New estimates of adequacy of official abortion statistics in Russia

Boris Denisov (Moscow State University, Russia)Victoria Sakevich (National Research University “Higher School of Economics”, Russia)

This study comprises research findings from the project “Reproductive health characteristics based on the RLMS-HSE”, research grant No 12-01-0076, carried out within The National Research University “Higher School of Economics” Academic Fund Program in 2013/2014

The First International «Russia Longitudinal Monitoring Survey of HSE»

User Conference Moscow, Russia, 17-18 May 2013

Content

1. Official abortion statistics in Russia2. Suspicious adequacy of these statistics3. Evidence from sample surveys4. What’s new ?5. Why it is important, and what for?

Abortions in the old Soviet Union and contemporary Russian Federation

• Legal 1920-1936, and 1955-now (total=74 years)

• Case reporting system (providers’ reports)• Ministry of Health – major provider• Other providers, including private• Statistical Agency, currently Rosstat

Abortions’ data before 1936In 1927 TsSU published two detailed analytical reports:1. Abortions in 1925, and2. Abortions in 1926The next publication appeared in 1988

From 1920 to 1936 abortion indicators skyrocketed Modern contraception had not appeared yet.

Data source for the pic = В. В. Паевский, 1929; ЦГА СПб, Ф.4965, оп.3, д.2, л.2. 10.

Recent abortions’ dynamics in Russia

Compare: Belarus, Russia, and Ukraine

Suspicious completeness• Almost all Soviet statistics are suspicious, the

tradition of disbelief is longer than 94 years• The concept of “abortion culture” made the

incompleteness of count a common place • The idea of undercount likely stemmed from

the first sample surveys, which showed TAR at a level 15-16

• Major supporting source – medical community and anecdotic evidence (experts’ stories)

Yet another data source

There are at least two independent estimates of abortions’ statistics completeness:

• Based on RLMS data (started since 1992)(Kozyreva, Entwisle, 1997)• Three regional surveys (1988/1989, 1996, and

2000)(Philipov et al, 2004)

Entwisle B, Kozyreva P.New estimates of induced abortion in RussiaStud Fam Plann. 1997 Mar; 28(1): 14-23

General abortion rate, 1994 = 56 (±12) per 1000 women 15-44!!! = an estimate varies from that advanced by official sources and other studies (PubMed abstract)✔ New estimate is significantly lower than the official (in text)

Philipov, D., Andreev, E., Kharkova, T. and Shkolnikov, V. Recent Trends in Induced Abortions in Russia and Under-Reporting in Surveys. European Journal of Population, 2004, 20(2): 95-117.

Authors:… survey estimates of the crude, total, and age-specific abortion rates emerge to be very close to respective figures from provider statistics for about two years preceding each survey…provider statistics on abortion in Russia are a true reflection of the situation they monitor, that the observed declining trend in abortion is a real one

However AGI: Abortion statistics for …Russia… were deemed complete in 2003 but incomplete in 2008. The proportion of abortions in Russia that are privately performed and unreported is increasing, according to experts and published research. (G Sedgh, S Singh, SK Henshaw, and A Bankole, Legal Abortion Worldwide in 2008: Levels and Recent Trends, Perspectives on Sexual and Reproductive Health, 2011, 43(3): 188–198)

Indirect evidence

Data from two nationally representative population surveys, conducted in Ukraine in 1999 and 2007, showed quite good matching with officially reported abortion figures.

Levchuk NB, Perelli-Harris B (2009) Declining fertility in Ukraine: What is the role of abortion and contraception? MPIDR Working Paper, WP 2009-045, December 2009.

The debate is far from being complete

• The 19th round of RLMS provided new opportunities

• RLMS became RLMS-HSE, thus more researchers obtained access to these data

• Probably an access to the data from previous rounds (?) will be granted

The 19th RLMS-HSE round contains module on reproductive health

There are two related questions:• Number of abortions in previous 12 moths, and• Life long number of abortions• + Questionnaire discriminates various types of

pregnancy termination: live/still births, miscarriages

Have you ever made an abortion ?

• Of all women 58% had at least 1 abortion• For women born before 1976 = 69%• after 1976 = 38%

Starting from cohort of women born in 1976 and younger proportion of those who had never made an abortion is greater than of those who had that experience

Number of abortions in last 12 months

• 2.5 per cent of women of reproductive age (15-49) answered that they had an induced abortion in the last 12 months.

• About 6 per cent made more than one abortion during this year

• Thus the abortion rate in these 12 months was 26.9 per 1,000 women of reproductive age.

• In 2010 Rosstat reported induced 27.1 abortions per 1,000 women of reproductive age.

The survey data and government statistics are very close, almost identical.

More from previous 12 months

Total abortion rate: • RLMS = 0.90 • Rosstat, 2010 = 0.92 (without spontaneous)Percentage of abortions performed outside MoH facilities• RLMS = 12.7% • Rosstat, 2010 =10.9% (without spontaneous and so called unspecified)

Thus four estimates based on various data confirm official reports

Authors (data source), year Estimate Official figure

Kozyreva, Entwisle (RLMS), 1994 44-68 73

Philipov, et al (three surveys), 1987, 1995, 1999 124, 76, 61 125, 77, 66

Denisov, Sakevich (RLMS-HSE), 2010 27 27

The importance of being sober

• 2011 experience• Current Mizulina initiatives (draft state family

policy)All based on faked data

Finally, in addition to various advocacy we must know the real thing.

Conclusion

Official Russian abortions' statistics are complete, but are not adequate for (1) planning interventions in order to improve reproductive

health, and (2) To avoid unwanted pregnanciesWe expect more from Rosstat:• Urban/rural breakdown + other social and economic indicators• More detailed age distributions• Distributions by order (birth, abortion, pregnancy)Publishing more detailed (beyond count) statistics Rosstat will undermine the myth of incompleteness.

Thank you for your attention

Boris Denisov Moscow State University, Russia denisov@demography.ru

Victoria Sakevich National Research University “Higher School of Economics”, Russia vsakevich@hse.ru