% of the respondents are in favor of the agreed opinion of a couple. However, only 5% agreed with the statement that postcoital contraception is essentially a medical abortion and should be banned. On the contrary, 68% believe that this is a method of preventing unwanted pregnancy that is relevant in some cases, so the sale of these drugs should not be tightly controlled.

The proposal to limit the free sale of abortion drugs – mifepristone and misoprostol – is negatively assessed by 59% of respondents, neutrally by 19% and 22% positively. Survey participants were asked to choose several possible options that such measures could lead to. Only 10% said about the decline in the number of abortions and population growth. But 87% of the doctors surveyed believe that this will lead to an increase in the number of criminal abortions, 64% – to an increase in the number of child abandonment, 57% – to an increase in the number of women who will have abortions in other countries, 47% – to an increase in homicides newborns, 44% – to an increase in maternal mortality.

In order to effectively prevent unwanted pregnancies, according to the respondents, large-scale sanitary and educational work with the population is necessary with state support and sufficient funding – this option was indicated by 71% of the respondents. Also, 77.5% chose the option “increasing the income of the population as a whole”; 58% considered it necessary to strengthen financial state support for young families and single mothers; construction of a sufficient number of nurseries, kindergartens, schools was indicated by 57%. State programs on contraception for low-income citizens and the availability of sterilization procedures were mentioned by 55%, legal protection of mother and child – 47.5%. 44% mentioned sex education lessons in schools/vocational schools/universities, and 11.2% of the surveyed doctors suggested transferring the function of preventing unwanted pregnancies to the private sector.

The authors of the study separately interviewed medical professionals whose professional duties include performing abortions – this was 101 respondents (or 6% of the total number of participants). The vast majority (71%) answered that they have an unspoken rule – to convince a woman to continue the pregnancy. 50% always try to convince a woman, even if she came to have an abortion of her own free will; another 43.6% admitted that it depends on the specific situation. And only 5.9% of gynecologists never try to change the patient’s decision.

22% of those who dissuade women act according to the methodology agreed with the leadership; 11% use manuals that are freely available and do not express their own opinion; 67% argue at their own discretion, sometimes from their own practice. At the same time, most doctors (90%) somehow believe that their patients made the right decision by refusing to have an abortion.

Kommersant approached several gynecologists with a request to comment on the survey, but they all refused, saying that the topic has a “political context.” One of the experts, on condition of anonymity, said that “the data obtained by colleagues probably do not fully reflect the true position of doctors, since the answer of an experienced doctor is more complicated and not always unambiguous.” The interlocutor of Kommersant also noted that any ban on the circulation of medicines gradually shifts the sale of drugs to the shadow sector. As a result, statistics are distorted – and decisions that affect the country’s demographic policy are made on the basis of incorrect data. The gynecologist recalled that the position of the World Health Organization does not exclude the free circulation of drugs for medical abortion. At the same time, special attention is paid to fully informing patients who purchase the drug about the risks and actions in case of complications.

Tatyana Kovalchuk, Deputy General Director of AlphaRM (specializes in research in the pharmaceutical industry), emphasized that abortion drugs are already used “exclusively in clinics” – they are already prescription and purchased by a doctor. Changes will only appear in the fact that now special forms will be used for them. However, RNC Pharma Development Director Nikolai Bespalov told Kommersant that misoprostol and mifepristone preparations in dosages intended for abortion are still sold in pharmacies, albeit in small quantities – no more than 2-3% of the total volumes (about 23-25 ​​thousand packs per year). According to him, they can be used both for abortion at home and for gray clinics that perform abortions unofficially.

Natalia Dolgushina, chief freelance specialist in women’s reproductive health at the Russian Ministry of Health, said that the new rules for dispensing drugs for medical abortion will not affect their availability. According to her, in medical organizations, work with such funds is well-established and does not cause any problems. “Medicated abortion drugs can be dangerous when used on their own. That is why their transfer to a drug-quantitative account is completely justified,” said Ms. Dolgushina. “The measure is aimed at preserving the health of women, since consultation and a doctor’s appointment are necessary to prevent the complications of medical abortion.”

Natalia Kostarnova, Ekaterina Rakitina