1. Demography of Russia and the Former Soviet Union Lecture 7 Sociology SOCI 20182

2. Suggested Plan of Presentation by students Overall description of the country (geographic position, population, etc.) Trends in fertility and family formation after the independence Trends in mortality and health after the independence Population aging Migration Similarities and dissimilarities with Russia List of sources used (data sources and publications)

3. Suggested Presentation Schedule March 1 – Armenia, Belarus, Latvia, Estonia March 3 – Georgia, Azerbaijan, Uzbekistan Duration: 15 min (15-20 slides)

4. Reproductive health

5. Abortions in Russia 1964 - 5.60 million 1988 - 4.60 million 1990 - 3.92 million 1995 - 2.57 million 2000 - 1.96 million 2002 - 1.78 million 2005 - 1.60 million Source: Russian Ministry of Health

6. Soviet poster circa 1925 against criminal abortions

7. Abortion rates in Russia and USA

9. Abortion rates in Europe, 2002

10. Changing pattern of abortion By the late 1980s, the number of women using modern contraceptive methods to prevent births exceeded the number who used abortion to do so. Russian contraceptive access has increased in part through efforts by the Russian government and the United States Agency for International Development (USAID)

11. Abortion and modern contraceptives use (IUD, pills) in Russia

12. Trends in Abortion Rates in Belarus Number of abortions per 1000 women aged 15-49

13. Trends in Abortion Rates in Belarus Number of abortions per 100 births

14. Reproductive Health Trends in Eastern Europe and Eurasia Report of Population Reference Bureau (2003) by Lori Ashford

15. Based on population surveys Two U.S.-based agencies, the Centers for Disease Control and Prevention (CDC) and ORC Macro, helped national institutions conduct surveys in Eastern Europe and Eurasia from 1993 to 2001. The two types of surveys, Reproductive Health Surveys (RHS) and Demographic and Health Surveys (DHS), interviewed women from a representative sample of households in each country to gather extensive information on fertility, family planning, maternal and infant health, and other reproductive health topics. Major support came from the U.S. Agency for International Development, with funding in some countries from the United Nations Population Fund and UNICEF.

16. Fertility decline in selected FSU countries

17. Abortions In most countries, abortions are most common among women ages 20 to 34. Most women who reported having an abortion said that they did not want and could not afford another child. The vast majority of abortions follow unintended pregnancies, which mainly occur among women who do not use contraception or who use traditional methods that have relatively high failure rates. Between 71 percent and 90 percent of unintended pregnancies end in abortion, indicating that women are strongly motivated to avoid an unplanned birth.

18. Trends in abortion rates in selected countries In many Central Asian countries decline in abortion rates was caused by emigration of Russians who have higher abortion rates compared to local ethnic groups

19. Trends in Abortion Rates in Four FSU Countries Number of abortions per 100 births

20. Reproductive health indicators in 1996-2001, FSU Lifetime number of abortions per woman % Mothers receiving prenatal care (1 st trimester) Births Outside Medical Facilities (%) Russia2.3831.8 Ukraine1.6660.9 Armenia2.6548.5 Azerbaijan3.24526.3 Georgia3.7637.8 Kazakhstan1.4601.6 Kyrgyzstan1.5723.8 Turkmenistan0.8724.2 Uzbekistan0.6735.9

21. Potential Need for Modern Contraceptive Methods* *Includes married, fecund women who say they would prefer to avoid a pregnancy but who either are not using any contraception or are using a traditional method such as withdrawal or periodic abstinence.

22. Traditional contraception methods and abortions

23. Mortality and Health in Russia

24. General Overview of Mortality Topic

25. Age Pattern of Mortality U.S. population in 1999

26. The Gompertz-Makeham Law μ(x) = A + R e αx A – Makeham term or background mortality R e αx – age-dependent mortality; x - age Death rate is a sum of age-independent component (Makeham term) and age-dependent component (Gompertz function), which increases exponentially with age. risk of death Non-aging component Aging component

27. Gompertz Law of Mortality in Fruit Flies Based on the life table for 2400 females of Drosophila melanogaster published by Hall (1969). Source: Gavrilov, Gavrilova, “The Biology of Life Span” 1991

28. Gompertz-Makeham Law of Mortality in Flour Beetles Based on the life table for 400 female flour beetles (Tribolium confusum Duval). published by Pearl and Miner (1941). Source: Gavrilov, Gavrilova, “The Biology of Life Span” 1991

29. Gompertz-Makeham Law of Mortality in Italian Women Based on the official Italian period life table for 1964-1967. Source: Gavrilov, Gavrilova, “The Biology of Life Span” 1991

30. Measures of Mortality Crude Death Rate Age-Specific Death Rates (Age- Specific Mortality Rates) Age-Adjusted Mortality Rates (Standardized Mortality Rates) Life Expectancy (at birth or other age) Measures of Infant Mortality

31. Crude Death Rate Number of deaths in a population during a specified time period, divided by the population size "at risk" of dying during that study period. For one-year period, Crude Death Rate, CDR = Deaths in that year /mid-year population size x 1,000 to adjust for standard-sized population of 1,000 persons mid-year population = total population for July 1

32. Crude Death Rate Pros and Cons Pros: - Easy to calculate, and require less detailed data than other mortality measures - Useful for calculation of the rate of natural increase (crude birth rate minus crude death rate) Cons: - Depends on population age structure (proportions of younger and older people)

33. Trends in crude death rates (per 1,000) for Russia, USA and Estonia

34. Distribution of crude death rates (per 1,000) in Russia, 2003

35. Age-Specific Death Rates (ASDR) or Age-Specific Mortality Rates (ASMR) Number of deaths in a specific age group during a specified time period, divided by the size of this specific age group during that study period. Example: For one-year study period, Age-Specific Death Rates, ASDR for males at age 45-49 years = = Deaths to males aged 45-49 in that year / Number of males aged 45-49 at mid-year x 1,000 to adjust for standard-sized population of 1,000 persons of that age.

