In an increasingly sterile environment

In Russia, the number of sterilization operations for women is increasing and the prevalence of other methods of contraception is decreasing. This follows from the Rosstat data collection “Healthcare in Russia-2023”. Russian women, statistics show, over the past 12 years have begun to give birth less and at the same time have half as many abortions. The only growing category where the number of pregnancy terminations has increased is women 45–49 years old. It also follows from Rosstat data that Russian women are more often diagnosed with malignant neoplasms and less likely to have tuberculosis and alcohol addiction.

The number of sterilization operations (surgical irreversible contraception) of women in Russia at the end of 2022 reached its maximum since 2006 – 15 thousand interventions, or 44.6 sterilizations per 100 thousand women aged 15 to 49 years. This follows from the statistical collection “Healthcare in Russia-2023” published at the end of December, to which the publication drew attention “Medvestnik”.

The last time the figures were higher was in 2006 – more than 17 thousand operations. Then the number of female sterilization operations in Russia steadily decreased, but the trend changed in 2014. After this, a short-term decline was observed only during the COVID-19 pandemic in 2020 – then 12.6 thousand operations were performed.

It should be noted that the increase in the number of sterilization operations occurs against the background of a decrease in the popularity of other types of contraception.

Thus, in 2010, 12.7 out of 100 women aged 15–49 years used intrauterine devices, and in 2022 – 7.3; hormonal contraception – 12.5 and 11.2 women, respectively.

According to the order of the Ministry of Health of the Russian Federation dated December 28, 1993 No. 303, sterilization as a special method of depriving a person of the ability to reproduce or as a method of contraception can be carried out only upon a written application from a citizen who is at least 35 years old or has at least two children, and if there are medical indications and the consent of the citizen – regardless of age and the presence of children. Medical indications include tuberculosis, malignant neoplasms, leukemia, heart defects, schizophrenia and other mental disorders, and some hereditary diseases.

The chief freelance specialist of the Russian Ministry of Health on women’s reproductive health, Natalya Dolgushina, noted that medical sterilization as a method of contraception is extremely rarely used. “Predominantly, this medical intervention is carried out in the presence of medical indications that are incurable and in which subsequent pregnancy has a high risk of death for the woman, for example, end-stage renal failure, chronic heart failure of the third stage, liver failure, etc. In such a situation, a decision may be made to medical sterilization as a surgical intervention that allows you to preserve the life and health of a woman,” commented Mrs. Dolgushina. In general, she assured, experts do not note a significant increase in the number of these interventions.

Corresponding member of the Russian Academy of Sciences, obstetrician-gynecologist Viktor Radzinsky suggested that the increase in sterilizations is associated with the frequency of cesarean sections – after several operations, women have the right to complete reproduction: “And the number of cesarean sections is increasing both throughout the world and here in Russia.” From the Rosstat report it follows that the number of such operations in Russia is really growing: in 2010, there were 22.3 caesarean sections per 100 births, in 2015 – 27.6, in 2019 – 30.1, in 2020 – 30, in 2021 – 30.9, in 2022 – 31.2.

Obstetrician-gynecologist of the Nearmedic clinic Evelina Tagirova confirmed that the demand for the medical sterilization procedure is growing. According to her, there are now several prerequisites for this:

“The level of awareness about the essence of the procedure has increased. Myths about its consequences have been dispelled. Modern technologies make it possible to avoid the risk of lifelong and irreversible refusal to have children. Now, even after sterilization of the fallopian tubes, a woman, if she wishes, can do IVF and give birth to a child.”

Ms. Tagirova noted that not all women are ready to have children for medical reasons, due to their financial situation or other personal beliefs. “Taking expensive hormonal contraceptives is contraindicated for many; there are side effects with long-term use. Of course, you can’t put sterilization and combined oral contraceptives on the same scale, but given a combination of factors, women have become more likely to choose surgery,” said the gynecologist.

Since 2015 in Russia, according to Rosstat, the number of births has been decreasing. In 2015, 1 million 898 thousand births were delivered, and then the figure began to decline: 1 million 440 thousand in 2019, 1 million 356 thousand in 2021, 1 million 258 thousand in 2022.

Against this background, the number of abortions is also decreasing. In 2010, according to Rosstat, 1 million 186 thousand 108 abortions were performed, and in 2022 – 503,809. A noticeable decrease was observed in the age category of 15–17 years (20,597 abortions in 2010 and 3,517 in 2022) and rising rates among women 45–49 years old (5,922 abortions in 2010 and 7,427 in 2022). Women aged 18–44 still account for the largest number of pregnancy terminations, but the decline is also more than doubled: 1,158,771 in 2010 and 492,525 in 2022.

In Russia, we would like to remind you that there has been a discussion about the need to partially limit the availability of abortions in order to thus increase the birth rate. Nizhny Novgorod parliamentarians submitted a bill to the State Duma for consideration, according to which pregnancy termination can only be done in state medical institutions. Patriarch Kirill and a number of political figures spoke out against abortions in private clinics. Speaker of the Federation Council Valentina Matvienko said that abortions in Russia in the future should be carried out only for medical and social reasons.

Rosstat also published general data on women’s health. In recent years, the number of newly diagnosed malignant neoplasms has been increasing. Thus, in 2010, breast cancer was diagnosed in 57.2 thousand women, and in 2022 – in 76.5 thousand; cancer of the cervix, uterine body, and placenta was detected in 34.6 thousand women in 2010 and in 43.9 thousand in 2022. Cases of alcoholism, alcoholic psychosis and tuberculosis, on the contrary, are becoming fewer. Active tuberculosis was first detected in 33.6 thousand women in 2010, and in 14.5 thousand in 2022; alcoholism and alcoholic psychosis – in 35.6 thousand in 2010 and 16.2 thousand in 2022.

The scale of the infertility problem has changed slightly in recent years. In 2010, 201.28 women per 100 thousand women aged 18 to 49 lived with this diagnosis, in 2015 – 278.33, in 2019 – 252.39, in 2020 – 192.52 , in 2021 – 204.06, in 2022 – 203.29.

Natalia Kostarnova