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High Noon in Moscow
Somewhere in the course of planning my latest journey to Russia I lost my fear of flying. It left me suddenly, without fanfare or notice. I simply came to the conclusion that fear of flying was an inappropriate phobia for a pioneer. And, so it was with great excitement and a sense of destiny that I boarded the plane for Moscow in early June, on a mission to actualize my dream of building Russia's first feminist medical center.
The events that led me to this point began with the 32 year old Russian woman who came to CHOICES in 1990 for her 36th abortion. Her amazement at my shock and concern was just the beginning of my gaining insight into the lives of women in Russian lives that are full of multiple and dangerous abortions with no access to birth control. Sexually conservative, Russian society is notoriously biased against contraception, particularly the pill. Convinced that the pill causes cancer, most gynecologists preach the virtues of repeat abortions. Of course, the fact that many of them subsidize their $10 a month salaries by doing abortions in women's homes might well have an influence on their thinking. The only contraceptive devices locally produced are condoms and so badly (due to problems working with latex) that they are called "galoshes;" few men consent to use them. Russia is a country where the obstetric wards are empty of patients, and where it is estimated that one out of three women die in hospitals from the complications of second trimester abortions. I heard story after story of lives that were blighted by sterility, sexually transmitted diseases, and domestic violence. They so moved me that I began to think in terms of replicating my women's medical center, CHOICES, in Moscow. There, I could offer Russian women state of the art family planning and counseling, as well as high quality abortion care. Yes, I felt that Russian women needed a safe harbor, a feminist outpost. I was, after all, a pioneer in the early '70's, when I opened one of the first abortion centers in the US. and my subsequent 23 years of experience, I knew, had positioned me for this work. Arrogance, vision, or a touch of madness, whatever it was, I felt I had to go there.
I was aware of the odds; out of 3,300 American/Russian joint ventures formed last year in Moscow, only 300 are still operative. The American press carries endless stories of the difficulties of doing business in Russia. I knew that, apart, from the basic challenge of negotiating with people whose core philosophy was for 70 years built around hostility to free markets, I had to take up the challenge of bringing a feminist consciousness to life in a medical setting, in a highly misogynist, authoritarian society.
Much had changed in Russia since my first exploratory visit in 1992. The rise of fascistic nationalism promoted by Zhirinovsky, rampant inflation, and growing disillusionment with American capitalism due to the loss of life savings had left much of the population anxious, frustrated, and despairing. Organized crime had grown at alarming rates a 43% rise in the last five months. The second day of my visit a car bomb exploded in the center of the city, maiming the occupant so horribly that identification was almost impossible. Gang violence, too, is so common that the Moscow Times reports that there is a bomb attack on the average of one every two days mainly carried out against bankers and businessmen as gangs battle for control of the city. Contrary to the relief felt on my first visit to Moscow that pornography was almost non existent, now I saw it was everywhere. The Russian version of Cosmopolitan had just hit the stands, and an article entitled "Would I rather have sex or chocolate?" extolled the joys of sexual pleasure without mention of the horrific price paid by so many Russian women.
The opening of Russian markets to all things American, like Snickers Bars and McDonald's, included imports of our special brands of fundamentalist misogyny: tapes of Jerry Falwell and Jimmy Swaggart now grace Russian television. Indeed, the American Right to Life Movement sponsors a weekly half hour TV program; a recent Right to Life conference in Moscow boasted 500 attendees. So, somehow I was not surprised to learn that the attacks on me in the press began before I hit the ground. A former KGB General, one Alexander Sterligov, leader of the Russian National Assembly and an ally of Zhirinovsky, was worried that under Yeltsin the mortality rate exceeded the birth rate for the first time since World War II. Calling my plans to set up a women's clinic in Moscow an "anti-Russian ploy," Sterligov was quoted as saying, "We will not put up with Russians having more coffins than cradles." Not only are women the victims of repeat unsafe abortions now they are being made to feel guilty for having them on both religious and political grounds.
On my first visit to Russia in 1992 my speeches and press conferences were mobbed by people demanding birth control information and free condoms. At Gynecological Hospital #53 my staff administered the first trial of Norplant. They taught Russian doctors and nurses how to perform safe abortions in hospital rooms where it had been common to perform three to four procedures at one time -with no anesthesia- and where the sterile technique is minimal (rubber examining gloves are washed and reused). In these rooms women stoically lie down on dirty tables for their fourth, fifth, or twentieth abortion.
I knew on that visit that even though I had passed the first obstacle and found partners with whom I could make the CHOICES EAST clinic a reality I faced many challenges. Not least of them was transporting my philosophy to a culture that is inherently resistant to it. The Russian physicians are by training and orientation highly authoritarian, and not attuned to my concepts of interdisciplinary, participatory health care.
But what I had learned led me to the realization that to graft my American feminist philosophy onto Russian reality would be a mistake. My mission was to work with the Russians on an equal basis; that way they could adapt the CHOICES philosophy of "Patient Power" to their Russian sensibilities. The philosophy could then grow organically and be replicated in other parts of the country.
And in this regard things were moving along well. In February I returned to Russia to sign the Protocol of Intent with my partners -the Moscow Clinical Center Marine Hospital and the Department of Marine Transport of the Ministry of Transport. CHOICES EAST would be built in the Moscow facility first and then in 18 other hospitals.
