Multiplication by zero: Russia’s promised childbirth support turns into reproductive pressure

RU

“There is no assistance program”

When Moscow women received mass referrals in September to take an AMH test, it raised numerous questions and concerns on social media. Users speculated that “the government is trying to interfere in women's private lives and force them to give birth.” Comments appeared speculating that authorities might use fertility data to pressure women into motherhood. Jokes even circulated about “forced insemination by heroes of the special military operation (SMO)” for women who did not want children.

At the same time, women from other regions voiced frustration, noting that this “privilege” of a free AMH test was only available in the capital. But the catch turned out to be something else entirely: the promised support program was nothing more than empty words.

The distribution of test invitations began on September 12. By early November, over 60,000 women had taken advantage of it, according to Moscow’s Department of Health. “If hormone levels are low, women will be invited to a women’s health center or consultation clinic, where they will be offered necessary procedures. For example, they can store their eggs for free in a specialized biobank through freezing — cryopreservation,” stated a notice on the mos.ru website.

Tatiana, a Moscow resident, was one of the first to spot a referral in her personal account on mos.ru. She shared her experience with The Insider in September, saying she had decided to take the test with the hope of eventually undergoing IVF.

“I’m 38, and as it turns out, my AMH level is 0.9. That’s slightly below the normal range for my age but still suitable for IVF. However, only if I pay for it! I can’t get IVF covered by public health insurance; it’s only available for women with a level of at least 1.3. But this threshold was the same in previous years, meaning nothing has changed. So, where’s the help?” Tatiana wonders.

The Insider interviewed 10 women, aged 27 to 38, who took the test through a referral from the Department of Health and received results below one. A Moscow reproductive health clinic explained to The Insider that 1.0 is considered the conditional threshold. All interviewees were denied treatment due to “low AMH” — contrary to the government's promises.

On the popular pregnancy forum Babyblog, Russian women share stories of falsifying their AMH test results in order to “qualify for the quota.” These women had ultrasounds showing normal ovarian function but low Anti-Müllerian Hormone levels, which they had to bypass through falsification.

According to reproductive specialists interviewed by The Insider, restrictions on the government program for free reproductive services are driven by the need for efficient allocation of federal and regional budget funds. Women with low AMH levels require more medication and additional stimulation sessions, while their likelihood of IVF success is lower.

Elena Merkunova (named changed for safety reasons), a gynecologist and reproductive specialist working for a state family planning center, explained to The Insider that successful IVF requires retrieving as many eggs as possible in a single cycle — even though a healthy, fertile woman’s ovary typically produces only one egg per month.

“Let’s say, ideally, at least 10 eggs, if not more, because some of them will be unsuitable for fertilization, some won’t make it through fertilization, and some won’t survive the first days… That’s an oversimplification, of course. To retrieve a high number of oocytes, hormonal stimulation medications are used. As a result of this stimulation, both ovaries produce several eggs in one month.

This number can range from 20 to as few as five, and in this context, Anti-Müllerian Hormone serves as an indicator of how well the ovaries are expected to respond to stimulation. It's not always precise, not always reliable, but public policy can’t afford to accommodate such nuances or consider each individual’s specific circumstances.”

That’s why the AMH test was introduced as a filter for participation in the program — it allows for screening out women with low hormone levels. These women will require multiple stimulations and high doses of hormones to produce a sufficient number of eggs, which, in turn, increases the cost of medications — along with the amount of time the doctor must devote to the case. However, AMH is not a universal marker of IVF success, and screening women solely based on this factor is a crude method.

“Yes, the expected success of IVF with an AMH above 1.3 is considered higher than with 0.7. But as a practicing doctor, I’ll say that the hormone level doesn’t indicate the quality of the eggs. For example, with an AMH of 1.5, we might not obtain any viable oocytes at all. With 0.7, we might get just two, but they could be of high quality, leading to viable embryos and a successful pregnancy.”

In other words, the government wants to encourage Russian women to have children and is willing to help, but only in cases where it does not involve significant costs — either financial or in terms of labor.

“The language used by the Department of Health, such as 'we’ll help you become the mother of a healthy child,' has a degree of disingenuousness, because nothing guarantees the birth of a healthy child,” Elena observes.

