Mothers and sons: Russia’s attack on abortion access

When General Eisenhower criticised the brutal determination with which Soviet generals spent the lives of their men on the Eastern front, Marshal Zhukov proudly told him that ‘Russian women will birth more.’ With Zhukov’s successors on the Ukrainian battlefield settled into a similarly callous military strategy, the leadership back in Moscow are scrambling for new ways to reverse a rapidly dropping birth rate which is threatening to turn Russia’s long-running demographic decline into an acute social crisis. 

At the heart of the government’s response is the return to traditional family values. One of the central pillars of Russia’s recent Strategy for the Implementation of Youth Policy is ‘advocacy and propaganda of motherhood, fatherhood, bearing multiple children [and] preparation of young people for family life.’ Underpinning the ideological message are generous welfare provisions and tax allowances for large families. 

However, seeing their limited effect, the government is trying other avenues. In the latest bid to make sure more babies are born, the state is subtly chipping away at women’s access to abortion. 

Instead of outright bans, Russia employs targeted regulatory measures and political pressure, exploiting the intricacies of the existing abortion care system. According to Lubov Erofeeva, a World Health Organisation expert, most regional state clinics only offer surgical abortions. As these are swift and require a single appointment, the overstretched and underfunded clinics prefer them to the medical alternative. State clinics also lack time and resources for the demanding tender process for mifepristone and misoprostol — the drugs prescribed to end the pregnancy medically. Private enterprises fill the gap, as the go-to for the less invasive, medical procedure. As such, they are an essential element of reproductive healthcare in Russia. 

In 2023, private clinics faced direct threats of closures for allegedly providing inadequate mental support. Although the ban did not become law, most private clinics in five regions, including Russian-occupied Crimea, have voluntarily given up their abortion provider licenses. Some independent media organisations suggested that this was due to the pressure exerted by the local politicians. Konstantin Skorupsky, the Crimean Minister of Health, confirmed that the regional government steered private clinics towards pausing abortion services to ‘contribute to the improvement of the demographic situation.’ 

Since then, the remaining abortion providers have been offering their services in an uneasy atmosphere of political hostility. 

A new challenge to private clinics, however, emerged in September, when the Ministry of Health added mifepristone and misoprostol to the list of medications subject to stricter accounting, storage, and dispensing regulations. Non-compliance carries a fine of up to 400,000 roubles (£3,000) and license suspension. 

The added layer of red tape is likely to further discourage small state clinics from procuring mifepristone and misoprostol, decreasing the already limited availability of free medical abortions. The main targets of the law, however, are the private clinics. The requirements are intentionally burdensome, designed to catch the businesses out. In such an unfavourable regulatory environment, private clinics have two options – refrain from buying and supplying the medication or risk a probable license revocation for the smallest accounting error. The outcome for Russian women is the same – an immediate reduction of access to medical abortion. 

With private clinics bullied out of operation, state-run clinics are free to use patient education materials and the pre-abortion counselling process to aggressively discourage termination. Anti-abortion bias is evident in information leaflets available on state hospital websites, reminding women ‘of their ultimate purpose – to be a mother.’ 

The state’s strategy may help prove Zhukov right: Russian women will birth more. The question is, will it be out of choice or coercion?