Modern trends in regulation of the social practice of artificial termination of pregnancy in Volgograd Region (sociological aspect)

Shelest Marina Viktorovna ORCID: 0000-0003-3567-5983 External Doctoral Candidate, the department of Sociology and Social Technologies, Volgograd State University 400062, Russia, Volgogradskaya oblast', g. Volgograd, ul. Universitetskii Prospekt, 100 marina_sheles@mail.ru

Introduction

Artificial termination of pregnancy continues to be one of the acute problems of our time. Based on the theories of P. Bourdieu's action and E. Giddens' structuration, we presented this phenomenon as a social practice. P. Bourdieu referred to these as everyday actions of individuals and their actions aimed at transforming society. He believed that practices also influence the behavior of individuals and themselves are influenced by the latter ^{[1, p. 552]}. E. Giddens determined that social practices are not created by actors, but only constantly reproduced by them ^{[2, p. 40]}. The phenomenon of artificial termination of pregnancy belongs to social practice, since it has the signs, characteristics and stages of formation characteristic of this category. The practice in question is a set of actions of various individuals for the deliberate termination of pregnancy, which has an impact on the entire society. The concept of an individual means both a man and a woman, since both a woman and a man indirectly participate in the social practice of artificial termination of pregnancy. In the study of social practice, the provisions of micro and macro-level analysis are used. At the macro level, the regulation of practice by institutional norms and legislation is studied, at the micro level - the impact of a hotel individual on it.

In Russia, the phenomenon of artificial termination of pregnancy attracted special attention at the end of the XX century, when the number of births decreased by 38% compared to 1990 (the rate of births per 1000 people in 1990 was 13.4; in 1999 - 8.3), and the indicator of natural population growth received a negative value, thereby showing its decline ^[3]. Since that period, there has been an active search for effective methods that would lead to a reduction in the number of abortions. One of these was chosen in the form of informing the population about modern contraceptives and their use ^[4], as well as about the consequences of abortion for the physiological health of women. This determined the direction of regulation of the social practice of artificial termination of pregnancy in the form of work with individuals in the period before the onset of unwanted pregnancy. Since 1993, Family Planning and Reproduction Centers have been entrusted with such activities in Russia. Many researchers devoted their work to the study and evaluation of prevention in the future ^[5-9], who came to the disappointing conclusion that, despite informing the population, the use of contraceptives remains low. It should be noted that the social practice of artificial termination of pregnancy has two aspects - medical and spiritual and moral. The first concerns the physiology of a woman, which is affected by health workers; the second concerns the inner world of the individual. The disclosure of this aspect is included in the framework of solving one of the tasks of the concept of demographic policy of the Russian Federation for the period up to 2025, namely, "strengthening the institution of the family, the revival and preservation of spiritual and moral traditions of family relations" ^[10] and the implementation of one of the directions of youth policy to strengthen civic identity and spiritual and moral values of youth ^[11], which are implemented by specialists of youth centers, social and other organizations. But since these formulations do not imply, within the framework of the activities of these specialists, the mandatory sanctification of the issue of artificial termination of pregnancy, it may not be affected by them, it depends on their education, experience and personal qualities. Meanwhile, the idea of the importance of disclosing this aspect of abortion prevention is becoming more common ^[12-14].

Another direction of regulating the practice of artificial termination of pregnancy was the work on preserving the pregnancy that has already occurred, since it was in abortions that they saw the main reason for the low birth rate in the country, which is still the opinion at the present time ^[15]. The list of social indications for artificial termination of pregnancy from thirteen (1996) was gradually reduced to one (2012) ^[16], which contributed to the elimination of the public perception of the indifference of the authorities to the abortive behavior of citizens, the formation of confidence that the government no longer justifies and supports such practices. In 2007, a list of medical indications for artificial termination of pregnancy was approved. Since the same year, on the basis of women's consultations, the creation of medical and social care offices began, whose specialists were supposed to carry out measures to prevent abortions, conduct consultations for women who applied for the purpose of artificially terminating pregnancy, on issues of their social protection, form their consciousness of the need to carry out pregnancy, as well as provide them with further socio-psychological support. The Ministry of Health has developed a sample of voluntary consent to perform an artificial termination of pregnancy at a period of up to 12 weeks for mandatory filling, a single form of which was approved in 2016 ^[17]. In 2017, uniform methodological recommendations for psychological counseling of women wishing to terminate pregnancy appeared. Currently, a woman who decides to have an abortion must undergo pre-abortion counseling, fill out a voluntary consent form, and think about her decision within 48 hours ^[18]. It is noteworthy that the involvement of a man in this process is not provided. The main disadvantage of this direction is that the possibility of its implementation involves the mandatory treatment of a woman for termination of pregnancy in a medical institution. 

