As few as one in four Russian babies are born totally healthy, and their mothers aren't feeling much better. In Part 4 of our look at the state of health care in the former Soviet bloc, RFE/RL correspondent Kathleen Knox finds that the reasons behind the poor health of Russia's infants are the same as those killing off its population -- a mix of poverty, unhealthy lifestyles, and ecological factors.
Prague, 22 March 2002 (RFE/RL) -- Russia's demographic decline is well known. People are dying faster than they're being born. The country is shrinking by about 750,000 people a year. If current trends persist, some demographers think the population could shrink by up to one-third -- from today's 144 million -- within the next 50 years.
As if that picture isn't gloomy enough, as few as one in four babies is born healthy, and around three-quarters of women suffer some sort of illness during their pregnancies.
Hans Troedsson is head of child and adolescent health and development at the World Health Organization (WHO), which this week held a conference on child health in Stockholm. On the phone from the conference, he told RFE/RL the simple reason why it is so important to give children a healthy start in life.
"It's an investment. If we don't invest in our children, which starts with the newborn, we will not make progress. And it's not just for the children to survive. It's also to develop to their full potential. We want healthy children. We want children who have good ability and capacity to learn because they are the future. They are the ones who are going to take over. They are our future leaders, engineers, doctors, workers, who are going to move ahead. So it also has a more practical reason, why we have to start with the newborns," Troedsson said.
Russia's problem is not high infant mortality -- at around 17 deaths per 1,000 live births, it's about double that in developed countries but better than most of the other republics that comprised the former Soviet Union. The problem in Russia is the poor start in life that many of these babies receive, and the poor health of their mothers.
The reasons are the same as those driving the country's demographic decline -- poverty, unhealthy lifestyles, overwhelmed health-care systems, and environmental pollution. Official statistics show that these children are also growing into unhealthy adolescents, which only exacerbates the country's health problems.
The figures vary depending on your definition of healthy. Neo-natologist Irina Ryumina says more than 50 percent of newborns are unhealthy, though she acknowledges this figure encompasses various minor problems. Asphyxia, pulmonary diseases, sepsis and hemolytic diseases and congenital anomalies -- especially of the heart -- are common.
"The morbidity of mothers in Russia has also grown. That's the ill health of women who gave birth to these babies. So there's a biological factor [involved]," Ryumina said.
Murray Feshbach is a prominent U.S. demographer specializing in Russia. He paints a gloomier picture than Ryumina and says that only 28 to 30 percent of newborn babies in Russia fit the definition of healthy, that is, suffering from no complications in the birth process. He says that 10 years ago, that figure was 35 to 40 percent.
In large part, Feshbach says, the situation has gotten worse because of problems experienced during pregnancy by a growing number of women. A common problem is anemia, which can slightly increase the chances for premature birth. Another is pre-eclampsia, or toxemia, which can appear suddenly in late pregnancy and is potentially fatal for both mother and child. Kidney diseases and sexually transmitted diseases are also on the rise.
"The percentage of women who have anemia during pregnancy has increased as a rate per 1,000 by six to eight times, and that's mostly I believe due to malnutrition, not due to frequency of birth like it would have been in Tajikistan or Turkmenistan, with the birth interval [there] being relatively short. However, here you have a different story. You have an issue of the quality of the food package, shall we say. Then again, you have issues of growing drug addiction, growing STDs [sexually transmitted diseases], as I said. The rate of 10- to 14-year-old girls -- it's a terrible statement I'm going to say -- who have contracted syphilis has officially gone up by 60 to 70 times in the past decade," Ryumina said.
It stands to reason that poor mothers are less likely to remain healthy during pregnancy, says Inga Grebesheva, the director of the Russian Family Planning Association. But she says there are no figures to prove it.
"There is no research on this here [in Russia]. But [there] has been research into the ill health of the population in general, according to income group. Of course, those who earn more, their health is better. I can say with confidence that a woman who doesn't eat properly, of course it has an impact on the health of her children. And apart from that, these women don't have the opportunities to get treatment and don't even know about their illnesses, including STDs. So of course logic says it's like this, but to give you data from research, I can't do that because there isn't any yet," Grebesheva said.
Environmental pollution is also taking its toll, with congenital anomalies and miscarriages more common in polluted areas.
The high number of abortions in Russia also affects the ability of women to have healthy, wanted pregnancies. Thanks to federal family planning programs and an increase in contraceptive use, the number of abortions in Russia dropped from 3.5 million in 1992 to 2.1 million in 2000. But Russia still has one of the highest abortion rates in the world. Nearly two out of three pregnancies end in abortion, and the average Russia woman will have two to three abortions in her lifetime.
Grebesheva of the Russian Family Planning Association: "Here, there's a very high percentage of complications after an abortion, probably higher than in Western European countries. Therefore, you have these infections, disruptions of the menstrual cycle and disruptions of the ability to conceive."
Demographer Feshbach says reducing the number of abortions even further is key if the health of Russia's women -- and that of the babies they do bring to term -- is to improve.
"Obviously, education is one issue. But that takes a long time to implement, when I want to turn things around in terms of teaching people to have safe sex in Russia, when the men don't give a damn and tell women just go have an abortion, and the only rule in the past used to be no more than one abortion every six months in a hospital. But there were a lot of illegal abortions or self-induced [abortions] and that affected the women's health condition, lives, potential for more children, etc., especially when you had lots and lots of abortions," Feshbach said.
Grebesheva offered a wish list of measures she says would help: "Bearing in mind that the birth rate is shrinking, I think the situation as regards the health of newborns and pregnant women is dire. The value to the country of each child is considerable, not in terms of money but in terms of the future generation. Now what's needed is to improve clinics for pregnant women, to provide them with food -- we have so few pregnant women that every region, every city can do this from their internal budget -- and provide for the treatment of all diseases that are discovered before or during pregnancy and that can be treated."
But Russia is poor, and Grebesheva acknowledges these are radical opinions. Public spending on Russia's overwhelmed, out-of-date and decaying health-care system shrank by perhaps one-third between 1991 and 1998 -- hyper-inflation of the early 1990s and the 1998 economic collapse make the actual figure hard to calculate -- and the regional system of mandatory medical insurance funds hasn't quite filled the gap.
The World Health Organization estimates that Russia now spends $251 per person per year on health care, compared with almost $1,700 per person per year in the European Union. Russia ranks 130th in the world for overall health system performance.
Last autumn, State Duma deputies asked the government to fund a "Healthy Child" program to improve, among other things, the health of newborns and pregnant women. Last week, the government instructed the Labor Ministry to draw up a federal program for the next four years entitled "Children of Russia," which will encompass the "Healthy Child" project. Russian Health Minister Yurii Shevchenko says a health survey of all children under the age of 18 will begin on 1 April.
In the meantime, Grebesheva said even education on reproductive health is lacking for young people, adding: "We're waiting for things to get worse."