Tyttärien vastuu: Terveyshuoli osana Venäjän alhaisen syntyvyyden retoriikkaa.

In 2006 the Russian population declined by 0.32 per cent. In 2003, the country's total fertility rate was 1.32 children per woman of reproductive age. In 2004 the figure edged up marginally to 1.34 children. As other post-socialist countries, Russia has recently seen much sharper demographic changes than Western Europe as its formerly relatively high fertility rate has turned into a significantly lower birth rate. Because of the country's negative demographic trends the political establishment and authorities in Russia have defined the low fertility rate as a public health problem. With the Russian population in absolute decline and the male life expectancy remaining extraordinarily low, there is much talk in Russian society now about a "demographic crisis", a "demographic catastrophe", even about a "nation in its death throes". This article provides an overview of these Russian health concerns as they are voiced in the Russian Federation's social, health and population policy programmes. Why are there so many people in Russia who are in poor health, who are crippled and disabled, and how does this tie in with talk about the country's fertility rate? How are the fertility problem and the need for change articulated in policy documents? How do the rhetorics of concern and statistical and ideal normalcy serve as Russian population policy tools when the policy focus is turned to mothers and daughters, to today's and future generations' potential childbearers? The material for this overview consists of seven social, health and population policy documents compiled by officials at the social, health, education and labour ministries in the Russian Federation in close consultation with Russian medical academies. The examination makes use of the tools of rhetoric and discourse analysis. The article is structured around the themes of concern, normalcy, and gendered citizenship. One of the key elements in the fertility rhetoric is the concern surrounding the health of the Russian people, which is described as poor in all the policy documents reviewed. The documents refer to the small number of "absolutely healthy" people, the decrease in normal deliveries and to severe health problems in children. The argument of poor public health is backed up by anonymous health experts' statements, statistical evidence and international comparisons. Numerical data are used to represent the statistical and medical norm. The statistical norm is adopted as the fertility policy objective. However in the policy documents reviewed that norm is not based on the average Russian health status, but the target level is set according to the average citizen in advanced Western countries. The Russian citizen is not compared against the Russian citizen, but the Russian population is compared against the population of Western countries. Women and young people are identified as targets for reproduction policy measures, but the responsibility for the nation's future is placed squarely on girls. Women are charged with moral obligations in the realms of family formation and sex life. It is interesting that none of the policy documents reviewed deal in moralistic terms with alcoholism, a particularly acute public health problem in Russia today. The burden of responsibility placed upon women implies a dual responsibility: for mothers, it implies the responsibility of raising their daughters and sons as ordinary responsible or "normal" citizens" who will later go on to form their own families. On the other hand, it also implies a responsibility for oneself and for one's own reproductive health. [ABSTRACT FROM AUTHOR]