Participants in both areas of regulation are not only state medical and social institutions. Russian Orthodox Church organizations have been working in this direction since 1991, whose participation in pre-abortion counseling for women was supported in 2015 by an agreement with the Ministry of Health of the Russian Federation ^[19]. Also in 2010, the All-Russian movement ANO "For Life" was organized, the participants of which directed their efforts both to preserve pregnancies and to prevent their onset. At the beginning of 2015, the Association of Family Protection Organizations was established in Russia, which included 120 family-oriented non-profit organizations working in the direction of protecting and supporting the family, fatherhood, motherhood and childhood, from 50 regions and all federal districts of Russia. The Association has launched a pilot pro-family project "Birth" with the support of the Presidential Grants Fund ^[20]. The NGO's activities include consulting pregnant women, providing legal assistance, preventive work, and so on.

One of the areas of regulation of the social practice of artificial termination of pregnancy continues to include material stimulation of fertility: financial support for young families, single mothers, the birth of children, etc. ^[21]. Meanwhile, the total fertility rate (live births per 1 woman), after a slight increase in the 2010s, decreased again and in 2020 amounted to 1.5 ^[22], which confirms the opinion about the current tendency of young people to minimize the number of children in the family ^[23], and indicates that two concepts should not be confused: the desire of a woman to consciously become pregnant in order to give birth to a child and the appearance of her willingness to keep an unexpected pregnancy. Having given birth to the desired number of children, in the event of an unplanned pregnancy, without preparation for it, a woman is likely to get rid of it in the "traditional" way.

Currently, the dynamics of the number of abortions has a negative orientation. At the same time, according to experts, the value of this indicator in itself remains high (the number of abortions in 2019 amounted to 622 thousand), which does not give reason for optimism ^[24]. In addition, there is an opinion that official data do not reflect the whole reality, the real number of abortions reaches four to five million per year ^[25]. This is attributed to the fact that the official statistics do not include those abortions that are carried out, firstly, in private clinics, and secondly, at home in a medicamental way without contacting a medical institution ^[26], which is becoming increasingly widespread. All this indicates the need to study the main directions of regulation of the social practice of artificial termination of pregnancy, to determine the more effective and promising ones in modern society, which determined the purpose of this work.

Research methodology

The study was conducted in the Volgograd Region, which is part of the Southern Federal District of the Russian Federation, on the territory of which about 2,500 thousand people currently live ^{[27, p. 61]}. According to the territorial body of the Federal State Statistics Service for the Volgograd Region, the number of registered abortions in the region has decreased fourfold since 2005 (in Russia as a whole - 4.5 times) and in 2019 their number amounted to 8,500. In 2008-2009, the number of abortions and births equaled, and by 2019, 47 abortions per 100 births began to occur ^{[27, p. 279]}; ^{[28, p. 305]}.

The study was conducted by a candidate of the academic degree of the Department of Sociology and Social Technologies of Volgograd State University. The main directions of regulating the social practice of artificial termination of pregnancy in the Volgograd region were identified during the study of relevant regional legal documents and conducting in-depth interviews (2021). The objects were 9 informants - representatives of various organizations in the region whose activities are related to the prevention of abortions, including: the institution of socio-psychological assistance and support for youth, youth policy centers, the regional center for psychological and pedagogical assistance to the population, family counseling center, women's counseling, regional center for public health and medical prevention, regional a public organization for the revival and spiritual and moral development of family relations, a mobile service for the prevention of abortions.

