Sex after the fall
by Merle Hoffman

In some ways my personal and political ties with Russia seem to have an uncanny quality -almost like destiny.

The ties began with CHOICES, the women's medical center I founded in 1971. and around which I've built my life and work. In the 1980s, as the immigration policies of the Soviet Union eased, masses of Russian emigrees found their way to New York and many of the women found their way to CHOICES. Counselors at the clinic would tell me that a surprising number of these women had 10, 15 and 20 previous abortions: and so we learned that abortion was the major form of birth control in the Soviet Union. For these women, the "issue" of abortion posed no questions of morality, ethics or women's rights versus fetal life. There was only the harsh reality that sex rarely came without anxiety and that the price one often paid for it was high and dangerous. Then one day there was a 35year old woman who came to me for her 36th abortion. She expressed relief and some pleasure at the supportive and positive aspects of the clinic as opposed to the brutal conditions she was familiar with, but seemed quite resigned to having continued abortions. Like so many other Russian women, she was violently opposed to using birth control because she was taught by her doctor that the Pill was far more dangerous than repeat abortions and other forms of contraception were practically unavailable.

Thinking about her and the conditions of her life, I began to have dreams and fantasies of going to Russia to rescue women from this brutal system of sexual oppression. Several months ago my dreams came closer to reality when two Russian feminist publishers visited New York and familiarized themselves with new work. My philosophy of informed medical consumerism, Patient Power, arid the need for personal and sexual styles to be part of an individual's birth control decision astonished them. In Russia you got whatever was being pushed at the moment. If they had a stock of old fashioned spiral IUDs, that's what was dispensed. If they had high dose estrogen pills, that's what was prescribed regardless of any individual contraindications or preferences!

The two feminist publishers had dreams also: Dreams of giving Russian women dignity, autonomy, and choice -and they viewed me as the vehicle to help make those dreams a reality.

Two weeks after they left New York for home they faxed me an official invitation to lead a team of physicians and counselors from CHOICES to Moscow for an educational exchange. We would be meeting with gynecologists from a state subsidized teaching hospital to demonstrate state of the art women's healthcare.

Taking little time to say yes, three months later I was on my way to Russia with nine of my staff, carrying visions of being a pioneer and of changing their world.

As the plane began its nine and a half hour flight, I recalled a different time 10 years earlier when I first traveled to Russia. I was with a friend who was familiar with the culture; she begged me to take a suitcase full of contraceptives: pills, diaphragms, condoms anything. My concerns about arbitrarily distributing hormonal medication and diaphragms which would not be fitted by physicians were laughed off. "They need anything and everything they can get." After learning that the two most popular forms of birth control were douching with lemon juice and jumping office boxes if periods were late, I Stuffed my bags full.

Now, here I was again -in Moscow.

My hosts had arranged for us to stay in a pre-revolutionary mansion called Perendelkina that now functions as a government artist colony where pensioned writers and old artists retire. Perendelkina is in a so called "green zone" 20 minutes outside of central Moscow, and boasts the grave of Boris Pasternack. As I walked the carpeted halls, with fading old Persian rugs buckling under my feet, I could hear the muted sounds of typewriters. These writers seemed content and secure in their work, but, in general, very little works properly in Russia at this time. At Perendelkina, the phone system is primitive and erratic. For a complex of 100 rooms there is only one outside line which often crosses wires with a private home. Getting anything done is always a matter of extreme negotiation. My hosts told me that despite the fall of communism many people are not ready for a "market economy. Most Russians did not work hard under the old system because the paternalistic state took care of everything - housing, healthcare and vacations were subsidized. Now they can't imagine why the have to work harder to get paid more. It seems that everyone wants to feel and use the only power the really have -the power to

no. Everything is a struggle: at least one to two hours a day are spent negotiating .and navigating just to he able to get from one place to another -or trying to find a phone that works.

Our first lunch at Perendelkina combined politics and poignancy. Apologizing fur the co for the country's economic crisis, an attentive staff served us a meal of boiled eggs, bread, cheese, squash and oatmeal. In the evening we were taken to an extraordinary banquet at the Artist Guild. The hall is a famous meeting place for intellectuals, artists and writers of the Russian intelligentsia. Oak-beamed walls and ornate glass chandeliers were the background to a pianist playing Chopin and Rachmaninoff with an occasional American favorite like "Feelings" thrown in.

