Introduction[1]

During the last several years, the Russian public and Russian policymakers have been becoming increasingly concerned about demographic trends in their country. Russia is currently experiencing unusually high mortality rates from preventable causes (e.g., alcoholism), extremely high induced abortion rates, and fertility rates that are among the lowest in the world. Consequently, the population growth rate in Russia has become negative, life expectancy appears to be decreasing, and the population has been aging rapidly. The evidence now available on these changes has led a number of observers to call the present situation a "demographic crisis." The public and the government are concerned about the detrimental effects that demographic trends may have on economic reform and development--for example, how a shrinking working-age population will support a growing number of elderly and the demands that the latter will make on the social safety net. Policymakers and demographers in Russia are eager to learn more about the causes and likely social and economic consequences of these demographic changes so that they can define appropriate domestic policy options as the reform process proceeds.

Under the Soviet system, Russian researchers were discouraged from studying behavioral and social causes of demographic phenomena. Therefore, until recently, much of Russian demographic research has focused on description and measurement issues, often with applications to historical information on the earlier parts of this century.[3] While recent Russian demographic research goes a long way towards documenting the existence of worrisome demographic phenomena, to date that work has been largely descriptive. The current situation demands a refocusing on the more recent years and efforts to understand the reasons underlying the observed demographic phenomena and the types of policy options that might be most effective in dealing with them.

The six papers in this volume reflect the current state of knowledge in two broad categories: (1) fertility and family planning; and (2) issues in the area of health and mortality--health status, health care, and population aging. Together these phenomena affect the size, composition, health needs, and growth rate of the Russian population. The commentaries that follow each of these papers summarize the main points of discussants at the conference who undertook to compare the data, research design, and substantive findings of the papers with those of analagous studies in other setttings (typically the United States) and sought to identify ways in which the Russian work could be extended to understand the behaviors underlying demographic trends and patterns and to address issues that are of interest and concern to Russian policymakers.

The first paper of the conference, by Dr. Anatoly Vishnevksy, Director of the Center for Demography and Human Ecology, gives an historical overview of Russia's demographic trends, concentrating on the modernization of the family, fertility decline, and immigration. He notes that the changes that the Russian family has undergone in recent decades have undermined traditional family patterns and produced alternative forms, such as single-parent families and unregistered cohabitation. Considering the decrease of Russian fertility, Dr. Vishnevsky notes that the current low fertility levels are normal for a developed country, albeit the most recent precipitous fertility decline was probably triggered by the economic hardships. Finally, the growing net immigration flow into Russia from other former Soviet republics is a direct continuation of the trend that emerged in the late 1970s, although the size of this flow increased dramatically after the collapse of the Soviet Union. While noting that Russia presently lacks an adequate infrastructure to receive and accommodate immigrants, Dr. Vishnevsky stresses that large immigration could offset the negative natural growth of the Russian population. He notes that, in general, the erosion of the traditional family, low fertility, and increased immigration should not be seen as signs of a demographic crisis. However, in Russian ideological debates, these phenomena are often exploited for political purposes. Many Russian politicians depict them as direct consequences of reform and even of a conspiracy against the Russian nation.

The next paper, by Drs. Sergei Zakharov and Elena Ivanova, considers fertility trends in Russia. Not unlike western nations, Russia has undergone a demographic transition from high fertility and mortality to relatively low fertility and mortality. The path of fertility (and mortality) change in Russia, however, has been different from developed countries in the last two decades. In contrast to other countries, age at marriage in Russia has been constantly decreasing and most reproductive activity is now concentrated in the relatively early ages. Pro-natalist policy measures enacted by the Soviet government in the 1980s led to an increase in fertility rates in the mid-1980s, owing largely to a rise in the number of second births. However, this fertility increase was short-lived. As the financial advantages of the government measures were swept away by inflation and the economic hardships of the early 1990s, fertility, which in any case is rarely affected by such measures on a long-term basis, dropped to one of the lowest levels in the world. Drs. Zakharov and Ivanova concede that the present state of fertility in Russia is not necessarily anomalous and may be the normal outcome of a longtime trend that has brought Russia to the beginning of what is often called "second demographic transition"--a fertility decline to below-replacement levels associated with greater individualism and less interest in childbearing. Nevertheless the role of the current economic crisis should not be ignored. Although a two-child family remains the ideal for most Russians, due to economic difficulties many families now postpone the second birth.

The third paper in this volume, on family planning in Russia, is by the late Dr. Andrej Popov, who tragically died several months before the conference; the paper was presented at the workshop by Dr. Zakharov. The paper notes that the incidence of abortion in Russia is by far the highest in the world. The unavailability of efficient contraceptives and the official legitimization of abortion have led to the formation of an "abortion culture," in which abortion has become the main, if not the only, method of birth control--readily available free of charge in virtually all clinics and often performed in improper hygienic conditions and even without anesthesia. The concentration of women's reproductive activity in early ages is also linked to abortion, according to Popov: Women try to achieve their desired number of children in young age and then abort all subsequent unwanted pregnancies without fear of secondary sterility and other reproductive complications that are often caused by frequent abortions. Only in recent years, as the availability of effective contraceptives has increased and the negative effects of abortion have been openly discussed in the media, have abortion rates begun a slow decline.

