Factors influencing the practice of artificial termination of pregnancy

Skobelina Natalia Anatolyevna Doctor of Sociology Professor, the department of Sociology and Social Technologies, Volgograd State University 400062, Russia, Volgogradskaya oblast', g. Volgograd, pr. Universitetskii, 100, of. 2-20 V volnatmax@mail.ru Other publications by this author

Shelest Marina Viktorovna Applicant, Department of Pedagogy, Psychology and Social Work, Volgograd State University 400062, Russia, Volgogradskaya oblast', g. Volgograd, ul. Pr. Universitetskii, 100, of. 2-20 V marina_sheles@mail.ru

In modern society, abortion (termination of pregnancy) is a social problem that is considered in the aspect of demographic and family policy, in the aspect of women's health, within the framework of political and legal issues. In this study, abortion is presented as one of the indicators of the demographic transition, characterized by a low birth rate and mortality, a change in marital and family behavior, and the transformation of the composition of the population of modern society. Along with the individualization of consciousness, the change in the institution of the family, the lack of motivation to have children, abortion is a factor in the conscious regulation of pregnancy. Therefore, the practice of abortion is at the center of our research and is considered in interaction with other social phenomena. Modern scientists consider the problems associated with behavior in the marital and family sphere, applying the provisions of the paradigm of "demographic transition". And this is due to the demographic situation that has developed in modern Russian society: a decrease in the birth rate, the spread of alternative forms of family, planning for the birth of children, the aging of the population.

There is a large number of works that reveal the essence of the theory of demographic transition and its indicators.  These are the works of A. Kashepov ^[1], T. Gudkova ^[2], N. Zubareva ^[3], M. Pintaeva ^[4] and other researchers. Many scientific works in this vein are devoted to issues related to women's health, to the socialization of women after abortion, to the identification of society's attitude to abortion, to the emergence and dynamics of the practice of abortion. Scientists determine the institutional, economic, geographical, sociocultural aspects of abortion in various societies. Along with socio-economic factors, socio-cultural and psychological factors influencing the decision to terminate pregnancy are being studied. Russian scientists Kalugina N., Pozdeev A. ^[5], Motova E. ^[6] consider the practice of abortion in the legal aspect and present an analysis of political and legal factors, paying attention to the legal status of the embryo in Russian legislation, the problems of Russian society in the context of artificial termination of pregnancy.

A number of scientific papers are devoted to women's health, the study of medical termination of pregnancy as a less traumatic interruption for the reproductive function of women (Grigorieva N. ^[7], Pavlov Ya. ^[8]). Among the works devoted to abortive practice, it is necessary to highlight the works of a socio-medical orientation (Bykova E. ^[9], Kvach E., Artemyeva E., Trubina P., Novokshchenova I. ^[10]).

The analysis of scientific literature has shown that there is a need to investigate the practice of abortion from the perspective of the theory of demographic transition. This is due to the fact that the practice of abortion is an integral indicator of the demographic situation along with the birth rate, mortality, behavior of men and women in the marital and family sphere. The purpose of the article is to identify the factors influencing the practice of abortion in the current demographic situation. Abortion is a complex and multifaceted phenomenon. In this regard, when determining the factors influencing it, both the institutional changes that took place at the turn of the XX – XXI centuries in Russian society and the processes that took place in the spiritual, economic and social spheres were taken into account.

In order to identify the factors influencing the artificial termination of pregnancy, an analysis of scientific articles by Russian scientists, an analysis of legislative acts of federal and regional authorities, a secondary analysis of statistical data of Rosstat and sociological research of VTsIOM was carried out ^[11]. The article used the results of a questionnaire survey conducted on the basis of Volgograd State University in November 2018 in order to identify the underlying factors affecting the behavior of women who decided to have an abortion (N=600, students aged 17-22 were interviewed, a quota sample was used, the quota parameters for respondents were age, gender, faculty; processing and data analysis using the SPSS program); as well as the results of an online survey conducted in the Volgograd region in December 2020 - February 2021 in order to determine the attitude of the population to abortions and establish personal reasons (N=1623, the method of spontaneous sampling was used, age and gender were taken into account to improve the accuracy of sample estimates). 