I was aware as I looked at the table spread out with caviar, lox, sturgeon and vodka that my hosts had gone to unusual expense and time to produce this. The dinner continued for hours with each one of us in turn rising to propose a toast, then drinking our vodka "to the end." One of my hosts rose and expressed her gratitude for my coming and for the chance to exchange ideas. She asserted that the country needs women to take it in hand and lead it out of crisis.

There was an easy affection, an ability to touch and to connect with each other's eyes and energies without the need for continual translation -and there was also a strange tension and excitement in the air. As I looked about me I saw that people had broken up into small groups and were discussing potential business deals -everybody was hustling!

There was a keen awareness that with the fall of communism people were able, indeed, desired, to show creativity and entrepreneurial spirit. One person rose to toast capitalism -and I found myself saying "Yes, capitalism, but capitalism with a conscience!" The next day brought meetings and interviews. I spoke with Dr. George Kavkassidze, who specializes in infertility, which has reached epidemic proportions in Russia. He was eager to assist with the creation of a women's health center where there could be pregnancy testing, counseling and state of the art abortion care. I learned that there are practically no pregnancy tests available in Russia; that by the time many women find that they are pregnant they are well within their second trimester. If they are to receive a state sponsored abortion at no cost, they must have the approval of three physicians, including a psychiatrist. Because most women cannot, and will not, navigate this difficult bureaucracy, most opt for "clandestine abortions," done in their homes by state gynecologists eager to earn extra money. The unsanitary and dangerous conditions result in many teenagers and young women becoming sterile.

Most of the women that I spoke with seemed to be insulated from feminist thought and the feminist movement as we know it in the United States. They continually referred to me as Miss or Mrs. Hoffman and one of my staff corrected them and wrote out "Ms." "But is she married or single?" I explained that yes, I am married but that it is not necessary that my marital status be public and they loved it! It was as if I were catapulted back 20 years to the dawn of the women's movement, remembering the "clicks of consciousness," the constant explosion of insights.

An interesting thought then occurred to me. There is no word for "counseling" in the Russian system, because they don't perceive a need for it. Abortion is not only the status quo, but the only choice the majority of women have to control their fertility. There is no organized opposition on religious or moral grounds (although there is a growing right to life presence in Moscow), and women regard their multiple abortions pragmatically, as just a way of "getting cleaned out." Abortion is not a major moral crisis for Russian women -it's just life.

If I bring in the concepts of "choice" and "responsibility," the need for women to think deeply about birth control and abortion, the need even for counseling prior to abortion, will I be adding to an antiabortion groundswell? Will I inadvertently be introducing anxiety or guilt to an already overburdened and oppressed female population? After all, the slogan of many pro-choice activists in the U.S., "Abortion on demand and without apology," is a reality in Russia. Russian women have abortions on demand -on request really -no apologies needed because there are no other choices. But because there are no other choices, abortion has little to do with freedom and privacy and much to do with oppression and coercion. As in most societies, women's health and women's lives are not a high priority for the Russian government.

The day of the Educational Symposium, I awoke with an intense feeling of excitement. This was the day I would make my presentation and challenge the assembled feminist physicians and journalists to create a truly revolutionary society - a society where women's lives really count for something.

At the symposium, I spoke of how reproductive freedom must be the bottom line of women's autonomy. If a woman cannot decide when, or whether, to bear children, the other choices in her life are diminished. The availability of legal and safe abortion is critical to her health and quality of life. But, it is not enough. Without full information about all reproductive and sexual issues, access to abortion is an illusory freedom.

I stressed what I know to be true in the most personal and political sense, that "there is no choice without knowledge. If we accept that the exercise of free will defines what it is to be moral and frilly human, then women who lack the information to make choices will be destined to remain second-class citizens."

The speech was received extremely well. The audience was intense, like sponges soaking up every word. Most interesting, I found a piece of anti-abortion literature on a chair as I left the hail. It was exactly the same propaganda that the anti-choicers thrust into the hands of patients every day at CHOICES except that it has been translated into Russian and printed in Alaska. I had to laugh; in a strange way, it made me feel right at home. It also reinforced a truth I have always known: The war against women's freedom is global and has no boundaries.

Along with translated literature, T-shirts and magazines, I had brought 7,000 condoms with me to distribute after the presentations. Suddenly, the well dressed professional journalists, feminists and physicians turned into a swarming mob. We were surrounded and pushed and shoved as a frenzy of hands reached out to grab the condoms. I was left breathless and amazed.

