The Effectiveness Of Russia's Demographic Policy

The effectiveness of demographic policy to stimulate fertility

During the study period, an active pronatalist demographic policy was implemented in the Russian Federation (Maleva et al., 2017). To stimulate the birth rate in Russia, Federal Law No. 256 of December 26, 2006, "On additional state support measures for families with children" was adopted in 2007, which defined payments to families at the birth of the second child (subsequent children, on condition they haven't used this right before) (Arkhangelsky et al., 2017). These payments are called "maternity capital" (Arkhangelsky et al., 2017). The initial amount of the "Maternity capital" was 250 thousand rubles.

The analysis of the birth rate across Russia showed that its growth continued until 2015. And it amounted to a maximum of 1942683 people since 2000. In 2019 the birth rate decreased to the 2006 figure and amounted to 1481074 people. In 2020 the birth rate reduced by 44560 people and amounted to 1436514 people (Table 2). Thus, we can state that during the observed period, fertility rates have been at a low level for 20 years, the current trend towards their decline continues.

The analysis of the birth rate after the start of payments of the "maternity capital" did not show stable positive growth dynamics. In 2007 and 2008 birth rate increased by 130485 and 103825 children, respectively. Since 2009 and the next three years, the birth rate grew slightly, and a sharp increase occurred in 2012 when the birth rate increased by 105,455 children. In subsequent years, the birth rate continued to grow, and the highest birth rate was in 2014, amounting to 1942683 children. In later years, the birth rate began to decline and in 2020 amounted to 1436514 children, reaching the birth rate of 2003. The catalytic role of the "maternity capital" has had its results, but it is crucial to remember that the population age factor influences this process, too (Maleva et al., 2017). In the analyzed period, numerous generations of the 80s entered the childbearing period affecting the birth rate growth. In the 80s, 2.4-2.5 million children were born annually, and a large generation gave a surge of fertility, stimulated by the "maternal capital" (Bulanova, 2017). By 2020, this reserve has exhausted itself, and changes have been made to Federal Law No. 256 to maintain the birth rate. The authorities began to pay the maternity capital at the birth of the first child at the rate of 483.881 rubles and 83 kopecks according to the amendments made to Federal law No. 256. And at the birth of the second child, they paid an additional 155550 thousand rubles. Thus, the total quantity of maternity capital amounted to 639,431 rubles and 83 kopecks. The government compensates mortgage payments equivalent to 450 thousand rubles at the third childbirth. According to the author, the given measures will not lead to an increase in the birth rate but will prevent a sharp decrease in subsequent years.

The impact of the "maternity capital" on fertility since 2008 is difficult to analyze since data on births order have been presented only since 2016. Despite this, we will try to trace the change in the dynamics of the births sequence in subsequent years. Table 3 presents an analysis of the birth rate by births order, which did not reveal a sharp increase in second and third childbirths. The share of first births from 2016 to 2020 varies between 39-36%, second - 40-36%, third - 16-18%, fourth - 4-8%, fifth - 1.8-3%. With a total decrease in births since 2016 by 452 thousand people, the share of third, fourth, and fifth births is growing. These show that the share of large families is growing. Therefore, we can state that the birth rate is influenced by demographic attitudes more that determine the number of children in a family (Makar et al., 2020).

The evaluation of the effectiveness of demographic policy to stimulate fertility was also carried out based on the analysis of the total coefficient. The total fertility rate shows the average number of children a woman will give birth to throughout her life (Table 1). Since an informative indicator can be used to analyze the rate of population maintenance, an indicator above 2.12 shows an expanded type (Sinelnikov, 2019).

Until 2016, the total fertility rate in Russia has been growing. Since 2016 it has been decreasing, and in the future, it will only decrease, since in the conditions of the second demographic transition (Klupt, 2020), demographic priorities of a person change, both concerning the marriage age and questions about the number of children (Zhuravleva & Gavrilova, 2017). The target of this indicator by 2024 should be 1.7 children per woman of reproductive age; the dynamics of the decline in the total coefficient cast doubt on the possibility of achieving (Table 4).

The effectiveness of the demographic policy of the Russian Federation to reduce the mortality

Mortality is the significant demographic process affecting the size and structure of the population (Shchepin & Shishkin, 2018).

