Time to read: 14 minutes(s)

What's happening with birth and mortality rates in Russia? Is it possible to increase the birth rate with maternity capital? And where is the head of the Ministry of Health going wrong?

Birth and mortality data published in Russian media are sometimes not just contradictory, but contradictory—even though they all seem to cite Rosstat.

While RIA Novosti comes out with the headline “The birth rate in Russia has increased for the second time this year,” and TASS rejoices The Moscow Times predicts a reduction in Russia's natural population decline by almost 40% in the first months of 2023. пишет, that between January and May, the birth rate—8,5 children per 1000 population—was the second-worst in the country's modern history. And presidential spokesman Dmitry Peskov is claiming that measures aimed at increasing the birth rate "did not produce the desired result", and the demographic situation remains “very difficult.”

And recently, the same The Moscow Times, citing sources in TASS and RIA Novosti сообщили, that Kremlin-controlled media outlets, news agencies, and media outlets were required to stop reporting on the birth rate crisis in Russia and to even present Rosstat statistics in a negative light.

NeMoscow asked a research fellow at the HSE International Laboratory for Population and Health Research Elena Churilova explain how things really are.

Please help me understand what's happening with birth and death rates in Russia over the past year or two. What's so deceptive about the official figures?

"I'm of the opinion that our birth and death statistics are quite reliable. However, to understand what's happening and to make a comprehensive assessment, we need to focus not on current statistics (monthly data), but on final, annual data and on integrated indicators of fertility and mortality—the total fertility rate (TFR) and life expectancy (LE)."

The absolute number of births and deaths is important for us to understand whether the annual number of deaths exceeds the annual number of births, i.e., whether there is a natural increase or decrease. In both 2021 and 2022, the number of deaths in Russia exceeded the number of births, indicating a natural population decline. In 2021, the natural population decline was just over 1 million people; in 2022, it was approximately 600 people.

The number of births in 2022 is 1,3 million, which is less than the 2021 figure per 100. The decline in births is a natural process, as women from the small generations of the 1990s are in their most active reproductive years. Since there are few of them, they can only bear a small number of children annually. The crude birth rate in 2022 will decrease because it is calculated by dividing the number of births by the average annual population. If the numerator decreases while the denominator remains relatively stable, then the crude birth rate will naturally also be lower.

The total fertility rate in 2022 was 1,42 children per woman, slightly lower than in 2021 (1,5). The total fertility rate (TFR) shows the number of children a woman would have if the current year's age-specific fertility rates remained unchanged. This indicator is very sensitive to so-called timing shifts or changes in the birth calendar. The current decline in the birth rate is the result of an increase in the TFR from the mid-2000s to the mid-2010s due to a slight reduction in the interval between births of different orders. It turns out that most women born in the 1980s from the mid-2000s to the mid-2010s gave birth to the number of children they planned, but with shorter intervals between births than would have occurred without the maternity capital policy.

And now, from some perspective, there's not much left to give birth to: the generation born in the 1990s is small, and some of this generation is just finishing their education and is in no rush to have children. And women born in the second half of the 1980s have mostly already had their planned number of children or are also temporarily postponing childbearing.

Regarding the death toll, 2021 was a COVID year, with high losses from the coronavirus infection and its consequences. Why the excess mortality from coronavirus in Russia was so high is a separate question. Rather, it was a combination of the failed vaccination campaign, the increased burden on the healthcare system, and the disregard for health on the part of the population. As a result, in 2021, the life expectancy of the entire population was 70,1 years, i.e., 3,2 years lower than in 2019, the pre-COVID year. Although we observed a mass incidence of coronavirus in January-February 2022, it appears that the virus itself has changed, becoming more easily tolerated and causing less severe lung damage, which is why the mortality rate was not as high as in 2021. As a result, the life expectancy for both sexes was 72,7 years, i.e., having recovered to the 2017 level. In my opinion, we can expect further growth in life expectancy in 2023.

— What are the main reasons for the decline/increase in the birth and death rates in Russia in 2022-2023?

