In July 2000, in his first annual presidential address to the Russian people, President Vladimir Putin listed the 16 "most acute problems facing our country." Number one on the list, topping even the country´s dire economic condition and the diminishing effectiveness of its political institutions, was the declining size of Russia´s population. Putin put the matter plainly. The Russian population is shrinking by 750,000 every year, and (thanks to a large excess of deaths over births) looks likely to continue dropping for years to come. If the trend is not altered, he warned, "the very survival of the nation will be endangered."

Unfortunately, even Putin´s grim reckoning of the numbers may understate the dimensions of the calamity confronting his country. Its birthrate has reached extraordinarily low levels, while the death rate is high and rising. The incidence of HIV/AIDS, syphilis, tuberculosis, hepatitis C, and other infectious diseases is soaring, even as the Russian health care system staggers. Perhaps 40 percent of the nation´s hospitals and clinics do not have hot water or sewage. Seventy-five percent or more of pregnant women suffer a serious pathology during their pregnancy, such as sepsis, toxemia, or anemia. Only about 25 percent of Russian children are born healthy. (The rate of infant mortality, however, has declined, at least according to official statistics.) The leading Russian pediatrician Aleksandr Baranov estimates that only five to 10 percent of all Russian children are healthy.

To continue reading, please click Download PDF, above.