The analysis of scientific literature, legislative acts, statistical data made it possible to determine the institutional and socio-cultural factors that influenced the practice of abortion. First of all, intensive institutional changes have had an impact on the demographic situation in modern Russia. Structural changes concern both the institution of the family (the emergence of new forms, types of family), and the institute of education (the transformation of the education system, the emergence of opportunities for most women to get higher education), and the legal institute (the emergence of new rules and regulations governing the dynamics of social practice of abortion, as well as the behavior of women who have decided to have an abortion), and economic institutions in modern Russia. The socio-cultural sphere is characterized by the transformation of traditional family values, a change in attitude to civil marriage, the spread of premarital sexual relations.

According to statistics, the reduction in the number of abortions in modern Russia has been observed since the 1970s to the present. Since 1988, the law on the authorization of abortions for social reasons came into force in the USSR, but already in 1990 and 1991, the number of abortions of pregnancies in the country decreased by almost 800 thousand or 19%, the negative dynamics persisted further.  It should be noted that along with the reduction in the number of abortions in the 1990s, a decrease in the number of births was recorded up to 2000. It is important to take into account the economic factor here, by this time almost a third of the country's population had an income below the subsistence level.

Since 2001, the value of the indicator began to decline and in 2010, the share of the population with this level of income was 12.6%. This indicator remained unchanged until 2019. Since the 2000s, there has been a certain increase in the well-being of the population in Russia: about 90% of residents began to have an income above the subsistence minimum, the percentage of unemployed has decreased, the procedure for registering with the employment service has been simplified, receiving benefits, and the purchase of housing has become more affordable. Such changes at the beginning of the XXI century can be explained by the fact that reforms have begun in the country, stabilizing the situation in various spheres of public life ^[12].

The results of sociological research conducted in various modern societies indicate that, along with economic factors, the practice is influenced by legislative norms and rules governing the activities of subjects. Since the end of the twentieth century, the Russian government has introduced a number of restrictions to the existing legislation on abortion, and new rules have been developed for the subjects of this process. The law "On the basics of protecting the health of citizens in the Russian Federation" emphasizes that abortion is carried out on a voluntary basis, at the request of a woman up to 12 weeks, both social and medical indications for artificial termination of pregnancy are noted. Despite the preservation in Russia of the right to an abortion for up to 12 weeks for each woman, social and medical indications that allow terminating a pregnancy at a later date have been minimized. Termination of pregnancy is still carried out within the framework of compulsory medical insurance, after a woman applies to a medical institution, she is necessarily given 48 hours to think about her act. In 2012, an order was approved according to which, at the initial request of a woman for an artificial termination of pregnancy, a medical worker should send a pregnant woman to consult with a psychologist. And before being referred for an abortion at a period of up to twelve weeks, it was recommended to conduct ultrasound of the pelvic organs, where a pregnant woman had to be shown an image of the embryo, its heartbeat (if present) ^[13]. In 2016, additions were made to the information voluntary consent form: the concept of medical abortion was added, mandatory counseling of all patients by a psychologist or social worker on issues of psychological and social support ^[14]. Referral for ultrasound of the pelvic organs continues to be of a recommendatory nature. To date, consent to voluntary termination of pregnancy does not contain psychological aspects of termination of pregnancy, no emphasis is placed on the second subject of the procedure – the child. The legislation does not provide for mandatory participation in the procedure of a man, whereas in the case of pregnancy, he is involved in the process indirectly (he takes tests, sometimes donated blood, attends courses of young parents with the expectant mother, and so on). There is no information about the social and legal guarantees that a woman can count on in case of child preservation and about possible assistance for those who are in a difficult life situation.