— The temporary decline in life expectancy and increase in mortality in 2020-2021 are due to excess mortality from coronavirus infection. From the mid-2000s to 2019, mortality declined annually, while life expectancy in Russians steadily increased. I would expect a recovery and further growth in life expectancy in 2023 and beyond. But again, everything will depend on the epidemiological situation, which is currently favorable, and on whether the proportion of smokers and the proportion of hard liquor drinkers continues to decline, as was observed throughout the 2010s. These are two factors whose elimination could significantly reduce mortality from cardiovascular disease. The unfavorable situation with mortality from circulatory diseases is also influenced by the prevalence of obesity and adherence to treatment for circulatory diseases (for example, hypertension control). Overall, however, Russia's lag in life expectancy compared to developed countries is largely due to excessively high mortality rates from circulatory diseases and mortality from external causes in the working-age population. Both are largely the result of human behavior. Reducing the prevalence of unhealthy habits and increasing the prevalence of healthy lifestyles (eating right, exercising regularly, and visiting doctors regularly) will lead to increased life expectancy.

The current decline in fertility rates is the result of a combination of factors. On the one hand, I've already mentioned maternity capital, which has led to changes in the birth calendar for some women. On the other hand, other women may be delaying childbearing until later ages: in recent years, the proportion of women having their first child after age 30 has been steadily increasing, and the birth rate after age 35 has generally increased. The reasons for postponing childbearing vary: some want to build a career first, others are waiting for a more stable economic situation, and still others are seeking greater certainty about the future.

Finally, public opinion polls regarding reproductive attitudes indicate that we can expect the proportion of permanently childless people to increase to approximately 15%. However, the impact of increasing childlessness can be overcome if Russian families shift from having one or two children to having two or three children more often.

— Russian authorities traditionally explain demographic problems with "We are now living in a decade where these troughs have merged; this is our historical tail that is haunting us," declares Dmitry Peskov. How true is this?

The demographic trough can partially explain the decline in births that began after 2016. It can also explain the fluctuating demographic burden on the working-age population. Yes, there was a dip in births during WWII, and this dip was natural given the mass mobilization of men for the war. But it's important to understand that, unfortunately, it was not possible to smooth out the demographic tides thereafter.

Why didn't it work? First, in the early 1980s, new family policy measures, followed in part by the anti-alcohol campaign, led to a sharp rise in the birth rate. And the rate of childbearing increased precisely among the rather large cohorts of women born in the 1960s. Then, in the 1990s, there was a decline in the birth rate, both because all the planned children of mothers from the 1960s generation were born earlier, in the 1980s, and partly because of the unstable economic situation. The introduction of maternity capital in January 2007 meant that this measure was available primarily to women from the numerous cohorts of the 1980s. Birth rates: by 2007, they were already in their prime reproductive years and were quick to take advantage of the new support measures, in particular by deciding to have two or three children within a short period of time while the maternity capital program was in effect (remember, the maternity capital program has been extended several times). Therefore, yes, the constant fluctuations in birth rates can be partially explained by the influence of demographic waves, resulting from sudden declines and increases in birth rates.

And demographic waves certainly create some problems. But I wouldn't attribute all of Russia's demographic problems to them. Our lag behind developed countries in life expectancy is the result of the incomplete so-called second epidemiological transition, when people begin to take full care of their own health: they lead a healthy lifestyle, give up bad habits, minimize risky behavior, regularly check their health, and, if necessary, undergo treatment. The government has already created the necessary conditions: we have a well-developed system of clinics and hospitals, access to essential vaccines, and efforts are being made to ensure road safety. Yes, there may be isolated problems locally, but right now, people's health is their primary concern. It's not the government that forces people, for example, to drink strong alcohol, smoke cigarettes, eat a lot of sweets, cross the road without checking it's safe, or speed on the road.

Regarding fertility, both the family policy of the 1980s and the introduction of maternity capital in the mid-2000s led not to a leveling of demographic waves, but to their exacerbation. This is a lesson for the future: it is not worthwhile to introduce measures to stimulate fertility when women from numerous generations are in active reproductive age.

The government regularly presents measures to stimulate the birth rate to the public—maternity capital, benefits for large families, "shaping societal attitudes toward increasing the importance of family and marriage, strengthening traditional family values," and so on. How effective are these measures? What's missing?

Maternity capital is essentially a material measure, and (as expected by many demographers) it had a short-term impact on the total fertility rate in the current period. The increase in the TFR was due to shifts in the timing of births, meaning many women decided to take advantage of the maternity capital program before it was cancelled, minimizing the interval between the birth of their first and second child.

I would call the decision to transfer a significant portion of maternity capital to firstborns a mistake. Almost all women who want children still have at least one child. If it were necessary to transfer part of the maternity capital funds, it would be to third children, since only a third of women who would like to have three children actually plan to do so or have already done so, while the rest forego having a third and settle for one or two. This is where the potential for increasing the birth rate lies.

