Economic damage from abortions (case study: St. Petersburg).

Abstract

There is currently an unfavorable demographic situation in the Russian Federation, which necessitates the modernization of the maternal and child health system, as well as the search for reducing the negative consequences for the economy, including from abortions. Purpose of the study: to assess the economic damage caused by abortions in St. Petersburg in 2018–2024. Materials and methods. The average cost per case of medical care was calculated based on the comprehensive tariff for a completed case of medical abortion in a day and night hospital according to the cost of the clinical and statistical groups of diseases of the general tariff agreement (GTS, appendix No. 23) of the TFOMS of St. Petersburg (direct costs of abortion). The frequency of abortions is taken from the data from the statistical collections of the Central Research Institute for Maternal and Child Health, and the number of women of reproductive age, the size of the gross regional product, and the number of employed are from the Petrostat statistical bulletin «Age and Gender composition of the population of St. Petersburg» for 2018–2024. To determine the indirect economic damage associated with abortions, data on the number of days of temporary disability due to abortions (line 52) from the annual form No. 16 VN «Information on the causes of temporary disability» in St. Petersburg for 2018–2024, as well as the maximum, minimum and average amount of benefits were analyzed. for temporary disability for 1 day. Re s u l t s . In St. Petersburg, there is a steady decrease in the frequency of abortions, consistent with the nationwide trend and due to increased coverage of contraception, low reproductive attitudes and the effectiveness of pre-abortion counseling with a period of «silence». The reduction in the tariff for medical abortion from 2022 is due to the optimization of the cost structure by reducing part of mandatory research, switching to domestic drugs from the list of VED, centralizing procurement and strengthening government regulation, including quantitative accounting of misoprostol and mifepristone. With a steady decrease in the number of abortions and days of disability in 2018–2024, there was a significant increase in the amount of temporary disability benefits, reflecting an increase in social support funding and should be taken into account when assessing the overall economic burden. Lost profits in GRP production are increasing every year due to a decrease in women’s participation in the labor force and potential losses to the state from under-produced GRP and taxes on unborn children, which is becoming strategically important in the context of the demographic crisis. The study did not cover women’s personal expenses, visits to private clinics, post – abortion follow-up and treatment of complications, including infertility, as their accounting can significantly increase the final calculations and worsen the prognosis. Conclusion. The key result of the study was the identification of multidirectional dynamics of the components of the total economic damage: an increase in the effectiveness of reforms in the field of maternal and child health resulted in a decrease in the number of abortions and an increase in social security, while the assessment of economic damage showed a reduction in direct costs of medical care against the background of an increase in indirect losses related to the payment of temporary disability benefits and undeveloped GRP. The results obtained require further strengthening of prevention of unwanted pregnancy and improvement of mechanisms for assessment and compensation of economic losses.