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New estimates of adequacy of official abortion statistics in Russia

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New estimates of adequacy of official abortion statistics in Russia New estimates of adequacy of official abortion statistics in Russia Presentation Transcript

  • New estimates of adequacy ofofficial abortion statistics in RussiaBoris Denisov (Moscow State University, Russia)Victoria Sakevich (National Research University “Higher School of Economics”, Russia)This study comprises research findings from the project“Reproductive health characteristics based on the RLMS-HSE”,research grant No 12-01-0076, carried out within The NationalResearch University “Higher School of Economics” Academic FundProgram in 2013/2014The First International«Russia Longitudinal Monitoring Survey of HSE»User ConferenceMoscow, Russia, 17-18 May 2013
  • Content1. Official abortion statistics in Russia2. Suspicious adequacy of these statistics3. Evidence from sample surveys4. What’s new ?5. Why it is important, and what for?
  • Abortions in the old Soviet Union andcontemporary Russian Federation• Legal 1920-1936, and 1955-now (total=74years)• Case reporting system (providers’ reports)• Ministry of Health – major provider• Other providers, including private• Statistical Agency, currently Rosstat
  • Abortions’ data before 1936In 1927 TsSU published twodetailed analytical reports:1. Abortions in 1925, and2. Abortions in 1926The next publication appearedin 1988From 1920 to 1936 abortionindicators skyrocketedModern contraception hadnot appeared yet.Data source for the pic = В. В. Паевский, 1929; ЦГАСПб, Ф.4965, оп.3, д.2, л.2. 10.
  • Recent abortions’ dynamics in Russia
  • Compare: Belarus, Russia, and Ukraine
  • Suspicious completeness• Almost all Soviet statistics are suspicious, thetradition of disbelief is longer than 94 years• The concept of “abortion culture” made theincompleteness of count a common place• The idea of undercount likely stemmed from thefirst sample surveys, which showed TAR at a level15-16• Major supporting source – medical communityand anecdotic evidence (experts’ stories)
  • Yet another data sourceThere are at least two independent estimates ofabortions’ statistics completeness:• Based on RLMS data (started since 1992)(Kozyreva, Entwisle, 1997)• Three regional surveys (1988/1989, 1996, and2000)(Philipov et al, 2004)
  • Entwisle B, Kozyreva P.New estimates of induced abortion in RussiaStud Fam Plann. 1997 Mar; 28(1): 14-23General abortion rate, 1994 = 56 (±12) per 1000women 15-44!!! = an estimate varies from that advanced byofficial sources and other studies (PubMedabstract)✔ New estimate is significantly lower than theofficial (in text)
  • Philipov, D., Andreev, E., Kharkova, T. and Shkolnikov, V.Recent Trends in Induced Abortions in Russia and Under-Reporting in Surveys.European Journal of Population, 2004, 20(2): 95-117.Authors:… survey estimates of the crude, total, and age-specific abortion ratesemerge to be very close to respective figures from provider statistics forabout two years preceding each survey…provider statistics on abortion inRussia are a true reflection of the situation they monitor, that the observeddeclining trend in abortion is a real oneHowever AGI:Abortion statistics for …Russia… were deemed complete in 2003 butincomplete in 2008. The proportion of abortions in Russia that are privatelyperformed and unreported is increasing, according to experts and publishedresearch. (G Sedgh, S Singh, SK Henshaw, and A Bankole, Legal AbortionWorldwide in 2008: Levels and Recent Trends, Perspectives on Sexual andReproductive Health, 2011, 43(3): 188–198)
  • Indirect evidenceData from two nationally representative populationsurveys, conducted in Ukraine in 1999 and2007, showed quite good matching with officiallyreported abortion figures.Levchuk NB, Perelli-Harris B (2009)Declining fertility in Ukraine:What is the role of abortion and contraception?MPIDR Working Paper, WP 2009-045, December 2009.
  • The debate is far from being complete• The 19th round of RLMS provided newopportunities• RLMS became RLMS-HSE, thus moreresearchers obtained access to these data• Probably an access to the data from previousrounds (?) will be granted
  • The 19th RLMS-HSE round containsmodule on reproductive healthThere are two related questions:• Number of abortions in previous 12 moths,and• Life long number of abortions• + Questionnaire discriminates various types ofpregnancy termination: live/still births,miscarriages
  • Have you ever made an abortion ?• Of all women 58% had at least 1 abortion• For women born before 1976 = 69%• after 1976 = 38%Starting from cohort of women born in 1976 andyounger proportion of those who had nevermade an abortion is greater than of those whohad that experience
  • Number of abortions in last 12 months• 2.5 per cent of women of reproductive age (15-49) answered that they had an induced abortionin the last 12 months.• About 6 per cent made more than one abortionduring this year• Thus the abortion rate in these 12 months was26.9 per 1,000 women of reproductive age.• In 2010 Rosstat reported induced 27.1 abortionsper 1,000 women of reproductive age.The survey data and government statistics are veryclose, almost identical.
  • More from previous 12 monthsTotal abortion rate:• RLMS = 0.90• Rosstat, 2010 = 0.92 (without spontaneous)Percentage of abortions performed outside MoHfacilities• RLMS = 12.7%• Rosstat, 2010 =10.9%(without spontaneous and so called unspecified)
  • Thus four estimates based on variousdata confirm official reportsAuthors (data source), year Estimate Official figureKozyreva, Entwisle (RLMS), 1994 44-68 73Philipov, et al (three surveys), 1987, 1995, 1999 124, 76, 61 125, 77, 66Denisov, Sakevich (RLMS-HSE), 2010 27 27
  • The importance of being sober• 2011 experience• Current Mizulina initiatives (draft state familypolicy)All based on faked dataFinally, in addition to various advocacy we mustknow the real thing.
  • ConclusionOfficial Russian abortions statistics are complete,but are not adequate for(1) planning interventions in order to improve reproductivehealth, and(2) To avoid unwanted pregnanciesWe expect more from Rosstat:• Urban/rural breakdown + other social and economicindicators• More detailed age distributions• Distributions by order (birth, abortion, pregnancy)Publishing more detailed (beyond count) statistics Rosstatwill undermine the myth of incompleteness.
  • Thank you for your attentionBoris DenisovMoscow State University, Russiadenisov@demography.ruVictoria SakevichNational Research University “HigherSchool of Economics”, Russiavsakevich@hse.ru