Substitution of contraception for abortion in Kazakhstan in the 1990s

A 1995 Demographic and Health Survey (KDHS) revealed that this replacement process was already well underway in Kazakhstan at that time. The 1999 KDHS afforded another opportunity to document these changes and provide more detailed data on the increase in contraceptive use. The evidence that the increase in contraceptive practice and the decline in abortion have continued is unmistakable and strong. Contraceptive prevalence has increased by 50% since the beginning of the decade and abortion has decreased by the same amount. The continuation of these trends is particularly impressive given the evidence of an increasing desire for smaller families in Kazakhstan. The decline of abortion has been particularly evident in the capital city of Almaty and among the Russian ethnic minority. There has been an especially sharp increase over the past few years in the use of contraception among Kazakh women. However, despite the decline in abortion, more than a third of all women say that they would have an abortion if they became pregnant unintentionally. The covariates of this variable, as well as the characteristics of women who have used contraception and have had an abortion, are examined in a multivariate context. A model of the fertility regulation process was constructed in order to examine the effects of different combinations of changes in contraceptive prevalence, failure rates, method mix, and rates of discontinuation of contraceptive use on the further reduction of abortion. The abortion rate is particularly sensitive to contraceptive failure, which is associated with about two-fifths of all abortions in Kazakhstan. Equally important is the level of unmet need in the population. If unmet need were eliminated and those women began using modern contraceptive methods, the abortion rate would drop from 48 to 22 per 1,000 women, even with existing failure rates. Discontinuation of contraceptive use is associated with about one-fifth of all abortions. It is clear that contraceptive practice is increasing rapidly in Kazakhstan and that the abortion rate is declining. Further changes in this direction in the near future seem likely. (Author abstract, modified)