36. Age-Specific Death Rates Pros and Cons Pros: - Allows to study mortality by age (and sex) Cons: - Requires detailed data on deaths by age (not always available for developing countries, war and crisis periods, historical studies)

37. Infant Mortality Rate, IMR Proportion of infants who die in their first year Number of deaths under age one during a specified time period, divided by the number of live births For one-year period, Infant Mortality Rate x 1,000 to standardize per 1,000 live births

38. Infant Mortality Rate Pros and Cons Pros: - Sensitive indicator of overall health conditions in a country, particularly child health - Useful for indirect estimates of mortality in other age groups through imputation, using the so- called "model life tables" Cons: - Requires accurate data on births and infant deaths (not always available for developing countries, war and crisis periods, historical studies)

39. Changes in infant mortality in Russia, USA and Estonia

40. Definition of live birth in the USSR was not consistent with WHO definition WHO definition of live birth: "the complete expulsion or extraction from its mother of a product of conception, irrespective of the duration of pregnancy which, after such separation, breathes or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord or definitive movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached.“ The Soviet Union adopted a less inclusive definition, excluding infants born before 28 weeks and those weighing less than 1000 grams, regardless of signs of life. Soviet definition resulted in underestimation of infant mortality After getting independence, many FSU countries adopted WHO definition of live birth

41. Distribution of infant mortality in Russian regions, 2003

42. Age-adjusted death rate (ADR), standardized death rate (SDR) or age-standardized death rate (ASDR) Death rate expected if the studied population had the age distribution of another "standard" population (arbitrary chosen for the purpose of comparison). Calculated as weighted average (with weights being proportions of the "standard" population at each age)

43. Age-Adjusted Death Rate or Age-Standardized Death Rate Direct method of age standardization: M ui is mortality rate in the studied population at age i P si – number of persons at age i in the standard population. P s – total standard population.

44. Age-Adjusted Death Rate or Age-Standardized Death Rate Pros: - Allows comparison of death rates of populations despite differences in their age distribution Cons: - Requires data on death rates by age (not always available for developing countries, war and crisis periods, historical studies) - Results of comparison may depend on the arbitrary choice of standard.

45. Typical standard populations European standard population and World standard population suggested by the World Health Organization In the United States: 1940 U.S. standard population and 2000 U.S. standard population (applied around 2003)

46. The Concept of Life Table Life table is a classic demographic format of describing a population's mortality experience with age. Life Table is built of a number of standard numerical columns representing various indicators of mortality and survival. The concept of life table was first suggested in 1662 by John Graunt. Before the 17th century, death was believed to be a magical or sacred phenomenon that could not and should not be quantified. The invention of life table was a scientific breakthrough in mortality studies.

47. Life Table Cohort life table as a simple example Consider survival in the cohort of fruit flies born in the same time

48. Number of dying, d(x)

49. Number of survivors, l(x)

50. Number of survivors at the beginning of the next age interval: l(x+1) = l(x) – d(x) Probability of death in the age interval: q(x) = d(x)/l(x)

51. Probability of death, q(x)

52. Person-years lived in the interval, L(x) L(x) are needed to calculate life expectancy. Life expectancy, e(x), is defined as an average number of years lived after certain age. L(x) are also used in calculation of net reproduction rate (NRR)

53. Calculation of life expectancy, e(x) Life expectancy at birth is estimated as an area below the survival curve divided by the number of individuals at birth

54. Life expectancy, e(x) T(x) = L(x) + … + Lω where Lω is L(x) for the last age interval. Summation starts from the last age interval and goes back to the age at which life expectancy is calculated. e(x) = T(x)/l(x) where x = 0, 1, …,ω

55. Life Tables for Human Populations In the majority of cases life tables for humans are constructed for hypothetic birth cohort using cross- sectional data Such life tables are called period life tables Construction of period life tables starts from q(x) values rather than l(x) or d(x) as in the case of experimental animals

56. Formula for q(x) using age-specific mortality rates a(x) called the fraction of the last interval of life is usually equal to 0.5 for all ages except for the first age (from 0 to 1) Having q(x) calculated, data for all other life table columns are estimated using standard formulas.

57. Life table probabilities of death, q(x), for men in Russia and USA. 2005

58. Period life table for hypothetical population Number of survivors, l(x), at the beginning is equal to 100,000 This initial number of l(x) is called the radix of life table

59. Life table number of survivors, l(x), for men in Russia and USA. 2005.

60. Life table number of dying, d(x), for men in Russia and USA. 2005

61. Life expectancy, e(x), for men in Russia and USA. 2005

62. Trends in life expectancy for men in Russia, USA and Estonia

63. Trends in life expectancy for women in Russia, USA and Estonia

64. Distribution of life expectancy, Men, 1999

65. Distribution of life expectancy, Women, 1999

66. Mortality reversal Situation when the usual time trend of declining mortality is reversed (mortality is increasing over time). Observed in sub-Saharan Africa (AIDS epidemic), Eastern Europe, and FSU countries including Russia. Mortality Reversal in FSU countries and Russia is particularly strong among male population, with excess mortality at ages about 35-55 years. Particularly high increase in mortality from violence and accidents among manual workers and low education groups.

67. Decline of life expectancy at age 15 between 1998-2005. Men

68. Decline of life expectancy at age 15 between 1998-2005. Women