The next paper, by Drs. Vladimir M. Shkolnikov and France Meslé, is on the epidemiological situation and mortality in Russia. The dramatic worsening of the epidemiological situation and the sharp drop of life expectancy are the most unequivocal signs of the Russian demographic crisis. The first negative trends in the dynamics of mortality in Russia and the Soviet Union appeared in the mid-1960s when, after decades of a steady increase, life expectancy stalled. The second half of the 1980s witnessed an apparent improvement in life expectancy that Drs. Shkolnikov and Meslé, and some other Russian scholars, attribute to the effects of the anti-alcohol policy. However, the improvement was as short-lived as the campaign that triggered it, and by 1993 mortality was rising again. Today, as before, Russia holds two somber records: the lowest life expectancy among males for a developed country in peacetime (59 years) and the largest gap between male and female life expectancy in the world (13 years). The data presented by Drs. Shkolnikov and Meslé show that the recent mortality increase has been especially dramatic among working-age men. When the mortality rate is disaggregated by the cause of death, it becomes obvious that deaths from accidents, violence, poisoning, and other non-natural causes are primarily responsible for the latest rise in mortality. Although death rates from chronic and degenerative diseases have also risen, reflecting the poor state of the country's health care, these changes are generally comparable to those elsewhere in Eastern Europe.

The next paper, by Dr. Boris Rozenfeld, discusses the state of the health care system in Russia--a topic that has also been at the center of both Russian public attention and political debate. Although the existing health care problems were not created by the current socio-economic crisis, they have been greatly aggravated by the breakdown of the old system. In the Soviet era, virtually all health care was provided free by the state-run health sector, which emphasized the quantity of medical personnel and facilities over the quality of services and pursued goals set on the basis of political ambitions rather than on objective medical needs and economic capabilities. As the command economy crumbled, the public health sector plunged into a deep financial crisis. The budget resources currently allocated to health care are hardly sufficient to pay the salaries of the sector workers, and there is virtually no money left for drugs or equipment maintenance and replacement. As a result of the dire crisis of the health care system, the health status of the Russian population is worsening, and many diseases that were long thought to be eliminated or controlled are now spreading again. Faced with this situation, the Russian government has attempted to reform the health care sector through decentralization, marketing of services in state-owned facilities, and the promotion of the private medical sector. One of the central goals of the reform is the establishment of obligatory health insurance financed through taxation and operated by both the state and private sectors. However, the reform has not yet produced any noticeable results. Russian citizens are used to receiving free care and are unwilling, and very often unable, to pay for the services. Besides, reform efforts often encounter strong political and administrative resistance. Dr. Rozenfeld contends that, under the current Russian conditions, the state has to maintain a prominent role in the regulation and provision of health care. At the same time, reform policy should seek a politically feasible and economically sound mix of public and private health sectors.

The final paper of the conference, by Dr. Sergei Vassin, focuses on two interrelated issues--population growth and aging in Russia. Today Russia is experiencing rapid population aging that will accelerate in the next two decades. The patterns and trends of population growth and aging in Russia have been strongly affected by such catastrophic events as the two world wars, the civil war, and famines. These catastrophes have distorted the population age-sex structure. For example, due to huge losses during the World War II, Russia has the lowest male-to-female ratio in the world, especially among the elderly. The irregularities of the age-sex pyramid will have an impact on the rate of population growth and aging for several decades. Dr. Vassin stresses that the age-sex structure of the population affects such vital spheres of society as kindergarten and school enrollment, employment, and retirement. He suggests that the state should try to smooth the population age structure by offering pro-natalist incentives when smaller birth cohorts enter the childbearing phase. He notes, however, that the current economic crisis significantly limits the government's ability to influence population growth and also exacerbates the problems of the elderly. The retired population is growing, while the financial resources the state allocates for its needs are dwindling. With the declining real value of pensions and the rising costs of health care, the Russian elderly are among the most economically vulnerable social groups.

The papers in this volume raise provocative questions about the interrelations between economic reforms and demographic trends in Russia. On the one hand, some of these trends appear to reflect a reaction to, or catch-up from, policies that were instituted in the 1980s and have since been abandoned. For example, the current decline in fertility appears to be partially due to the fact that, in the 1980s, pronatalist policies caused couples to have a second child sooner than they would have otherwise; they are now returning to a slower pace of child-bearing. Similarly, some portion of the current increase in adult male mortality appears to be a result of the postponement of the deaths that did not occur during the anti-alcohol campaign of the 1980s. On the other hand, these policy changes do not seem to account for all of the recent demographic changes. Further research is needed to disentangle the effects of earlier policies, current reforms, and other factors in explaining Russia's unique demographic patterns.

[2]Julie DaVanzo is Director of the RAND Center for the Study of the Family in Economic Development.

[3]In July 1992, in a paper entitled, "A Conceptual Plan for Support of Demographic Research and Training in the Former Soviet Union," Dr. Anatoly Vishnevsky, Director of the Russian Center of Demography and Human Ecology, wrote:

"During the postwar decades, scholarly and policy-relevant research in demography developed rapidly in the Western countries. . . . (D)emography assumed an important place among the other social sciences and substantially contributed to governmental policy planning and the formulation of public opinion. In developing countries also, the importance of accurate information about the population and analysis of this information assumed a growing role in policy planning in new nations. . . . In the Soviet Union, demography moved in the opposite direction. This was due to a lack of interest by Soviet authorities in practical information for policy planning."