Yes, large families enjoy certain benefits. But it's important to understand that the more children a family has, the lower the per capita family income. A family with three children also has greater needs: they need at least three rooms of housing to comfortably accommodate children of different ages and genders; they need a car that can comfortably accommodate three child seats; they need to organize summer vacations for three children, enroll them in clubs and activities, and ensure they receive vocational or higher education. These are significant expenses—not just financial ones, but also the parents' time and energy.

Essentially, almost all the measures we currently have are financial support measures. Maternity capital isn't effective in encouraging the birth of third children, as all women who have given birth to two children by now have received maternity capital for their second child, and upon the birth of a third, they can now only use a subsidy of 450 rubles to pay off their mortgage. However, paying off a mortgage isn't feasible for all families. And those families who have already used maternity capital for their second child to purchase a home will struggle to improve their housing conditions upon the birth of a third due to the difficulty of selling a home with children's shares.

The unified child benefit is also a material measure, and it's a poverty-fighting measure, as it's only available to families whose per capita income is below the subsistence minimum and who meet all other eligibility requirements. This means the unified child benefit will have no impact on the birth rate.

If we look at the experience of developed countries with a virtually stable fertility rate of close to 1,8-1,9 children per woman, we see, firstly, a lack of diverse policies to reconcile work and childcare. What are these measures? For example, accessible nurseries and kindergartens for children aged 1 year and older, which would allow some women to return to work much earlier than when their child is 3; flexible work schedules with the opportunity to arrive at work earlier and, correspondingly, leave earlier; part-time employment; extended day care until 19 pm for younger schoolchildren; and separate parental leave for fathers.

Secondly, if we are talking about financial support for families with children, we must strive to ensure that all families with children receive child benefits, even if small, regardless of income, and the amount of this benefit should depend on the number of children, and not on whether the family's income per person is below the subsistence level.

As for "the development of societal attitudes toward enhancing the importance of the institution of family and marriage and strengthening traditional family values," the number of children in a family is irrelevant. Marriages can be as strong as one wishes, but if the country experiences severe economic uncertainty and parents can't be sure that over the next two decades they will earn enough to feed, clothe, and educate three children, have the time to devote to them, and the health to raise them, then families will continue to have one or two children, or no children at all.

In my opinion, increasing the birth rate above 2,1 children, or creating large families, or increasing the proportion of families with four or more children, is unrealistic. A realistic goal is to increase the proportion of families with three children while maintaining the proportion of families with two children at approximately the same level. This is possible if the state and society create the best possible conditions for families to achieve their desired number of births. Then, the TFR and the total fertility rate across generations could reach 1,8-1,9 births per woman.

The Minister of Health called on Russian women to give birth first and then pursue a career. Furthermore, restrictions on medical abortions and a ban on abortions in private clinics have been announced. Do such measures help increase the birth rate?

"No, such measures won't help increase the birth rate. It's perfectly rational for women to first get an education, work for a few years, and only then have a child. This scenario gives women the confidence that they are professionals who can then relatively easily return to the labor market and contribute to the family's well-being. Furthermore, working women who take maternity leave can count on a much higher child care benefit for children under 1,5 years than non-working women. Not to mention, career opportunities for mothers with one or more small children are extremely limited: children get sick periodically, they need to be picked up from preschool and then from school at precise times every day, and their work schedule needs to be adjusted to accommodate children's clubs, activities, and school holidays."

Therefore, in my opinion, it would be much more beneficial for the economy and for families themselves if mothers had a planned number of children at short intervals and returned from maternity leave as quickly as possible to preserve essential professional skills. But again, this requires policies that balance career and parenting.

Regarding abortion, everyone agrees that abortions are bad and that efforts should be made to minimize their number. In recent years, Russia has achieved some success. The abortion rate per 100 live births has been decreasing annually. In 2020, it was 38,8 per 100 births, compared to 66,6 in 2010 and 117,4 in 2005. However, the experience of various countries shows that restricting abortions, or partially or completely banning them, is ineffective. In the case of an unwanted pregnancy, if a woman is unable to obtain a safe abortion in a medical clinic, she will, at best, travel to another country where abortions are not restricted; at worst, she will have an illegal abortion outside of a clinic, which will be completely unsafe for her reproductive health.

But there is another way to reduce abortions, which involves, firstly, raising public awareness, including among adolescents, about modern, effective contraceptive methods, for example, by introducing sex education classes in schools; secondly, increasing the availability of modern contraceptives for women, for example, by partially subsidizing the purchase of hormonal contraceptives or intrauterine devices from the compulsory medical insurance fund.