“They treated me as if I were hopeless”

Despite the bold claims made by Moscow Deputy Mayor Anastasia Rakova, women’s health clinics are unaware of any new programs. The promised egg freezing under the mandatory health insurance system is not actually available within the healthcare system on a permanent basis. Moscow resident Alina (name changed) shared her experience:

“I saw the news about the option to freeze eggs for free, and I even got a referral for an AMH test. But when I went for a consultation at the clinic, they told me, 'No directives have been issued; it’s just something they announced on TV,' and they offered to freeze my eggs for a fee. There was no free freezing at all, only free IVF for those with an AMH between 1.3 and 1.5.”

Another Moscow resident, Maria, suffered a nervous breakdown instead of receiving help after visiting a women’s health clinic. She took the test at the end of July at one of Moscow's private laboratories. The result of 0.7 shocked her, as she did not expect to see such a low reading, especially since in the summer of 2023, her level had been twice as high. After receiving a referral from the Department of Health in September, she retook the test and saw a result of 0.95. A few days later, she received a call from the women’s clinic and was invited for an appointment:

“By that point, I had already read about the special program in Moscow for women like us, those with slightly reduced fertility, but who were being offered help to make the decision to have a child,” the young woman explains. “I was very happy that such an initiative existed. I’m not planning to have children right now, so I wanted to try freezing my eggs, especially since it was listed among the free services. I agreed to come in to understand what options I had and what they could offer me.”

Nothing, it turned out. Maria describes her visit to the women’s health clinic as “just a disappointment”:

“They treated me as if I were some kind of hopeless case. They spoke in a completely indifferent tone. I was told that if I didn’t want to have children, there was no problem — I probably wouldn’t be able to conceive naturally anyway. And this was before the ultrasound — just based on the AMH level!

It turned out that I was not eligible for either free IVF or free egg freezing, precisely because of my very low AMH. Although for paid IVF, my AMH level somehow seemed acceptable to them.

The doctor also threw in the remark: 'They’ll do everything for you for a fee, but the question is whether it will be successful...' And when I mentioned egg freezing, she said, 'Why freeze them at 36?' I left in a hysterical state, with tears in my eyes, panicked, and couldn’t calm down for two days.”

The decision to grant an IVF quota under the mandatory health insurance system is made after assessing the condition of the ovaries through ultrasound — the only way to reveal how many antral follicles a woman has. If there are fewer than five of these follicles, it indicates a reduced ovarian reserve.

However, Maria did not undergo an ultrasound because her period started that day. She was refused solely based on her AMH level.

“After visiting that clinic, I went to a gynecologist under my private insurance. We did an ultrasound, and it turned out that my reproductive function was not reduced at all! One ovary had more than seven follicles, and the other had ovulation. These are excellent results! My AMH, in my specific case, doesn’t reflect fertility — it’s apparently low due to thyroid issues and endometriosis, as the doctor suggested,” Maria explains.

“Moreover, I was told that egg freezing is not available for free, only embryo freezing is. So why did they promise it?”

The program for free egg cryopreservation does exist, but only for those willing to donate some of their oocytes. It has strict limitations — women must be under 35 and have at least two children, two Moscow residents told The Insider. These women had planned to donate eggs but were refused due to not having children. “It’s just strange — who would even want to donate eggs when they already have two kids?” one of the women wonders.

The women interviewed by The Insider question what the real purpose of the mass mailing of referral forms for fertility tests could be, given that the assistance program has not actually been launched. Maria also suspected the authorities of collecting and processing her personal data without her consent — she was assigned to a women’s health clinic in a district where she had never been registered.

“To take the blood test for AMH, I had to choose a date, time, and clinic that was most convenient for me. I logged into the EMIAS portal and saw that several clinics in eastern Moscow were available to me, but I was registered at the women’s health clinic in Novogireevo! And I live in the southwest! There’s a clinic on the west side where I’ve been registered since 2016.” The young woman explained that she had lived with her partner in his apartment in the southeast of the city, in Lyublino, for four years but had not registered there. “So somehow the city found out about it when it compiled its database and assigned me to Novogireevo. But how did they know?” the Moscow resident wonders.

Questions also arose among the staff of a cultural institution in one of Moscow's suburbs. They were handed questionnaires about reproductive health, which requested information about their menstrual cycle, sexual life, gynecological and other health issues, children, and pregnancy planning. The data was intended for the human resources department. Those who refused to fill out the questionnaires were promised a follow-up conversation.