Research results

During the interview, the general opinion of informants was determined that, despite the negative dynamics of the number of abortions, their prevalence in the Volgograd region remains a serious problem that needs to be solved. The informants argued their opinion with statements. One of them noted that 8,500 people whose lives were interrupted during 2019, this is an entire settlement. Another is that due to the spread of coronavirus infection, the number of abortions will grow again, as women have become afraid to give birth due to the unknown consequences of this virus for human health. The opinion expressed indicates that the methods of regulating the social practice of artificial termination of pregnancy require mandatory revision, updating and development.

Currently, in the Volgograd region, on the basis of state healthcare institutions (hospitals, maternity hospitals), medical and social assistance offices for pregnant women who find themselves in a difficult life situation are operating ^[29]. The work of such offices is based on interdepartmental interaction with the offices of medical and social assistance of women's consultations, medical psychologists of obstetric hospitals. They also cooperate with the Department of Psychology and Social Work of the Volgograd State Medical University, public organizations, non-governmental foundations, representatives of traditional faiths. On the basis of social service centers, there are 42 family counseling centers, the main tasks of which are: prevention of abortions; prevention of refusals from newborns; formation of a conscious attitude to the marriage union among couples of newlyweds who have applied to the registry office and their orientation to childbearing ^[30]. As part of the implementation of youth and demographic policy, the Youth Policy Centers of Volgograd and the Volgograd region are operating, which are implementing a number of projects, one of which is aimed at promoting family values among young people. It should be noted the activities of the department of support and promotion of Breastfeeding of the Volgograd Regional Center for Public Health and Medical Prevention on the development and distribution of leaflets, booklets, articles, recommendations on the topic of motherhood, fatherhood, family and abortion ^[31]. Since 2019, a mobile mobile service for the prevention of abortions has started working in the Volgograd region ^[32], which includes representatives of the Volgograd diocese and specialists of the centers for social protection of the city's population.

When asked what forms you use to prevent abortions, informants of youth organizations named such as: holding thematic lectures for students, organizing and holding family holidays and events in park areas. Representatives of social, medical, non-profit organizations spoke about the use, in addition to these forms, of the following: conducting conversations with married couples, radio broadcasts, visiting family events, conducting educational messengers, developing and distributing thematic leaflets, booklets, posters, conducting pre-abortion counseling, providing various financial and material assistance to pregnant women who find themselves in a difficult life situation situations.

When applying these forms, employees of organizations face some difficulties. So, informants involved in pre-abortion counseling indicated that there are more and more women who do not make contact. According to one of the informants, the reason is that some women resort to the abortion procedure not for the first time, others believe that they know everything about life and they do not need advice, others that they have not yet had enough. It's almost impossible to talk to them. There are women who, faced with the need to undergo pre-abortion counseling in a women's clinic, turn to a private clinic for the procedure. It is rarely possible to attract a man to participate in the consultation. These statements explain the limitations of this form of work.

When organizing thematic lectures for students, the conduct of which is entrusted mainly to youth centers, the informants attributed to the difficulties: the need to attract third-party specialists. The consecration of the topic of sexual life, and even more so of abortions, implies the mandatory participation of medical workers in the conversation, since, according to the staff of youth centers, they themselves are not competent in these matters. To sanctify the spiritual and moral aspect of abortions, they also invite outside specialists from non-profit Orthodox organizations, psychologists. In this regard, lectures on abortion are not held systematically, and the conversation about the family is often limited to questions about the need to create it, about the family rights and responsibilities of men and women, and so on. Requests for preventive conversations about abortions from heads of educational institutions are received regularly, and increasingly, as informants note, for students in grades 7-8. This also requires a certain pedagogical training from the lecturer. The informant of the regional Center for Public Health and Medical Prevention, based on the results of their survey among students under 18 in 2015, indicated that the need for preventive work to prevent abortions was expressed by the teenagers themselves. Thus, out of 1943 respondents, 40% noted that parents never talked to them about the basics of sex education and moral relationships between the sexes, girls receive important information for themselves from the Internet and the media ^[31], often filled with false ideas and stereotypes about reproductive health, children and so on. As a result, according to an informant of a social organization, during a conversation, women often reveal a lack of willingness to take responsibility for their actions, the notion that there is a living being inside her during pregnancy, and in the decision to terminate pregnancy, she is most often driven by selfishness. The informant of the Orthodox organization noted that there are currently a lot of materials on the prevention of abortions before pregnancy, but there are not enough specialists capable of correctly sanctifying the topic of abortion. That is, the demand for informing young people about various issues of sexual life and family is high, but there are not enough quality specialists to meet it, which dictates the need for training appropriate personnel. 

