Hesitantly and with little public debate, Russia has increased its restrictions on abortion for the first time in nearly half a century.
Russia's abortion regulations remain among the most permissive in the world - there are still no limits on abortions in the first 12 weeks of pregnancy - but the new restrictions appear to reflect the first stirrings of a wider debate here over the morality of abortion, as well as the effect abortions are having on women's health and on the demographic future of Russia.
Ever since 1955, when the Soviet Union lifted a ban that had been imposed by Stalin in 1936, abortion here has been a common and widely accepted means of birth control, giving Russia one of the highest abortion rates in the world.
The collapse of the Soviet Union, and with it the increased availability of contraceptives, has resulted in a substantial decline in abortions in Russia - from a high of 4.6 million in 1988 to 1.7 million last year.
But now the Ministry of Health, under pressure from conservative lawmakers, has decided to reduce the number further through government-imposed restrictions on what has effectively been free and virtually unlimited access to abortion.
Before the new restrictions, which took effect on Aug. 11, women could receive an abortion between the 12th and 22nd weeks of their pregnancies by citing one of 13 special circumstances called "social indicators," including divorce, poverty, unemployment or poor housing.
The government's decision has reduced the number to four: rape, imprisonment, the death or severe disability of the husband or a court ruling stripping a woman of her parental rights. Being a single mother or a refugee is no longer reason enough to abort a pregnancy after the 12th week.
As before, pregnancies can still be aborted after 12 weeks on medical grounds, including severe disabilities of the fetus or a threat to the mother's life.
The reaction to the government's decision - announced with little publicity in Russia's equivalent of the Federal Register - has been subdued.
But some lawmakers and leaders of the Russian Orthodox Church have welcomed the change and vowed to continue fighting for greater restrictions through new legislation. That has raised concerns among some doctors and the Russia Family Planning Association that a woman's right to an abortion - basically a given here - could soon be curtailed.
"It's a first step," said Alexander Chuyev, a member of the lower house of Parliament, who introduced legislation earlier this year to ban all abortions after the 12th week and then took part in negotiations with the Ministry of Health on drafting the new restrictions.
He welcomed the restrictions, characterizing them as a compromise. He said he planned to sponsor a new bill this autumn, during the campaign for parliamentary elections, that would give a human fetus the same rights as a child.
"Maybe then women will think more before they have an abortion," he said.
The nascent debate over abortion here has been influenced by a variety of factors, including the resurgence of religion and the growing influence of the Russian Orthodox Church after 70 years of official atheism under Soviet rule.
Russia's demographic crisis has also led to demands that steps be taken to reverse the declining population trend.
Though the country's birth rate rose last year - to 9.8 births per 1,000 people from 9.1 the year before - the population over all is projected to continue to decline. For every 10 births in Russia, there are still nearly 13 abortions.
Few are calling for an outright ban on abortions, even within the church, said Vsevolod Chaplin, a spokesman for Patriarch Aleksy II. But the voices against abortion are growing. "I think this debate will continue on the political level," he said. Anatoli Korsunsky, the Health Ministry's chief of maternity and childhood health, said in an interview that the new restrictions had been carefully weighed, taking into account the risks abortions carry for a woman's health. Abortions in the later stages of pregnancy and repeated abortions, which are common here, pose the greatest risks to fertility and health generally, he said. He acknowledged, though, that the decision was also influenced by what he called "the social aspect" of allowing virtually unlimited access to abortion.
Of the 1.7 million abortions in 2002, 40,000 were carried out under one of the 13 indicators. Korsunsky said that limiting the circumstances under which these abortions would be allowed was not intended to force women to continue with unwanted pregnancies, but rather to encourage them to avoid abortions through traditional family planning and birth control.
"The adherence to a wide range of social indicators for abortion has given the impression to the public that it is easy to get an abortion at any stage of pregnancy," he said. "It lowers the responsibility of a woman for her reproductive health, her general health and the health of her children."
The list of social indicators has been in place since the Soviet government adopted them in 1987. At that time, they served the purpose of significantly expanding access to abortion after the 12th week.
Yuri Bloshansky, Moscow's chief gynecologist for the past 40 years, said the government did so at that time in large part to address the risks posed by women seeking illegal abortions, often in unsafe conditions.
"I remember vividly those women dying, forced to go anywhere else, going to swindlers operating in septic conditions," he said. "I don't want to see a repetition again."
Within the Ministry of Health, there was considerable debate over how many of the indicators should remain.
In the end, the ministry settled on preserving four, though the number includes a statistical sleight of hand that underscored the government's sensitivity to the perception that it was reducing the number as much as possible.
Death and disability of a husband, which had been counted as separate circumstances in the old list, were combined in the new list, meaning in reality that five of the previous conditions remain codified in the new list of four.
Inga Grebesheva, director of the Russia Family Planning Association, said her organization did not vigorously object to the new regulations since they would not greatly affect a woman's access to abortion.
She expressed concern, however, that the government's decision reflected the beginning of a trend in which the church and conservative lawmakers would seek to wield greater influence over public policy on moral grounds. She noted that Parliament voted in 1998 to eliminate federal financing for family-planning clinics, though city and regional governments have since continued many of the services.