The fight against childfree

Arguably the most controversial and scandalous initiative in the push to stimulate birth rates is the draft law banning the “promotion of childfree ideology,” which the State Duma approved in its final reading on November 12. The package consists of two laws: the first bans the dissemination of information promoting the rejection of childbearing via the internet, media, films, and advertisements; the second introduces administrative penalties for violating this ban. These are similar to the punishment for promoting LGBT propaganda: individuals could face fines of up to 400,000 rubles (around $4,000), officials up to 800,000 ($8,000) rubles, and legal entities up to 5 million rubles ($50,000).

People who do not wish to have children or adopt are, much like LGBT individuals, labeled as supporters of a destructive ideology promoted by a non-existent international movement. Lawmakers clarified that the law is intended to protect Russians from this “destructive trend.” Human rights activists fear that the law will likely be used as a tool for repression — against activists, and also anyone else, openly expressing such views online.

Amid its preparations for life under the new law, the largest VKontakte community supporting mothers, #shchastyematerinstva, with 150,000 subscribers, shut down. The group had existed since 2015. The administrators stated that they had removed all posts to avoid facing charges. They were unwilling to edit the posts accumulated over nine years. In the group, women had anonymously shared the challenges of motherhood and supported one another, but some posts included confessions from users who regretted their decision to have children.

“I have two children, one with autism, and I definitely won't be having any more. I used to say to everyone that I gave birth and became childfree. Of course, it was a joke because I love my children. But now I realize that this joke could lead to a denunciation and prosecution for promoting childfree,” says Olga, a resident of Novosibirsk, who was part of the VK community.

Now, people will have to talk in whispers — not only about politics and war, but also about children. Women in difficult life situations will suffer the most, according to the subscribers of the public chat group.

“I support responsible motherhood. I believe you should first ensure all the necessary conditions for a child before deciding to have one, especially when you don't even have enough to eat. In such circumstances, having a child should be the last thing on your mind! So now we can't even discuss this without risking criminal charges? Well, people will just create underground groups to learn about the difficult realities of motherhood, because they do exist, and it's important to understand them before deciding to have a child — if, of course, you are a responsible mother who wants the best for your child. Don’t try to put rose-colored glasses on young women by only talking about the positives.”

Judging by surveys, the absurdity of the statement about the need for a law banning childfree ideology is further proven by the fact that Russians cannot be considered a childfree nation. According to the sociological project To Be Exact, by the age of 45, 10% of women in Russia do not have children, but only 2.4% of respondents firmly do not want them. Data from other studies show similar figures, meaning there is no widespread desire for childlessness among Russians, experts conclude.

Among the main reasons for not having children, experts highlight infertility and unfavorable social conditions. The highest proportion of those who refuse to have children is found among women with below-average education. “This can be explained by the fact that women with lower levels of education often have fewer men around them with whom they can establish a stable family, and fewer resources. Money and housing play a huge role,” the study states.

Reproductive programs are indeed an expensive affair. Elena did freeze her eggs, but at a private clinic. It cost her around 500,000 rubles — a sum inaccessible to most Russian women, especially if the woman is single and has no partner. In general, private clinics offer cheaper programs starting from 200,000 rubles, while in public ones, prices begin at 120,000 rubles.

This situation could at least be partially addressed via programs like the one announced by the authorities in Moscow — if only it actually existed.

“No more benefits, aid goes to SMO veterans rather than large families”

Against the backdrop of declining birth rates in Russia, Vladimir Putin, after the start of the war with Ukraine, has repeatedly expressed support for measures aimed at increasing the population's levels of reproduction. In May, he set the goal of encouraging more frequent births of third and subsequent children.

In practice, however, the kind of support for large families that the Kremlin has declared to be a priority is diminishing.

Muscovite Lyubov (name changed) has seven children — five biological and two adopted. After the war began, it became difficult to provide them with educational opportunities outside the regular school program. Up until September 2022, the family had enjoyed discounts of up to 20% on extracurricular activities at the Children's School of Arts, but then those discounts were canceled.

“This was very noticeable since we have many children, and therefore many extracurricular activities. With the rising costs of these programs, the difference became quite significant. Some of the extracurriculars that the children enjoyed had to be dropped,” Lyubov explains.

