Reproductive health in the post-Soviet state : abortion and contraception in Estonia

Until 1991 Estonia was a republic of the Soviet Union and in common with other former Soviet and Eastern European States, Estonia has been experiencing ‘transition’ since independence. Official statistics show that, in Estonia, period fertility rates have declined dramatically over the transitional period. The use of modern contraceptive methods is thought to have increased, although there is a dearth of data to substantiate this. Abortion rates have declined, but rates remain high by European standards. However, little is known, at least outside Estonia, concerning the relevance of the Soviet model and ‘abortion culture’ today. Qualitative research methods are employed to investigate fertility control in Estonia. New analyses of survey data and evaluation of official statistics are used to illustrate the context within which qualitative findings can be better understood. Findings indicate that the use of modern contraceptive methods has increased and abortion rates, although high in comparison with Western Europe, are falling despite the challenges of transition. However, abortion rates for non Estonian women are higher than for Estonian women and the differential is growing. The results of qualitative research suggest that transition has been a painful experience for some inhabitants of Estonia. Young adults express wariness of having children when they feel insecure about the future, especially in terms of employment opportunities and living costs. Attitudes to contraception are positive, but fears concerning the safety of hormonal methods remain. The cost of modern and effective contraceptives may serve as a barrier to some potential users. Participants make a number of pertinent suggestions concerning how reproductive health in Estonia might be improved.