While condoms are the only birth control method produced and sold in Russia, they are not highly utilized. Most are substandard and break easily -and the strength of the "macho" myth prevents many men from even using them. I think of the enormous statue of Yuri Gagarin, the first man in space. It stands like a colossus overlooking the main thoroughfare in Moscow. How a society with the technology to conquer space cannot find its way to produce an adequate rubber speaks volumes about its priorities, and the primacy of politics over reason.

I was still recovering from the onslaught of grasping hands, when I found my way to the ladies' room. I was with my translator, who was part of my staff, and with whom, before leaving for Russia, I had practiced a few phrases like "Women of the World Unite." We were saying it together and laughing as an old lady came in to clean. Listening to us she asked, "Unite? What do they want to unite for? And if they unite, what will they do?" Looking at her and picturing my mother saying, "Are you playing Joan of Arc again?" I said, "Well, maybe we will make the world a little bit better place." "Okay," she said resignedly as she went off with her bucket and pail.

The next day my staff was scheduled to perform abortions and Norplant inserts at the state teaching hospital, Gynecological Hospital #53. It would be historic: the first time Norplant would be inserted into Russian women, and the first time abortions would be performed with state-of-the-art technology. We had brought equipment, machinery and drugs with us that had never been imported to Russia. The entire hospital was on full alert. There were approximately 25 people in the operating room where CHOICES physicians would be giving a demonstration. Students of anesthesia, gynecology residents and the administrative staff of the hospital hovered around the operating room tables. The patients were brought in in their own nightgowns because of the shortages of paper and supplies. Fashions ranged from plain flannel to see through red lingerie. The women's stoicism and seeming lack of modesty amazed me -even more so when I remembered that these are women who were taught to be so ashamed of their bodies that they were not permitted to mention the word menstruation in mixed company. It's a dangerous form of modesty that I've seen lead to medical and sexual problems. Of the small amount of birth control available, out of date spiral IUDs are the most commonly used (by 5 percent of the population). But because of the social stricture against openly acknowledging menstruation, women are too embarrassed to go to their gynecologists during their periods, the optimum time when IUDs should be inserted. As a result they are often left infected and infertile. Yet, there in the operating room there was no observable modesty, and absolutely no concept of privacy or patient dignity. The collectivism of this society even extends to the medical sphere where it is not uncommon to see four or five abortions performed in the same room at the same time. The women did not notice the large audience as they obediently lifted their gowns above their waists. It is just the way life is here, and they deal with it: They place themselves on the table and follow orders.

I looked at their faces and into their eyes. What I saw there were the thousands of women before them whose hands I'd held. We are all sisters.

The staff at the hospital was extraordinary -eager to learn -eager to please -eager to participate with me in a joint capitalist venture. The abortions cost 900 rubles, which equals $3.00 -less than the cost of a McDonald's hamburger and about one week's average salary.

The next day brought a meeting at the Russian Family Planning Association; it was to produce an historic feminist act. Formed nine months earlier and existing on donations and government subsidies, the Association is the major voice in Russia calling for a reasoned and intelligent family planning program. The director, Inga Grebesheva, famous for being the "only woman deputy" of the Central Committee of the Communist Party, told me she became a feminist when, at party meetings, her colleagues began to refer to her as the "woman minister." She recognized that they had never thought of her in relation to her work or her tide, but only to her gender.

Grebesheva, having produced one film on the horrifying state of abortion care, was raising funds which she hoped would educate people further on the Russian abortion system. She envisioned producing 12 hours of tape of individual women telling about their abortion experiences. It seems that having 15, 20 or even 30 abortions does not equal coming to terms with it. Most women are ashamed to talk about their abortions, and doctors, with their fanciful prescription for birth control, do not help them break the silence: They tell them if they worked harder, they would not have time to think about sex and, therefore, would not get pregnant.

My mind immediately flashed to all the soap box actions I had arranged in the American abortion wars -all the "My name is Joan or Ruth or Karen, and I've had an abortion" feedback that led me to the knowledge of how important it is for women to own that experience.