Summarizing the materials obtained, it was possible to conclude that the regulation of abortive practice in the Volgograd region corresponds to the implementation of federal regulatory documents and is carried out in two main directions: the period before and the period after pregnancy. State healthcare institutions, institutions subordinate to the Committee for Social Protection of the Population, educational institutions, various non-profit organizations, youth policy centers, organizations of traditional faiths are involved in the work.

The second direction has a more systematic character, the main form of which is pre-abortion counseling, which includes three stages:

conversation with the doctor of the women's consultation;

a conversation with a medical psychologist, whose task is to find out the reasons why a woman decided to have an abortion, an attempt to find an alternative way out of the situation, to help a woman maintain pregnancy;

a conversation with a specialist of the social center, whose main task is to inform women about the forms of social assistance they can count on; about benefits; about the possibility of obtaining psychological, legal assistance, employment.

The first direction, that is, the prevention of abortions before pregnancy, is more spontaneous, random, unstable in nature, despite the large amount of material developed on this issue. It is carried out in the form of individual conversations, lectures for students of various educational institutions; events aimed at popularizing family values, a healthy lifestyle. It should be noted that all informants named this particular direction as more promising and effective in regulating the social practice of artificial termination of pregnancy. One of them noted that the complexity of the work aimed at preventing abortions before pregnancy is that it is practically impossible to see its result. At the same time, work on sanctifying not only the medical, but also the spiritual and moral aspect of the practice of abortion is necessary, especially with adolescents. According to the informant, at an older age, when a person has already developed a certain worldview, the idea of desires, values becomes much more difficult to convince him. The informants agreed that in this case it is better to prevent the problem than to solve it. For the development of this direction, they noted the need for state support in the form of: ensuring the possibility of conducting systematic conversations with students of general and secondary educational institutions about the social practice of abortion; conducting anatomy lessons on the topic of human reproductive function in the ninth grades by specially trained personnel with the consecration of its not only medical, but also spiritual and moral aspect; control for the placement of information about the consequences of medical abortions on packages of abortive drugs, increased punishment for their illegal distribution; a ban on posting information about the safety of such an abortion on medical websites, and so on. In addition, one of the informants stressed that intimidating the population with the consequences of abortions has not been an effective method for a long time, especially in the context of the spread of such a concept as safe abortion, therefore, broad advertising of motherhood and fatherhood, the positive aspects of maintaining unplanned pregnancy is necessary. That is, the prevention of abortions before pregnancy has the potential for development, it is this direction that is more in demand and promising in modern society.

Conclusion

Thus, at present, a more developed direction of regulation of the considered social practice is the prevention of artificial termination of an already occurred pregnancy, the main form of which is pre-abortion counseling. This form assumes, firstly, the mandatory appeal of a woman to a medical institution, and secondly, her willingness to dialogue about the preservation of pregnancy. If a woman is categorically not set up for the birth of a baby due to age or she already has children and she is not ready to increase their number in the family, this method has practically no effect. Moreover, if a woman decides to have an abortion on her own at home, having bought the necessary drug and received advice on its use via the Internet, the use of such a form becomes impossible at all.

In this regard, there is a need to develop another direction, namely, strengthening preventive work with individuals before pregnancy. At the same time, the work should be aimed at sanctifying not only the medical, but also, more importantly, the spiritual and moral aspect of abortion. The younger generation easily assimilates the distorted ideas offered by society about the phenomenon of pregnancy, reproductive function, negative stereotypes about children, about large families. Therefore, such prevention should be started as early as possible. Targeted, large-scale, consistent work on the formation of traditional attitudes among young people, ideas about motherhood, fatherhood, and the relationship between men and women with support at the federal level, will increase the responsibility of young people for sexual behavior, will lead to a reduction in the number of abortions and an increase in the birth rate without financial incentives.