Along with the transformation of legislative norms, a special role should be given to the changes that have occurred in the social institutions of Russian society. In recent years, the Institute of education has been radically transformed. The emergence of many universities and the expansion of opportunities for women to obtain higher education in the 1990s of the twentieth century contributed to the increase in the age of marriage and the institutionalization of the practice of abortion. Drastic changes have also taken place in the family institute in recent years. First of all, this refers to the spread of such a variant of family life as civil marriage, which has taken root in Russian society in recent years.

Analysis of the results of a study of the practice of premarital sexual relations conducted in 2015 by VTSIOM showed the attitude of young people to premarital sexual relations. Whereas in 1989, 29% of men and 37% of girls considered premarital relationships unacceptable, by 2014 the percentage had dropped to 21% for men and 26% for women. At the age of 18-24, only 8% of men and 16% of women recognized premarital relationships as unacceptable, at the age of 24-34, less than 15% of men and 20% of women thought so. The acceptable age for entering into sexual relations, as well as 25 years ago, in 49% of cases was 18-19 years old, 17% - earlier than this age. Despite the fact that the age of marriage has increased significantly over the compared period. 52% of respondents cited the decline of morality and morality as the reasons for the widespread spread of premarital affairs (from 42% in 1989), 34% - imitation of the Western way of life. Others blame poor sexual education of young people (31%), some see the reasons in earlier physical maturation (29%), only 27% in changing ideas about love ^[11].

Statistics show that the age of marriage has risen. The availability of abortion (the practice of abortion at the request of a woman and the transformation of the value component of Russian society) allowed young people to reconsider the age of marriage and postpone it to a later date. Until 1995, more than half of the marriages were concluded before the age of 24 of the bride and groom, by 2000 men began to seek to postpone the time of registration of the relationship to an age close to 30 years, and by 2010 they were joined by this indicator and women. In 2019, only 19% of men and 32% of women married before the age of 25.

It should be noted that the opposite of the dynamics of the age of the beginning of sexual life and marriage indicates that the processes of entering into sexual relations and the creation of a family in the minds of young people are not interrelated: they enter into sexual contacts early, and the creation of a family is postponed to a later date. The reproductive function is not considered by them as procreation, there is no willingness to bear responsibility for the possible consequences of sexual relations, the idea of love as the ability to yield and sacrifice is lost. In this regard, an unexpected pregnancy, which means an unplanned child becomes a hostage of the situation. He is perceived not as a subject resulting from sexual relations, but as a problem that needs to be eliminated by terminating pregnancy. That is, the social practice of artificial termination of pregnancy has helped to form the idea of abortion among young people as a means that will "help" when entering into early or casual sexual relations to keep plans for life without burdening themselves with a "sudden problem".

The results of our own sociological research provided an opportunity to identify categories that characterize the personal factor that influenced the practice of abortion. In the current demographic situation, it is necessary to take into account a woman's attitude to "unexpected pregnancy", the availability of opportunities for women to terminate pregnancy (formal and informal norms), the perception of abortion as a social problem.

In recent decades, the medical method of termination of pregnancy has become widespread in Russia, which has been replaced by medical abortions. It is an artificial abortion without surgical intervention and consists in taking a drug that stops the vital activity of the embryo, after which it expels the fetal egg. Depending on the duration of pregnancy, there are various types of drugs that provoke termination of pregnancy ^[16].

The Order of the Ministry of Health of the Russian Federation dated 10/20/2020 No. 1130n "On approval of the Procedure for providing medical care in the profile "obstetrics and gynecology" outlines the standards of medical care, conditions for examination of pregnant women and defines two practices of artificial termination of pregnancy (medical and surgical termination of pregnancy) and conditions for their implementation. 

After the emergence of the drug method in Russia and the adoption of appropriate legislative norms regulating the activities of subjects of abortive practice, initially women aged 35 and over began to resort to it, but now young girls aged 17-19 are increasingly turning to it ^[17]. Against the background of the appearance of the drug method, women have a positive attitude towards the abortion procedure itself, which takes place as taking a "medicine" to get rid of the "disease", that is, as treatment becomes more natural compared to surgical. It is also attractive that it does not require hospitalization and distraction from work.

