Pregnancy prevention,reproductive health risk and morality: a perspective from public-sector women's clinics in St. Petersburg,Russia

The use of reliable contraception in Russia remains lower and rates of induced abortion higher than in Western Europe, even though reliable contraception has been accessible for nearly two decades now. Due to the organisation of women's health services in Russian cities, gynaecologists can have a major influence on women's contraceptive choices, but little is known about their attitudes and practices in terms of contraception promotion. This study draws on qualitative observation and interview data of gynaecologists in public-sector women's clinics in St. Petersburg, Russia's second largest city in order to investigate their perceptions of various birth control methods and contraception counselling. Also in focus are clinical counselling practices. The results reveal that gynaecologists in St. Petersburg had up-to-date knowledge of the latest contraception methods and that they were willing to promote their use. They took an active role in counselling, although the coverage was not full. The depth of counselling varied considerably and counselling practices were mainly paternalistic. Yet, in about a third of the observed cases, patient preferences were incorporated into clinical decision-making. The gynaecologists perceived reliable contraception essentially as a means of fostering future fertility and avoiding harmful health consequences of induced abortions. Using reliable contraception was equated with being a responsible and morally respectable woman. The results suggest that links between health, risk and morality are vividly present in contraception counselling in St. Petersburg, and that reliable contraception has become a powerful source of new moral demands for individual women to foster their reproductive function.