To achieve the targets, national projects "Demography" and "Health Care" have been developed, whose activities are aimed at lowering mortality. Within the framework of the national projects "Demography," the federal projects "Sport is the Norm of Life," "Strengthening Public Health," "The Older Generation," the attention is focused on preserving health and reducing mortality. All federal projects within the project “National Health Care” are aimed at lowering mortality and increasing life expectancy. It is planned to develop a network of the primary health care systems within the federal project "Development of System of Rendering Primary Health Care." It implies the construction of paramedic-obstetric, paramedic stations, and outpatient clinics, the development of sanitary aviation, the acquisition of mobile medical complexes, and the development of the medical organization of a new model. Regional vascular centers, provision of medical personnel, and preventive measures are being created during the federal project implementation "Fight against Cardiovascular Diseases." The federal project "Fight against Oncological Diseases" involves the creation of outpatient oncological care centers, the re-equipment of regional medical organizations, information and communication companies to conduct preventive medical examinations for early diseases detection. Its objective during the implementation of the federal project "Development of Children's Health Care, including Creation of Modern Infrastructure of Delivery of Health Care to Children," is to create simulation centers for training specialists in the field of perinatology, neonatology, and pediatrics, conducting preventive medical examinations, and construction of children's hospitals. The federal project "Providing medical organizations of the healthcare system with qualified staff" provides for the implementation of accreditation procedures, continuous professional development through the creation of simulation centers, the development of interactive educational models for the portal. The federal project "Development of a Network of National Medical Research Centers and the Introduction of Innovative Medical Technologies" provides for the use of telemedicine technologies by these centers for consultation. The federal project "Development of the export of medical services" involves communication measures to attract foreign specialists to the healthcare system of the Russian Federation. The federal project "Creation of Single Digital Contour in Health Care on the basis of the Single State Information System of Health Care (SSISHC)" involves the creation of a single state information system in healthcare, the interaction of this system with similar systems of the subjects of the Russian Federation and the of Public Services Portal of the Russian Federation. The implementation of national projects began in 2018. We will try to assess the effectiveness of the measures to reduce mortality by comparing the planned indicators of the national project passport in Russia as a whole.

According to the Decree of the President of the Russian Federation No. 204, the mortality rate reduction in the working-age population to 350 cases per 100 thousand people should be achieved by 2024. Is it possible to achieve this indicator in Russia as a whole?

This indicator showed a downward trend in Russia for ten years from 2010 to 2019. From 2015 to 2020, the mortality rate of the working-age population decreased by 14%, but in 2020, mortality increased by 10% (Table 5). One of the crucial causes of the mortality increase is the COVID-19 coronavirus infection. In 2020, 144,691 people died from the COVID-19 coronavirus infection.

In 2020, the actual mortality rate of the working-age population was 49% higher than planned (350 cases per 100 thousand people). Within five years, the decrease was 14%; the achievement of the target value is questioned. The decline in mortality rate should be approximately 12% annually, which is practically unrealistic in the current conditions.

According to the National Health Care project, the mortality rate in working-age in 2018 should have been 455, in 2019 – 437, in 2020 – 419 deaths per 100 thousand people. The expected results were not achieved in Russia during the study period (Table 6).

In 2018, the lag of the actual indicator from the planned one was 6%. In the future, it only increased, and in 2020 it reached 24.5%.

The first place in the structure of mortality reasons in the Russian Federation and the mortality of the working-age population is mortality from circulatory system diseases (Popova & Taranenko, 2017). The target values of this indicator by year in the national project "Healthcare": in 2018 - 565, in 2019 - 545, by 2020 - 525, in 2021 -505, by 2024 450 deaths per 100 thousand population (Table 7).

Over the years of the national health care project implementation since 2018, the indicator has not reached the target values. In 2018 the gap was 3%, and in 2020 it was 22%.

The next significant cause of death in Russia is mortality from neoplasms. By 2024, the target is 185 deaths per 100 thousand people. Let's analyze the dynamics of deaths in Russia and predict the chances of achieving the intended result. It should be noted beforehand that the national health care project is being implemented in Russia, which includes the federal project "Fight against Oncological Diseases."

The federal project provides for the development of programs "Fight against Oncological Diseases," additional financial support for the provision of medical care to patients with oncological diseases, staffing of oncological medical centers, the construction of oncological dispensaries, the creation of reference centers for immunohistochemical, pathomorphological and radiation research methods, information and communication campaigns aimed at early detection of oncological diseases and increasing adherence to treatment, re-equipment and improvement of medical organizations, and creation of outpatient oncological care centers. The evaluation of the effectiveness of the measures taken showed that mortality from neoplasms in Russia as a whole is higher than planned. In 2018, the target figure was 199.9 deaths per 100 thousand people. In 2019 it was 199.5 deaths per 100 thousand people, and in 2020 it was 197.0 deaths per 100 thousand people (Table 8).

Mortality from neoplasms in Russia is 2.5% higher than planned in 2020, which indicates the possibility of achieving the target (Table 8). Thus, the measures provided for by the federal project "Fight against Oncological Diseases" have a positive effect.

In Russia, there is an increase in the mortality of the working-age population. Mortality from circulatory system diseases and neoplasms is higher than the target values. Coronavirus infection increased the mortality rate. Thus authorities shifted their attention to the treatment of this disease and the reduction of medical care for other types of morbidity (Rusanova & Kamynina, 2021).