Analysis of the process of introducing a medical method of termination of pregnancy does not give a complete picture characterizing the practice of abortion. It is necessary to take into account the availability of opportunities for a woman to terminate a pregnancy, which are provided by the state and society. The results of our own research allowed us to determine the attitude of women and men to "unexpected pregnancy", as well as the forms of behavior of various subjects of abortion practice, which are a factor of a personal nature. During the questionnaire survey conducted by the authors of the article, the respondents' attitude to termination of pregnancy was revealed. When answering the question: "Do you agree that banning abortions will help solve the problem that women face?" - 86% of respondents objected. The opinion of the majority of respondents coincided with the results of modern world research on this issue and the attempt to ban abortion undertaken in the twentieth century. Such an answer to the question indicates the desire of the majority of respondents to preserve their independence and the right to choose themselves in the event of a collision in life with an unexpected pregnancy. 75% of respondents from the number of respondents expressed their negative attitude to the very phenomenon of abortion. That is, the social practice of terminating pregnancy causes a negative attitude in society, but respondents perceive the practice as a means of controlling the birth rate (as a "backup option"). To the question: "Why does an "unexpected" pregnancy occur?" - 65% of respondents stated that the reason is the ignoring of contraceptive methods and only 28% - casual relationships, 3% premarital relationships. That is, most of the respondents are sure that the problem of abortion can be avoided with the help of regular use of contraceptive methods. Such an answer indicates the attitude of respondents to the reproductive function of a person, which consists in the birth of offspring. 60% were able to see the cause of an unexpected pregnancy in a frivolous attitude to the possibility of such an occurrence.

Respondents to the online survey mostly shared the opinion that there is a weak link between material wealth and a reduction in the number of abortions. When asked what could affect the reduction in the number of abortions in the country, the option of increasing financial payments and benefits was approved by 18% of respondents.

Most of them spoke in favor of contraceptives, that is, for the use of measures that will prevent the onset of pregnancy. A significant part of respondents expressed their doubt that external conditions can be attributed to the real causes of the spread of the phenomenon of abortion. The answer to the question: "Do respondents agree with the opinion that the main reason for termination of pregnancy is related to a person's fear of losing their usual lifestyle?" - 45% of respondents agreed. In case of an unexpected onset, pregnancy becomes one of the events in a person's life that has gone out of his control. It seems to be a threat to interests, plans for the future and causes internal protest. More than 95% of abortions in Russia are currently performed due to a woman's unwillingness to give birth to a child, that is, getting rid of an unexpected or unplanned pregnancy that does not fit into her immediate plans.

Against the background of the current demographic situation, many concepts related to the practice of abortion have taken root in society and in the minds of each individual. They serve as a factor influencing the behavior of women who have decided to have an abortion. First of all, we are talking about such categories as: unexpected pregnancy, unwanted pregnancy, safe abortion, artificial termination of pregnancy. Their use has become habitual for Russian society. This is also a factor that affects the practice of abortion.

The results of sociological research and official statistical data indicate that formal and informal norms and rules, the development of pharmacology, the emergence of new methods of contraception, changes in the basic institutions of society, the transformation of values of post-industrial society, conscious birth control by a woman herself influence her behavior. At the same time, it is necessary to pay attention to the fact that the practice of abortion itself forms certain stereotypes, attitudes towards abortion and public health in the minds of individuals. Of great importance are the traditions that have developed in a particular society, the level of development of the health and education system, as well as the specific situation in which a woman who has decided to have an abortion finds herself, her worldview, attitudes, values, marital status, social status.

The practice of artificial termination of pregnancy, considered as an indicator of demographic transition, made it possible to determine that the socio-cultural, institutional environment, the availability of opportunities for a woman to have an abortion, as well as the attitude of women and men to the process of termination of pregnancy is of great importance in the current situation.