MOSCOW Women of all ages used to fill gynecologist Lyubov Yerofeyeva's Soviet state clinic, lined up by the dozen for back-to-back abortions. "It was more common to take sick days for an abortion than for a cold in those days," she said.
Two decades after the Soviet Union's collapse, wider availability of contraception and a resurgence of religion have reduced the numbers of abortions overall, but termination remains the top method of birth control in Russia.
Its abortion rate -- 1.3 million, or 73 per 100 births in 2009 -- is the world's highest.
Backed by the Russian Orthodox Church, an influential anti-abortion lobby is driving a moral crusade to tighten legislation and shift public attitudes that are largely a legacy of the Soviet era.
Adding to the debate is the Russian government's effort to reverse a population decline caused by low birth rates combined with very high death rates. With Russians dying nearly twice as fast as they are born, the United Nations predicts that by 2050 its population will shrink by almost one fifth to 116 million.
Women's rights groups voice outrage that the Church would play a role in shaping Russia's secular laws and say abortion must remain a choice. They acknowledge the statistics point to a public health travesty but suggest the problem would be better resolved by sex education.
At the heart of the debate is an amendment to Russia's law on health that is all but guaranteed to pass in the lower house after it was approved in a critical second of three readings on October 21.
The law would cap abortions at 12 weeks, impose a waiting period of up to one week from initial consultations and require women over six weeks pregnant to see the embryo on ultrasound, hear its heartbeat and have counseling to determine how to proceed.
"Our two main motives are the fact that Russia is dying out and our religious tradition. We cannot forget our faith," Yelena Mizulina, chair of the family issues committee that fielded the law, told Reuters. "Despite the long Communist period, it is seen as murder, as a violation of the ten commandments."
Russia's sharp demographic crisis, she said, adds to the urgency. "America is not threatened with extinction, it can afford to be more lenient," Mizulina said.
The government has worked hard to foster a baby boom, honoring big families at pomp-filled Kremlin events, offering subsidies to parents with more than one child and even raffling off cars to women who give birth on the national holiday.
Experts say only migration can help plug the demographic black hole, but that is a solution with potentially explosive side effects given the country's ethnic tensions.
Fear that mostly Muslim migrants from Central Asia and the Caucasus will replace a dwindling ethnic Russian populace have helped fuel the Orthodox Church's newly vocal role on abortion and other issues since the demise of the atheist Soviet Union.
One of the prominent personalities promoting the Church's position on the issue is Russia's devout first lady Svetlana Medvedeva, whose Foundation for Social and Cultural Initiatives held a national week-long campaign in July dubbed "Give Me Life!"
Such initiatives have sparked protests. More than 150 human rights and feminist groups signed a global petition against the measures last month, while others have staged rallies in Moscow.
At one such demonstration, a handful of young activists unfurled banners with the slogans: "Fight Abortion, Not Women," "My Body Is My Body," and "Better Abortion than Bad Parenting."
"Why should a priest decide what I do with my body?" said one young feminist, Dina Orlova, 31, objecting to the inclusion of priests on an expert council that drafted the Russian bill.
But the Church says Russians are ready to see more limits.
"Attitudes are clearly changing swiftly and should be reflected in politics and the law," spokesman Archpriest Vsevolod Chaplin said. In a first victory for the anti-abortion camp, lawmakers approved legislation in July requiring abortion advertisements to carry health warnings. [ID:nLDE76017F]
Nevertheless, stricter rules -- requiring parental consent for young women under 18 or spousal approval for married women and eliminating state support for abortions -- were left off the new draft bill after polls showed them to be unpopular, Mizulina said.
One of the next steps, she said, is banning over-the-counter sales of the so-called morning-after pill -- which she called "poison".
The Soviet Union was the first country to legalize abortion, in 1920, but dictator Josef Stalin outlawed it in 1936, seeking to boost births, and it was illegal until after his 1955 death.
Women's groups point to a surge in deaths from illegal abortions under the total ban.
"They should look to history: If a woman doesn't want to have a baby, she'll end her pregnancy with a coat hanger," said Yerofeyeva, who set up the non-profit Russian Association for Population and Development (RANIR) in the 1990s to promote sex education.
"Women do not owe the state, they don't have to give birth like machines," she said.
Her organization used to receive state financing before funding for the majority of family-planning programs was slashed when Russia defaulted on its debt in 1998.
Today Russia has no sex education in schools.
The only way to reduce abortions, Yerofeyeva said, is to disabuse women of " stigmas " and "superstitions" handed down from Soviet times, when condoms made in the Eastern bloc were not only scarce but notoriously thick, uncomfortable and prone to break, while Soviet-made intrauterine (IUDs) often did not work.
Patients and physicians were equally skeptical
about first-generation, high-dosage oral contraceptives, believing hormones to be responsible for all manner of ills and discomforts.
With the arrival to the market of modern methods of contraception in the 1990s, abortion rates fell by almost a third but have since dropped more slowly. Experts say women using the pill as their main line of defense against unwanted pregnancy remains low, below 20 percent.
"'There was no sex in the USSR'," gender-studies expert Irina Kosterina said, quoting a Communist party official whose off-color comment remain a poignant joke on Soviet-era taboos.
Many women remain shy about consulting gynecologists or talking about sex, particularly with their partners , about how to avoid unwanted pregnancy or protect against sexually transmitted diseases, she said.
"Our sexual revolution came 30 years later than in the West and was only for a very small class of women," Kosterina said.
Only ten percent of Russian women who abort are ending a first pregnancy, she said, adding most have one or two children.
At a peach-and-teal toned private clinic, Irina, 27, was having her second operation in
a little over a year. Unmarried, with a mortgage and parents in a faraway provincial city, she said she cannot afford a child.
"Besides, my boyfriend doesn't want it," she said -- but admitted that they do not use any regular form of contraception.
(Editing by Steve Gutterman and Sonya Hepinstall)