Kazaks Alarmed by Abortion Rate

Monday, 21 February, 2005

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Erbol Jumagulov

Pro-life or pro-choice? Kazakstan is increasingly divided over abortion. It's been legal since the Soviet era, but the sheer number of terminated pregnancies, around 300,000 a year, is leading to growing calls for the practice to be curbed.

The authorities blame this on women's "irrational reproductive" behaviour but the main reason, it seems, is that women simply cannot afford to have children. Out of a population of 15 million, one million are jobless and most of these are women.

Worryingly, half of those who have abortions do so in cheap, illegal clinics, where standards of treatment and care are woefully low.

Although the constitution provides for free health care, budget shorfalls mean people have to pay for many medical services. Clinics generally charge between thirty and fifty US dollars to perform an abortion in a country where the minimum wage is around thirty dollars a month.

It's not surprising, then, that many women opt for backstreet clinics where termiantions cost just ten dollars. The repercussions for women's health are dire. Post-operative deaths are commonplace - so to is infertility, infections and a myriad of other complications. The situation is especially critical among prostitutes - over a third of whom have been through several abortions.

"Abortions are fine with me," said an Almaty prostitute. "At least, it's better than giving birth and then taking your baby to an orphanage because you can't afford to support it."

Sex education and birth control initiatives could help - currently there is only one such programme. Kyzyl Alma or Red Apple counselling service, supported by the government and western cash, has had encouraging results. Since it started, there has been a four-fold fall in the number of abortions among Almaty teenagers, from 2600 operations in 1998 to 650 in 2000.

New legislation intended to spread awareness of sexual issues throughout the education sector seems to have floundered. Once again the problem is money. In addition, hospitals and clinics appear to have little interest in implementing educational programmes on contraception and family planning.

As a result, it is estimated that less than 40 per cent of women in the 15-24 age group use modern family planning methods. Half of abortions are carried out on women in this group. " Although we work hard at counselling and advising our clients, we're still strong suppporters of legal abortions," said Tatiana Makarova at Kyzyl Alma.

The powerful anti-abortion lobby in the country, led by religious groups, appears determined to pressure the government into making it harder for women to get terminations.

"We have no right to deprive a person of life," said Svetlana Shakhnina from an Almaty orphanage. "An abortion is justifiable only if there is a chance that the foetus has congenital syphilis or HIV."

But, even such a diagnosis shouldn't condemn a foetus, argues gynaecologist Margarita Rukhlova. "An HIV-positive woman can still give birth to a healthy child, " she said. " She just needs to have her health monitored by doctors throughout her pregnancy."

Rukhlova says a woman's chance of delivering an HIV-positive child if she adheres to the prescribed course of treatment may be as low as 25 per cent. " So we cannot say an abortion is justified just because the woman is HIV-positive," she said.

However sanitary the conditions in state clinics, one consequence of abortion seemingly cannot be tackled. Thirty per cent of women are rendered infertile by terminations irrespective of the surgeon's prowess - a trend contributing to the country's falling birthrate.

This combined with the rising mortality rate and the emigration of hundreds of thousands of the ethnic Russians and members of the other minority groups - fleeing the country to escape the harsh economic climate - is resulting in a shrinking population. Something Kazakstan, whose 15 million inhabitants live in a country nearly 5 times the size of France, cannot afford.

Nontheless, President Nursultan Nazarbayev appears to be blissfully unaware of the threat, conifidently prediciting that there will be a 25 million increase in the popualtion by 2030.

Taking all these factors into consideration, plans by Alibek Khadji, imam at Almaty's main mosque, to call on the government to consider reversing abortion legislation may well find a ready audience.

Erbol Jumagulov is a freelance journalist in Almaty