To Combat Demographic Decline, Moscow Must Focus on Mortality Rather than Fertility

Executive Summary:

• Russia’s continuing population decline means it will soon not have enough people to run its economy and fight in its wars. Russian President Vladimir Putin is talking ever more about falling fertility rates but doing little to decrease the increasingly high mortality rates.
• Russia’s birthrate reflects underlying social changes, such as urbanization, and is at about the same level as other industrialized countries. Its mortality rate, however, is far higher, in part due to Russia’s failure to support the health of its citizens.
• Putin is loath to address the mortality rate, as it would be both expensive and require him to change his goals in Ukraine. As a result, Russia’s demographic decline and the restrictions it will impose are likely to last as long as he remains in power. 

Demography is not destiny, but declining demographic trends impose limits on what a country can do in the long term. Russia’s population decline is becoming its most pressing issue, and one Russian newspaper warned that demography is now the Kremlin’s most serious constraint (see EDM, October 24, 2023; NG.ru, April 18). Unsurprisingly, President Vladimir Putin has sought to limit the demographic decline’s effects on Russia. In response, Putin has been importing migrant workers, an approach that is becoming increasingly unpopular among Russians in large part because of Moscow-promoted nationalist policies (see EDM, February 6, May 15, October 22). Most recently, Putin has enlisted North Korean troops to fight in his war in Ukraine (see EDM, October 30; The Kyiv Independent, October 31). He has sought to squeeze more work and military service out of the existing population by allowing older men to serve and boosting signing bonuses (see EDM, October 24; Window on Eurasia, October 30). In addition, Putin is requiring the elderly to go back to work and those in the workforce to do overtime; neither group is enthusiastic about the state’s rising demands on them and their time (Iarex.ru, October 29; Moscow Times, September 9). Over the last several years, Putin has focused on boosting Russia’s birthrate by promoting the image of large families as the Russian ideal, paying women to have children, and making both abortion and divorce more difficult (Window on Eurasia, August 7; see EDM, October 1).

Putin has not done anything to address the country’s increasingly high mortality rate despite Moscow’s seeming priority to control its population decline. Russian demographers say that Russia’s most significant bottleneck lies in its mortality rate, which is more susceptible to policy changes than its birth rate, though such reforms would require a ruler in the country willing to make them (Holod, October 16). These steps would include expensive and fundamental alterations to both domestic and foreign policy—ones Putin shows no sign of willingness to undertake. Demographers suggest all his talk about boosting the birth rate is, first and foremost, a smokescreen to conceal his almost complete unwillingness to address mortality issues.

Russia’s fertility rate—the number of children per woman in her lifetime—has fallen well below replacement levels, much as in other European countries. Russia’s mortality rate—the number of deaths relative to the population as a whole—however, is far higher than in all other developed and urbanized countries. This is due in part to the fact that most of these states have adopted social policies designed to reduce death rates and boost life expectancy. Given that pattern, demographers say Russia should focus on reducing the latter if it is to prevent the country’s total population from continuing to shrink, possibly to as few as 100 million by the end of this century. According to Russian demographers Aby Shukyurov and Dmitry Zakotyansky, the Russian government has focused almost exclusively on boosting birth rates, something it thinks it can do despite all the evidence to the contrary from its own experience and that of other countries. Moscow does this while ignoring far more effective policies that would reduce mortality rates.  

Shukyurov pointedly notes that while Russia’s birth rate is lower now than at any time in the past, it “might be fine” given that the country is becoming increasingly urbanized. Its mortality rate, on the other hand, “is anything but.” While Russia’s birth rate is comparable to Europe’s, its mortality rate is far higher, and the causes of death are different as well. In Russia, cardiovascular diseases are the primary cause of death, while in Europe—which has used various healthcare strategies to reduce those—cancer is now the leading cause. Zakotyansky, for his part, points out that economic inequality is a significant contributing factor to Russia’s low life expectancy, with as many as 40 percent of all Russians living in poverty, continuing to smoke and drink heavily, and more likely to be involved in or affected by crime. The Kremlin could do more to combat all of these economic inequalities, but is not. Moreover, both demographers say that Russia’s demographic situation has been seriously affected by the war in Ukraine, a conflict which, according to some estimates, has killed 120,000 Russian soldiers and injured more than 400,000 more. Once again, the regime could improve the country’s demography by bringing the long war to an end. Even when Putin does talk about the mortality rate, he obscures the true figures by playing games with statistics, as the real numbers are too horrific. Apart from fertility questions, the mortality rate is almost always discussed so as not to lead to any challenge to Putin’s policies (Tochno, March 14; Window on Eurasia, March 18).

Presently, the Kremlin wants to block questions regarding Putin’s healthcare “optimization” program, his decade-long effort to cut back healthcare facilities so as to allocate more money for other projects, including his war in Ukraine. Hospitals and medical centers have been shuttered across the country, making Russians increasingly angry (Novaya Gazeta, September 16). Reversing his course now would be prohibitively expensive. To just return to what Russia’s mortality rates were in 1991, academician Robert Nigmatullin says Russia would have to double the share of its gross domestic product (GDP) spent on healthcare. Otherwise, it will continue to suffer 200,000 or more excess deaths every year (Nakanune.ru, June 27, 2023).

Looming behind these immediate healthcare and financial concerns is another that is likely to grow and play an increasing role in Putin’s failure to address mortality issues. Even though abortion rates have fallen 90 percent from Soviet times, research suggests that this occurred for many reasons, and that a pro-natalist hyperfocus on them has proved less effective than advertised (Tochno, July 28, 2023; Cherta, September 5). Additionally, to the horror of many Russian nationalists, mortality rates are far higher in predominantly ethnically Russian regions of the country than they are in non-ethnically Russian regions, while fertility rates remain higher in the former than the latter (Window on Eurasia, July 30). Failure to address the high mortality rate means that the Russian Federation will become ever less ethnically Russian, despite Putin’s increasing support for a Russian nationalist agenda (see EDM, October 29). Even worse, from his perspective, Moscow’s pro-natalist policies, besides being overwhelmingly ineffective in ethnically Russian areas, appear to be maintaining or even boosting the high birthrates in non-ethnically Russian regions, exactly the opposite of what the Kremlin leader wants (Kavkazr.Realii, October 23).    

Focusing only on what Putin says he is doing to address the demographic situation distracts from what is really going on: a continuing population decline exacerbated by his focus on pushing for a higher fertility rate rather than also helping to reduce the super-high mortality rate. Unfortunately, both for Putin and Russia, those being deceived by his words almost certainly include the Kremlin leader himself, making any change of course highly unlikely before dramatic demographic collapse or his departure from power.