Female reproductive health in Russia: Demographic and behavioral determinants of pregnancy outcomes, contraceptive usage, and repeat abortion.

摘要

Background. Russia has a complicated history of low fertility accomplished largely through a reliance on abortion for birth control. Even after the end of communism, there remain substantial issues surrounding access, supply, and knowledge of modern contraceptives. This thesis investigates how demographic and behavioral characteristics affect pregnancy outcomes, modern contraceptive behavior, and repeat abortion.;Methods. The data for this thesis comes from the second wave of the Russia Longitudinal Monitoring Survey collected between 1996 and 2003. Three different samples were developed; a sample of pregnancies to explore pregnancy outcomes, a sample of fecund women to investigate contraceptive usage, and a sample of ever pregnant women to evaluate repeat abortion. The analysis consists of descriptive statistics as well as a mixture of multivariate regression models.;Results. The results suggest that family formation and fertility decisions are strongly governed by low fertility preferences for only one or two children. The majority of births occur to young mothers and abortion is most frequently employed to limit fertility. Parity and an abortion history have a strong effect on the likelihood of having an abortion versus a birth in subsequent pregnancies. Parity also has a strong positive effect on the likelihood of using modern contraception. In contrast the relationship between the number of previous abortions and modern contraceptive usage is not uniform. Women who have had one to three abortions are more likely to use a modern form of contraception than women who have never had an abortion and women who have had four or more abortions. Parity has a positive effect on the odds of having multiple abortions.;Conclusions. The results of this study imply that abortion remains an important tool for fertility control in Russia. Policy and programmatic efforts should be made to ensure that abortion remains legal while making it as safe as possible. Better long term contraceptive options such as the IUD and sterilization should be made more accessible through post-abortion and post-partum care.