(June 2001) Kazakhstan, Kyrgyzstan, and Uzbekistan became independent states in 1991. Recent evidence suggests that since the dissolution of the Soviet Union, these three former Soviet Central Asian republics have experienced a decline in induced abortion. Induced abortion, when performed by people lacking the necessary skills or in an environment lacking the minimal medical standards, may damage a woman’s health, diminish her chances for further childbearing, and contribute to maternal and perinatal mortality.
Based on data from the UNICEF TransMONEE database for the period 1989–1997, the abortion ratio (the number of abortions per 100 live births) fell in Kazakhstan (from 78 to 68); Kyrgyzstan (from 66 to 31); and Uzbekistan (28 to 14 from 1990-1998). (The TransMONEE database is a component of a regional monitoring project to monitor the impact on children of the major social and economic upheavals taking place in the countries of Central and Eastern Europe and the former Soviet Union.)
Findings from the 1999 Kazakhstan Demographic and Health Survey (KDHS) also suggest a decline in abortion. According to the KDHS, Kazakhstan has experienced a 22 percent decrease in the abortion rate since 1995 and greater reliance on methods of family planning such as the IUD. This represents an increase in the use of modern methods among currently married women from 46 percent in 1995 to 53 percent in 1999.
Overall, the 1999 KDHS found that 37 percent of all pregnancies ended in abortion; of these, more than 50 percent were preceded by contraceptive failure. This indicates that the availability of more reliable methods might help further reduce the incidence of abortion. In order to reduce the use of abortion in Kazakhstan, the Ministry of Health has promoted the dissemination of contraceptive methods throughout the country for the past decade. One aspect of this strategy has involved opening family planning offices in cities and villages. These offices offer women advice regarding family planning methods and supplies.
While women in all demographic groups in Kazakhstan appear to resort to abortion after contraceptive failure, there is great variability by residence, region, education, and ethnicity. For instance, women living in urban areas terminate 46 percent of their pregnancies whereas women residing in rural areas terminate 28 percent. Finally, women of Russian ethnicity are almost twice as likely to terminate a pregnancy (49 percent) as Kazakh women (27 percent).
In Uzbekistan, 1996 DHS data indicate that induced abortion accounts for 14 percent of pregnancy outcomes. Twelve percent were preceded by contraceptive failure. As in Kazakhstan, women in urban areas are more likely to use induced abortion (22 percent) than women in rural areas (9 percent). In Uzbekistan, women with university-level education are more likely to terminate their pregnancies (23 percent) than those with primary and secondary education (10 percent and 19 percent, respectively). Uzbek women are about half as likely to seek abortion as women of Russian origin.
According to the Uzbekistan DHS, knowledge of contraceptive methods is high among women in Uzbekistan — 89 percent. However, only about half of married women are using contraception; of these women, 46 percent favor the IUD, followed by traditional/folk methods (4 percent), the pill (2 percent), and the condom (2 percent).
Based on 1997 DHS data, in Kyrgyzstan abortion accounts for 27 percent of all pregnancy terminations. In urban areas, pregnancies are twice as likely to end in abortion (42 percent) as in rural areas (21 percent). Among currently married women, 49 percent report using a modern method of contraception; as in Kazakhstan and Uzbekistan, the IUD is the favored method (38 percent).
Women Lack Information About Reproductive Health Issues
Surveys in the three Central Asian countries indicate that women in the region, particularly young women, are often unfamiliar with reproductive health issues. In Uzbekistan in 1996, only 10 percent of women of reproductive age (15 to 49) and 29 percent of women in Kazakhstan in 1995 knew when their fertile period was. The prevalence of contraceptive use also varies widely according to education, socioeconomic status, and residence.
Policymakers in all three countries have publicly stated their support for providing their populations with a broad choice of modern, safe, and effective contraceptive methods. For instance, in-depth interviews with policymakers in Kazakhstan conducted in 2000 indicated that there was widespread concern about the high level of abortion. These policymakers rated it one of the three main reproductive health problems in the country. There was some recognition, however, that the abortion rate had declined somewhat over the past five years. Furthermore, Kazakh policymakers viewed high levels of abortion as impeding the nation’s development and threatening women’s health. These interviews were conducted jointly by a former Kazakh Deputy Secretary of Health and an American social scientist under the MEASURE Communication project funded by the U.S. Agency for International Development.
While abortion remains a highly visible element of the reproductive health profiles in Kazakhstan, Kryzgystan, and Uzbekistan, promising trends such as declining abortion rates and increasing use of contraception may signal advances in preventing unintended pregnancies in parts of Central Asia.
Induced Abortion Primary Form of Birth Control in Soviet Union for Past 40 Years
Upon its legalization in 1955, induced abortion became the primary method of birth control in the Soviet Union because of dissatisfaction with domestically produced condoms and IUDs, opposition to oral contraceptives by health practitioners, and the availability of free abortion services in government facilities. According to researchers with the Alan Guttmacher Institute, by the 1980s, the country had the highest prevalence of abortion in the world. One of every four abortions in the world was performed in the Soviet Union. According to Russian demographer Andrej Popov, since the dissolution of the Soviet Union in 1990, the prevalence of induced abortion has varied greatly among the different republics and regions of the Soviet Union.
Liz Creel is a population specialist with the Population Reference Bureau.