“A Planned Baby Is a Rarity:” Monitoring and Planning Pregnancy in Russia

Abstract

Russia provides an interesting case for comparative research of maternity care due to the rapid social change and steep fertility decline since the collapse of the Soviet Union. I analyze out-patient maternity care in public sector women's clinics in St. Petersburg on the basis of qualitative observation and interview data. Gynecologists’ role in monitoring pregnancy is central, resulting in an emphasis on medical expertise and risk management. Ideally, gynecologists see themselves as medical experts and maternal caretakers, but the latter role seldom materializes in practice. Gynecologists’ ideas of pregnancy planning demonstrate a wish for further medicalization of maternity care.

Acknowledgments

The study was financially supported by the Academy of Finland (project number 128002; Russia in Flux programme numbers 208180 and 208186) and the Baltic Sea Task Force. The cooperation of the St. Petersburg Committee on Public Health, the St. Petersburg Medical Academy for Postgraduate Studies (MAPS), the informants, and the women's clinics that participated in the study are gratefully acknowledged. I am grateful to Research Assistant Daria Odintsova, Special Researcher Anna Rotkirch, and other members of the REFER research consortium for their valuable comments during the writing process.

Notes

1. The WHO statistics of 2006 report 28.8 maternal deaths per 100,000 live births in Russia in 2006, while the equivalent figures for United Kingdom, Germany, and the neighboring Finland were 6.7, 6.1, and 6.8 correspondingly. The tendency is similar when it comes to perinatal mortality, although differences are smaller (9.0 perinatal deaths per 1,000 births in Russia in 2006 in comparison to 8.2 in the United Kingdom in 2004, and 5.6 in Germany and 3.0 in Finland in 2006; WHO, 2009).

2. The data include 16 visits to confirm pregnancy, 69 regular pregnancy monitoring visits, and 4 postdelivery check-ups (89 in total).

3. Women can refuse to participate in the ultrasound examinations, and the data included one such case. The physician's reaction was neutral, with no attempt to pressure the woman. The interview data reveal that physicians found it expected that pregnancy would be terminated if ultrasound showed fetal defects.

4. This is the time to give contraception counseling that typically is equal to recommending mini-pills for the breast-feeding period. The recommendation seems to have limited influence on women's contraception use, as condom use is common in comparison with oral contraceptives and many women still rely on traditional methods (Perlman & McKee, 2009; Regushevskaya, Dubikaytis, Nikula, Kuznetsova, & Hemminki, 2008). One reason might be that contraception counseling tends to be expert centered, with limited space for patient preferences (Larivaara, 2009).

5. Day hospital services are not only for pregnant women, but patients can be observed there also after abortions and small operations that can be done at women's clinics.

6. “Partner” always referred to a male partner in the data of this study. The physicians did not mention even once the possibility of a same-sex relationship. Pregnant women were always discussed as being either in a heterosexual relationship or single.

7. In Russia, raising children and running family life traditionally have belonged to the women's realm, and motherhood has been an expected part of a woman's life (Rotkirch, 2000; Rotkirch & Haavio-Mannila, 1996). This is likely to influence the limited role of fathers in maternity care. The current situation with the majority of gynecologists and obstetricians being women may further enforce this development.