ContraceptionandAbortionsinRussia

Vera Nikolayevna Prilepskaya

Professor, DMedSc,President of the Russian Society of Contraception.

Deputy Director for scientific activities at FSBI“Kulakov Federal Research Center for Obstetrics,

Gynecology, and Perinatology”Ministry of Health of the Russian Federation

Population of Russia - 146 349 142

Female population - 78 546 066 (53.7%)

РоссияRussia

Dynamics of the Rate of Abortions in Russia(Absolute Values)

Years Number in mln.1992 3.602004 1.782005 1.672006 1.412007 1.302008 1.242009 1.162012 0.932013 0.882014 0.812015 0.75

Ministry of Health of the Russian Federation“Key figures of obstetric and gynecological care in 2016”.

It is seen from the slide that the rate of abortions in Russia is decreasing annually.

In 2015,therewasregisteredadecreaseinnumberofabortionsby 8.3% as

comparedto2014

Ministry of Health of the Russian Federation“Key figures of obstetric and gynecological care in 2016”.

StructureofAbortionsinRussiaAbortiononrequesttakes1stplace(59.8%),Spontaneousabortiontakes2ndplace(31.7%),Abortionduetomedicalreasonstakes3rdplace(3.6%),Socialreasonsforabortiononthe4thplace(0.004%),Criminalabortion– 5thplace (0.02%).

• Decreaseintotalnumberofabortionsin2015hasoccurredduetodecreaseinnumberofabortionsonrequestfrom511799 in2014to446716in2015.

Medication-InducedAbortionAnnual increase of rate of medication-inducedabortion in the structure of abortions on requesr isworth noticing.

• 2010 - 4.87%• 2011 -6.27%• 2012 -8.23%• 2013 -12.26%• 2014 -16.0%• 2015 -19.4%

Agestructureofwomenwhounderwentanabortionin2015

• Girls below 14 visit a medical institution for thepurpose of termination of pregnancy with mother ora guardian, who give their consent for termination ofpregnancy.

• Pregnancy is terminated in gynecology departmentof the hospital after 2-stage consultations by boardof doctors with involvement of psychologist andobservation of standard “days of silence”.

• At discharge from an in-patient hospital, these girlshave a consultation on issues of contraception andreceive hormonal contraceptives free of charge.

Use of Modern Methods of Contraception in Russia(in %tothenumberofwomenofchildbearingage)

Types of contraception

1992 2003 2004 2005 2006 2007 20082009 2010 2011 2012 2013 2014 2015

Hormonal Contraception

2.1 8.4 8.8 9.3 9.8 10.8 10.8 11.2 12.5 11.9 12.3 12.5 12.8 14.3

IUD 15.8 14.3 14.0 13.6 13.5 13.3 13.1 12.8 12.8 12.3 12.4 12.0 11.5 10.2

Ministry of Health of the Russian Federation“Key figures of obstetric and gynecological care in 2015”.

.

Russia has one of the highest rates of traditional contraception methods: calendar method and coitus

interruptus: 34% (10% in the developed countries)

Distribution of the most frequently used contraception methods, in %

Source: internet survey in five countries including Russia (1510 respondents of both sexes) INCITE (July 2012)

AllmethodsofcontraceptionrecommendedbyFDAareavailableinRussia,includinginnovativedrugswithvariouscompositionandvariousdosageregimens:

• LARCuse• Emergencycontraception• Pills• Releasingsystems• Hormone-releasingSystemIUS

• Emergency contraception is an important

method in reducing the number of unplanned

pregnancies and abortions. The emergency

contraception means administration of the drug

containing levonorgestrel 1.5 mg (Eskapelle,

Gedeon Richter). Every year 10% of women in

Russia use emergency contraception.

Family and Demographic Policy in Russia:

Nowadays, muchisbeingdoneinRussiatoincreasebirthrate,preventabortions,introducemodernmethodsof

contraceptionandtoimprovefemalereproductionhealth.

Family and Demographic Policy in Russia:

• Setupofperinatalcenters• Setupof“healthcenters”• Attentiontotheyoungergeneration• Improvementofcouplecounselingsystem• Introductionofnewcontraceptionmethods• Improvementofphysicians’ trainingandpopulationeducation

• Developmentofinternationalcollaboration

CHOICE of contraception in Russia

HighlevelofabortionsandunintendedpregnanciesinRussiapredefinesthenecessityofcounselingonsafeandeffective

contraceptivechoice.

Counselingisthedeterminingfactorincontraceptivechoice.

Austria

CzechRepublic

Slovakia

Israel

Poland

Russia

Ukraine

Belgium

Switzerland

Netherlands

Sweden

Germany

3,250women 1,850women 19,000women

CHOICE – ContraceptiveHealthResearchofInformedChoiceExperience

Egarter C., Frey Tirri B., Bitzer J., Prilepskaya V. et al. Women’s perfections and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling BMC, Women’s Health. 2013.Vol. 13. No.1. P.9.

StepsofCounselingStep1– clarificationoflastcontraceptionexperienceStep2 – analysisofrisksinaccordancewithWHOMedicaleligibilitycriteriaforcontraceptiveuse,anamnesisStep3 – counselingaboutvariousdosageregimenofcombined

hormonalcontraception(ifthereweren’tanycontraindicationsatStep2)

Step4 – counseling,individualapproach,individualcontraceptionchoice

Step5 – questionsandanswers.Motivation.

REgIMenR – Risks(WHOMedicaleligibilitycriteriaforcontraceptiveuse,anamnesis)Eg – Everyday,Everyweek,EverymonthdosageregimenI – IndividualapproachМ – Motivationforwoman

30.5

69.534.6

65.4

10.9

89.1

New choiceVaginal Ring – 22%Patch – 5,5%Other method – 3%

New choiceVaginal Ring – 25%COC – 9.6%

New choiceCOC – 5.4%Patch – 2.2%Other method – 22%

CHOICEResultsinRussiaChangesafterCounseling

Majority of women kept loyalty to monthly regimen Egarter C., Frey Tirri B., Bitzer J., Prilepskaya V. et al. Women’s perfections and reasons for choosing the pill, patch, or ring in the CHOICE study: a cross-sectional survey of contraceptive method selection after counseling BMC, Women’s Health. 2013.Vol. 13. No.1. P.9.

Wesupposethatthesechangesofcontraceptivechoicewereduetoprofessionalcounseling.

• Thestudyshowedthatsucheducationalprogramsshouldbeintroducedintoclinicalpracticeandprofessionaladviceoneffectivemethodsofmoderncontraception,whichwillhelptochangepeople'sattitudestotheirreproductivehealth.

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