According to her, the number of paid services is growing, while the number of budget-friendly options is decreasing.

“Next, the funds. This is a minor matter, but still. In the past, we would occasionally get calls from different fund representatives. They offered food, office supplies, clothes. They found us themselves, probably through the local district administration,” says Lyubov. “Now, all these funds are 'looking out' for the children of military servicemen, and for the servicemen themselves.”

It has also become more difficult to receive child support. In 2022, Russian authorities allowed men with outstanding child support debts to go to the front. Bailiffs closed enforcement cases and lifted freezes on the accounts of those who went off to fight. They also lifted travel restrictions for these men. Those convicted under Article 157 of the Criminal Code — for willful non-payment of child support — were granted a deferment: they do not have to serve their sentences while on the front lines. As a result, large sums of money have accumulated in servicemen's accounts, but bailiffs cannot seize these funds while a serviceman is on active duty.

The offer of maternal capital payments, which showed decent results in stimulating birth rates in 2020 and 2021, has lost its effectiveness since the start of the “special military operation,” says political scientist and economist Vladislav Inozemtsev. Childbirth payments are indexed based on official inflation data, while military service and funeral payments in 2024 are increasing about 30 times faster than inflation.

For comparison: the amount of maternity capital for the birth of a first child in 2024 is just over 630,000 rubles, while the one-time payment for signing a military service contract in Moscow is 1,900,000 rubles.

“How are we supposed to raise them if they are already being groomed for war from school?”

In September, Kremlin spokesman Dmitry Peskov called the demographic problem one of the country's main challenges, with increasing the birth rate being a priority. “Therefore, everything that needs to be done to increase birth rates must be done. And everything that hinders this, of course, must disappear from our lives,” he concluded. Still, there is no talk of eliminating the main factor that hinders population growth in Russia — the war.

Russians who oppose the war in Ukraine argue that the growing propaganda in schools and the preparation of children for military service are causing people to reconsider having children in the country. Families who have already had children are considering relocating abroad. All of this exacerbates the demographic crisis.

This was the case for Lyubov. By the standards of the Russian state, she has a “proper” family — with multiple children being brought up to follow the Orthodox church. Taking five biological and two adopted children abroad and reestablishing their lives elsewhere seemed like a very difficult — and unnecessary — task. But that is exactly what they are doing now. Lyubov cites the intensification of propaganda and the reduction of benefits for large families as the cause. The final straw was the persistent attempts by teachers to gather documents for the initial registration of her eldest son, who recently turned 16, for military service.

“Every member of the school administration is chasing after him,” complains the Muscovite. “The teachers, the deputy principal, the headmaster — they're pressuring him, demanding that he fill out his military registration forms! In one of the papers they gave him, there are some curious questions,” says Lyubov. “For example, about his involvement in the school's activities. What role does he play — organizer, participant, or does he avoid taking part altogether? They ask for details on his personality traits, his inclination toward professional activities, and his reaction to criticism from adults. It's obvious what they're getting at.”

Lyubov refused to fill out the forms for her son and withdrew his documents from the school. Afterward, the teachers began asking her other children for details about all their relatives, including their occupations and places of residence. Lyubov speculates that these addresses could be used to track down the child if he fails to appear at the military enlistment office.

Like many other parents, Lyubov fears the “patriotic education” in schools. At the end of September, her children's school held a lesson on the topic “Defending the Homeland as the Duty and Responsibility of Every Citizen.”

In early November, for National Unity Day, the school administration required students to wear clothing in the colors of the Russian flag and participate in a flash mob — arranging themselves in the shape of a heart, taking a photo, and posting it on their social media as a “symbol of unity in defense of the motherland.”

“It used to seem to me that these flash mobs, where everyone lines up and takes photos, happen somewhere in the regions, but now they are organizing such events in our Moscow school. How can you give birth, raise, and educate children when they are being groomed for war from school, even from kindergarten?” wonders Lyubov.

In the regions, patriotic actions for schoolchildren are indeed organized more frequently than they are in the capital. In the Rostov region, preschoolers at a meeting with “SMO participants” were given a model of the destroyed Ukrainian city of Bakhmut. In the same Rostov region, 10 children from the Raduga kindergarten in the village of Rassvet joined the Yunarmiya military youth movement.

