The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.

BackgroundRussian society has faced dramatic changes in terms of social stratification since the collapse of the Soviet Union. During this time, extensive reforms have taken place in the organisation of health services, including the development of the private sector. Previous studies in Russia have shown a wide gap in mortality between socioeconomic groups. There are just a few studies on health service utilisation in post-Soviet Russia and data on inequality of health service use are limited. The aim of the present study was to analyse health (self-rated health and self-reported chronic diseases) and health care utilisation patterns by socioeconomic status (SES) among reproductive age women in St. Petersburg.MethodsThe questionnaire survey was conducted in 2004 (n = 1147), with a response rate of 67%. Education and income were used as dimensions of SES. The association between SES and health and use of health services was assessed by logistic regression, adjusting for age.ResultsAs expected low SES was associated with poor self-rated health (education: OR = 1.48; personal income: OR = 1.42: family income: OR = 2.31). University education was associated with use of a wider range of outpatient medical services and increased use of the following examinations: Pap smear (age-adjusted OR = 2.06), gynaecological examinations (age-adjusted OR = 1.62) and mammography among older (more than 40 years) women (age-adjusted OR = 1.98). Personal income had similar correlations, but family income was related only to the use of mammography among older women.ConclusionsOur study suggests a considerable inequality in health and utilisation of preventive health service among reproductive age women. Therefore, further studies are needed to identify barriers to health promotion resources.

IntroductionSocial determinants of health have not been intensively studied in Russia, even though the health divide has been clearly demonstrated by an increased mortality rate among those with low education. A comparative analysis of social health determinants in countries with different historical and economic backgrounds may provide useful evidence for addressing health inequalities. We aimed to assess socioeconomic determinants of self-rated health in St. Petersburg as compared to Estonia and Finland.MethodsData for women aged 18–44 were extracted from existing population-based surveys and analysed. In St. Petersburg the data were originally collected in 2003 (response rate 68%), in Estonia in 2004–2005 (54%), and in Finland in 2000–2001 (86%). The study samples comprised 865 women in St. Petersburg, 2141 in Estonia and 1897 in Finland.ResultsSelf-rated health was much poorer in St. Petersburg than in Estonia or Finland. High education was negatively associated with poor self-rated health in all the studied populations; it was (partially) mediated via health behaviour and limiting long-term illness only in Estonia and Finland, but not in St. Petersburg. High personal income and employment did not associate with poor self-rated health among St. Petersburg women, as it did in Estonia and Finland. In St. Petersburg housewives rather than employed women had better self-rated health, unlike the two other areas.ConclusionWomen’s self-rated health in St. Petersburg varied similarly by education but differently by income and employment as compared to Estonia and Finland. Education is likely the most meaningful dimension of women’s socioeconomic position in St. Petersburg. More research is needed to further clarify the pathways between socioeconomic position and health in Russia.

Educational programs that promote the consistent use of condoms, especially among young women, and family planning programs that reduce financial barriers to contraceptive use, are critically needed in Russia.

In addition to youth, sexual education should be targeted to older women, many of whom practice risky sexual behaviour.

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The new financing mechanisms introduced into the Russian health care system since the beginning of the 1990s have not resolved its severe financial problems. This article examines the consequences for outpatient services and the daily work of individual doctors in St. Petersburg, using women's reproductive health services as a case example. Interview and observational data reveal a constant opposition between formal rules and informal practices at both the administrative and polyclinic levels. Polyclinics for women's reproductive health services have developed various strategies as a response to insufficient financing, but many of these strategies are questionable within the current mandatory health insurance system. Ordinary doctors perceive the development as mainly negative. The results raise the question of increasing arbitrariness, from patients' perspective, in the health services provided. The study illustrates how in a post-socialist context, the past constantly permeates the present in the form of novel adaptations to the new social context.

Risky behaviour predicts STIs, but does not explain the varying rates of STIs between areas.