I took great care in having the legal documents drawn up because the law, like everything else in Russia, seemed to change almost daily. Of particular importance was the division of control. We agreed that both the American and Russian sides would hold equal shares in the venture, sharing in both the potential success and risk of the project. Needless to say, it took many phone calls and faxes to produce the detailed legal documents necessary to form the company.
The head of the Moscow Clinical Center Marine Hospital, Dr. Nicolai Ivanovitch Osipov, was a force to be reckoned with. He was previously Gorbachev's private physician and a former high Communist Party functionary. In fact, I witnessed his difficulties in making the transition to the "new Russia" (during our meetings he would address his hospital staff as "my Soviet Comrades"). Nevertheless, Osipov seemed genuinely taken with my feminist ideas. He expressed concern over the state of women's health, and appeared to be excited about what CHOICES EAST could potentially mean to the status and financial strength of his hospital.
At the end of my February trip, with much fanfare and press attention, we signed the Protocol of Intent that would lead to our agreement. On my return in June, we would finalize and sign the formal documents. Then the real work of setting up the clinic could begin.
In June, my first working day in Moscow was to be spent at the Moscow Clinical Center Marine Hospital, where I had signed the Protocol of Intent. Upon approaching the hospital, I noticed changes. Our cars were met at the gate by armed guards. And at our meetings, Osipov was either continually walking around or holding a cellular phone, like a new toy. In fact, he made calls every ten minutes. He seemed nervous and distant, his behavior was erratic.
When I questioned my Russian aides about this, they informed me that he had been involved in a business venture that soured, and had been the victim of an attack that left him in a coma for three months. Because this is a country where being machine gunned in the street adds to an entrepreneur's risk of losing a financial investment, I was not terribly surprised. But I began to be concerned that whatever his motivations, Osipov did not seem willing to move forward on the terms we had agreed upon.
The meetings continued to evoke confusion in me and obstinacy in him. Finally, it was with a sense of shock and amazement that I heard him demand 51% of the company. - In the meetings my advisers had with Osipov during my absence, he gave no indication that he wanted anything but the agreed upon 50%. Yet, here he was insisting that I had agreed to a 51/49 split.
I certainly had never agreed to this, nor could I now. To accomplish anything for women, I needed equal control of the project. Forty nine percent would render me powerless to control the healthcare CHOICES EAST provided, and would allow my Russian partners to make use of my status, name, and the investments I had arranged. They knew my motivation was not financial gain; the possibility of the clinic making a profit was minimal; my goal was to make it self-supporting.
Osipov began to claim he was directed by his "collective" (the employees of the hospital) to accept only a controlling share. I knew that this was an outright lie. My deputies had been at the meetings in which the employees had voted to move ahead with an equal share, and they told him so to his face. I caucused with my aides; they believed that this was a negotiating strategy, political theater, designed to gain a controlling share, and that in the end he would sign.
I was on a deadline. I had scheduled a press conference to announce the signing of the agreement; 70 international journalists planned to attend. I would have to cancel it. I gave Osipov my ultimatum: by noon the next day he would have to agree to the terms laid out in February, or the deal was off.
He looked at me quite arrogantly and said, "If you are so concerned about saving women's lives, what's one percent to you?" I replied coolly, "It's because I want to save lives that I have to have control."
The next day, at noon, I asked Osipov for his decision. He answered, "fiftyone/forty nine."
It hit me like a body blow. So much work undone, so many hopes dashed. I stood up, shook his hand, wished him well, and walked out of the room, my dreams on hold. Osipov's aides were amazed. If Osipov was surprised he seemed to hide it well. After all, I am sure he felt that this "little girl from America," who came with such big dreams, who spent so much money, who went so very public, who had arranged a huge press conference, would not walk out. He underestimated me.
The press conference was canceled, but I did give many private interviews. The reporter from Izvestia was dismayed. She asked me, "What will Russian women do now? How long will they have to wait?" We discussed organizing a feminist grassroots movement. She cautioned me that Russian women would be difficult to mobilize on an issue of women's rights, but that if we could appeal to them to mobilize for the benefit of their children and then slip in issues concerning their own lives we would have a better chance. I mused over the irony of women once again reinforcing the traditional role of being there for others -Mother and Wife- and not for themselves. Indeed, the women who had begun to "do it for themselves" were in great danger. I met with a young American woman who had been working on setting up the first battered women's shelter in Russia. The day that she opened the hotline they received 400 calls. But in the last year, two of the "volunteers" were murdered by their husbands.
Now, back in New York, I think of the two murdered women, of the birth of feminism in Russia, and of all the midwives in attendance who must put their lives on the line, and sometimes lose them, in the process of bringing this feminist consciousness to life. I tell myself that the struggle for reproductive freedom is a global one, that the battlefields may change, the strategies vary, but the war remains the same. I remember that the qualities needed for the long haul are patience, persistence, and stamina, and that the answer to the reporter's question -how long will Russian woman have to wait? -is that they will have to wait as long as it takes to birth a society where women have full reproductive freedom. This midwife intends to be there to help make it happen.
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.