When I suggested to Grebesheva that we replicate this in Red Square, she loved the idea but said, "Our Russian women do not yet have the courage for this." But the energy in that room was so strong and driving, I urged them to do something now. The result was a decision to draft an open letter to Boris Yeltsin outlining the grave conditions of women's healthcare and demanding economic funding for birth control and education. When I asked Grebesheva if she could have it done by the next day so that leading feminists at the Feminist Round Table where I would be speaking could sign it, she smiled "I've been writing it in my head for four years," she said. This was one of those transcendent connections, the times when you meet someone -a group of women -and you know that the different languages and different realities cannot obscure the one reality -that we are all struggling with the same issues and the same problems.

The next afternoon brought over 30 feminists together to share information at a "Feminist Round Table." Writers, scientists, journalists and representatives from governmental agencies engaged in lively dialogue. A self described radical feminist made the distinction between women who were part of the "women's movement," and women who called themselves feminists. Women who were part of the women's movement believed in a philosophy of "women are people, too," whereas feminists wanted to change the patriarchy. I asked whether it was the difference between being a liberal and a radical, and she said it was much greater than that. Another raised her voice to say that it didn't matter what women called themselves, "all women are feminists and fighting for the same thing."

And still others said that they never thought of using the word sisterhood, that the concept was always one of "brotherhood." Women never considered themselves unequal or oppressed because they believed the propaganda fed to them by the communists that men and women were truly equal. At that point, Grebesheva came into the room and, not taking time to remove her coat, proceeded to read the letter she had drafted to Yeltsin. I watched the faces -pleasure, pride, anger, anxiety. Some got up to sign, some left the room and some watched transfixed. A feminist movement begins?

The mixture of the spiritual and profane surrounded me. Lunch in a Moscow hotel had me sitting next to a young couple who held hands across the table, had their eyes closed tightly and mumbled under their breaths. This went on for about five minutes, and I realized that they had been praying. As the young man left the table, the woman turned to me and started a conversation. It seemed that they were missionaries; Evangelical Christians who had been in Moscow one year and had started their own church on October Street. "This is extremely fertile ground for gathering new souls," she told me as she searched her handbag for prayer cards. "Now that communism is dead, their spiritual hunger can be fed." In Moscow I saw advertisements for Billy Graham's Crusade and remembered the delegation of Bible students who shared my plane ride over. Souls are a new growing market, ripe for the picking.

Conversations in the hotel leapt into my memory. They continued to affirm that the personal is the political. The one with Maya, for instance, a Russian chemist who was my liaison, who stated, "You can build a clinic for the elite. We can treat women who are part of the government or married to high government officials." I explained that I would have no part of that -my clinic would offer the highest quality care to all women regardless of who they were. Fees would be based on an ability to pay, so that if there were any profit to be made it would not be made off the backs of the poor .Maya listened to me with amazement and said, "But that is not what we do here -you must be a Christian." I replied, "No, I'm a Jew and the Jews taught before Jesus (who was also a Jew) about equality and social justice." Maya in formed me that she knew nothing of Judaism because it was so suppressed. She also told me she had been taught that "Capitalism is cruel."

Then, there was Svetlana, a dark eyed Russian journalist, who was writing a newspaper piece on my visit. We had gotten into a discussion about Stalin's criminalization of abortion, when she put down her pen and said quietly, "You know, there was some good in what Stalin did. If he had not criminalized abortion, I would not be here." I responded that Stalin's motivation was to populate Russia with soldiers to counteract Hitler's rising militarism. Certainly, encouraging the birth of girl children was not part of the equation. Nevertheless she still thought it was a good thing because she would not have been here.

I was being moved and challenged on all counts. So much of myself elicited through these extraordinary meetings so much to give back.

Now, once again in New York, I think frequently of Moscow and recent reports of street demonstrations calling for the return of communism. I worry that the driving need for security may indeed stamp out the sense of risk, the desire for growth, and the seductive pull of freedom that this new era has ushered in. I think of the women I met, the energy, the drive and the vision for a better life -of the new society that is being created: One where women can have a hand and a voice, one where they have the opportunity to create, to make a true revolution, to make their world a place where a woman's life really matters.

Note: Merle Hoffman is planning to open a clinic in Moscow through a joint venture with the Russians. The center will be called, "CHOICES East" and will be modeled after CHOICES Women's Medical Center, Inc. in New York. It will be the first of its kind and will offer counseling, abortion and family planning services.

Merle Hoffman is publisher/editor-in-chief of On The Issues magazine and founder/president of both Choices Women's Medical Center, Inc., and Choices Mental Health Center.

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