The governor of Primorye, Oleg Kozhemyako, stated that providing assistance to the children of deceased soldiers helps promote patriotism in the next generation:

“Children of SMO participants do not fall under the category of orphans, who are eligible for financial support from the federal budget for housing. Those who gave their lives for the Motherland deserve that their children live well. Our approach is somewhat different now — the worse the family's social situation, the better it will be for the child. However, the child of someone who gave their life for the Motherland or became a first-group disabled veteran is somehow left without housing. Yes, there is a military mortgage program, but we are talking about children. We need the child to understand: yes, the father performed a heroic deed and died, but thanks to his sacrifice, I now have an apartment and a future. This instills patriotism in children.”

“Must give birth for the country”

Rhetoric against abortion has also intensified. As of the time of this writing, ten Russian regions have introduced fines for “inducing abortions.” As the Telegram channel of the Legislative Assembly of the Zabaikalye region states: “Actions aimed at coercing a pregnant woman to undergo an abortion include persuasion, offers, bribery, deceit, or other forms of influence.”

The fine will start at 5,000 rubles for individuals, 20,000 rubles for officials, and 50,000 rubles for legal entities. In the Perm region, women who give birth to children fathered by SMO participants are promised an additional payment of 128,000 rubles for each child.

On the Spas TV channel, Russian women were called “criminals” for wanting to have an abortion, even after rape. At the end of the program, the host stated that a woman who undergoes an abortion “becomes a criminal no less than the person who committed the violence.” To cope with the trauma, Russian women were advised to turn to a church or a Christian psychologist. This advice was given on air by Lyudmila Podolskaya, a frequent guest on the Direct Lifeline show. She gave birth to two children before she was 17 and now provides Orthodox psychological counseling, trying to dissuade women from having abortions.

Pro-Kremlin nationalist groups that previously focused on fighting migrants and raising funds for Russian military forces in Ukraine (“Russian Community,” “Northern Man,” etc.) have also joined in on the reproductive pressure, intensifying their “fight against abortion” and spreading numerous fake claims — including one about how cancer will retreat if a woman carries a pregnancy to term instead of having an abortion. The Ministry of Health is also aiding in the effort by putting out clinical guidelines falsely stating that abortion may lead to cancer, mental illness, and heart disease. This contradicts the old version of the document from 2021, which stated that complications from medication-induced abortion occur in only 2–5% of cases.

Nationalists are also creating petitions against doctors who perform abortions, urging their supporters to sign them on behalf of the “Russian public.” They are organizing protests against clinics and doctors providing abortion services and recording videos denouncing “murderers in white coats” on behalf of Russian military personnel. “We will definitely win, come back, and hold everyone accountable for the murders of our yet unborn children,” says one of the soldiers in the video.

Abortion under the mandatory health insurance system in Russia is still available at the woman's request, but it has become more difficult to obtain in some regions. Women are complaining about delays, with a “week of silence” required before making a final decision, during which the pregnant woman is asked to reflect on their situation.

Patients share that they are being sent for a consultation with a priest, resulting in abortions being delayed to later stages than originally planned. Additionally, pregnant women at women's clinics will now receive personalized letters from Patriarch Kirill. According to Natalia Moskvitina — the organizer of the campaign and chairwoman of the anti-abortion project “Hello, Mom!” — the letters will be distributed across 16 regions, including Karelia, Mordovia, Kamchatka, Arkhangelsk, Kemerovo, and Tambov regions.

Moskvitina explained that the letter from Patriarch Kirill will be placed in a folder of documents given to first-time visitors to the clinic. Typically, these folders already contain greeting letters from local authorities and a brochure with information on support for pregnant women. In his letter, Patriarch Kirill “blesses the woman and her child” and wishes them “good health, peace of soul, and many blessings from Christ, the Giver of Life.”

Maria Zakharova, the official spokesperson for the Russian Ministry of Foreign Affairs, proposed at a meeting of the Tsargrad society that the term “abortion” be replaced with “murder.” This initiative was enthusiastically supported by pro-government Telegram channels. One such outlet suggested: “When a woman purchases medication, it will be labeled: 'A substance for killing a child in the womb.'“ Another channel called for criminal liability to be imposed on women who undergo abortions.