Putin’s Theoretical Demography

Paul Goble reports:

Officials at the Russian Ministry of Health and Social Development have rushed to take partial credit for the slight uptick in the number of newborns in the first quarter of 2010, but an analysis of the ministry’s behavior, some in the Russian medical community say, shows that it is engaging in “theoretical demography” for show. That is because, Nadezhda Larina writes in the current  Argumenty Nedeli, the ministry is putting most of its money into a few new showcase perinatal centers in the major cities while ignoring most of the existing birthing centers across the Russian Federation or even putting burdens on the latter which they cannot meet.

“One of the main achievements in the area of demographic policy,” Larina writes, at least in the view of the ministry, is “the creation of necessary conditions for births” through “the construction of new perinatal centers” where infertility can be cured and newborns with serious medical problems can be treated. Since the end of 2007, the health ministry has spared no expense for the construction of what are planned by the end of 2011 to be 24 of these institutions with Moscow prepared to spend “not less than one billion rubles (33 million US dollars) on each,” a program that is helping those Russians who can gain access to them. “But at the same time,” Larina says, “the bureaucrats have literally forgotten about the enormous number of existing birthing homes and specialized centers which need not so much new outfitting but elementary repairs.” And because Moscow has made that choice, many of these, which are the only ones most Russians can reach, are in trouble of closing down entirely.

An example is the perinatal center in Tula oblast. Already more than a decade old, it has not had any repairs since it was build, and the facility needs major repairs. They would cost a billion rubles (33 million US dollars), but Moscow does not plan to provide any money and the oblast can give only six million rubles (180,000 US dollars). As a result, that facility may be forced to close because it cannot meet current sanitary norms, an example of a pattern Larina says that is found across the country. Moscow officials can point to bright shiny new places accessible to a few while ignoring the large number of older facilities on which most Russians rely. Moreover, she continues, Moscow officials have comforted themselves with the notion that if one or another birthing facility outside of the major cities has to close, Russian women can simply turn to another nearby one that continues to operate. But that ignores the reality of Russia’s horrible roads and the particular difficulties they present to mothers and children.

And these problems, the Argumenty Nedeli journalist continues, are compounded by another of the ministry’s making. The central bureaucracy is sometimes prepared to pay for new equipment, but it does not provide the money for training doctors and nurses on how to use these new tools. Sometimes, doctors say, the cost of retraining that they are expected to pay out of their own salaries, is more than half of their monthly pay, a barrier to their getting the kind of training they need and one that means that much of the shiny new equipment Moscow is so proud of never is used – or is used by people who do not know how it should be employed.

The health ministry’s drive toward centralization of such facilities, Larina continues, is one that is found in many countries. “But will it work in Russia?” The answer doctors say is that it won’t. The country is simply too large and the situation in the regions too varied to allow for such an approach if the health of the population is the goal. Birthing facilities in smaller population centers have been left “in the situation of ‘poor relations.’” In one case, women have been left without a birthing facility anywhere close to their homes because while local officials are prepared to provide financing, neither Moscow nor businesses where these women work are prepared to help.