The 29-year-old woman was nervous as she arranged the hospital appointment for her fifth abortion recently, remembering the nightmarish pain when she ended an earlier pregnancy.
''I asked them to give me an injection, but they didn't pay any attention to me,'' said the woman, Nadezhda V. Lobikinova, who is a nurse. ''They ended up having to do the abortion twice. It was very painful.''
Abortion - widely accepted here, and performed in assembly-line conditions - has suddenly become the target of a lively and unusually frank debate.
Unlike the abortion debate in the West, which has focused on the rights of the unborn and the woman's right to choose, the Soviet debate is on women's health care - the right to adequate supplies of reliable contraceptives, to sanitary conditions, anesthetics and the respect of medical workers. 'Stone Age Equipment'
Abortion statistics are sketchy in many countries, but abortion may be more common here than anywhere else in the world. By official count, 6.4 million legal abortions were performed in 1987, almost 1 million more than the number of Soviet babies born in the same period. The data show almost one of every 10 Soviet women of childbearing age had an abortion. By comparison, the rate in the United States was about 1 in 36, according to the Alan Guttmacher Institute, a nonprofit research center in New York.
Some Soviet health researchers believe the real number of abortions may be far higher - as much as double the official figure. Many women readily pay $75 to $150 for an illegal abortion, often performed after hours in a state hospital or outpatient clinic.
A paid abortion has two advantages over the state's free operations: a woman is given enough anesthetic, and she avoids the required hospital stay, typically three days long.
''Our medicine is very cruel - it has a stone heart and Stone Age equipment,'' said a Moscow woman who recalled her own abortion, performed by rude medical workers with an ineffective dose of painkiller. 'Cruelest Abortion System'
The Soviet Union has ''the world's cruelest abortion system,'' charged a commentator in New Times magazine. ''The main thing is to queue up in time and not shudder when you climb onto the obstetrical execution block.''
The most graphic account appeared last month in the weekly Moscow News, under the headline ''I Don't Want to Be Sorry I'm a Woman.''
The author, Yekaterina Nikolayeva, condemned the ''conveyor line'' atmosphere at the clinic where she had an abortion. When she entered the operating room, a doctor yelled at her for staring at his blood-stained rubber gloves.
''Hurry up, you,'' he said. ''I'm sick and tired of your stupidity.''
The author quoted another doctor scolding a frightened patient: ''You should have had second thoughts before. You're all fond of sweets, but you're not willing to pay the price.'' Abortion Rate 'Not Normal'
The Moscow News account dismayed Aleksandra P. Biryukova, the highest ranking woman in the Soviet Government, who ordered a Health Ministry investigation and called the high Soviet abortion rate ''not normal.''
''We must change this radically over the next year and a half to two years, by developing the contraceptive industry,'' she said at a recent news conference in Moscow.
Mrs. Biryukova's call for change will not be easily accomplished, though. Despite their bitter complaints, many Soviet women still see abortion, which has been legal here since 1955, as their simplest birth control option.
''My mother had 3 children and 13 abortions,'' a young Moscow woman said. ''My father refused to use condoms, and there was nothing else she could do.''
Abortion is available to all women in the first trimester of pregnancy. In the second trimester, abortions can be performed for medical reasons, or for ''social reasons,'' like rape or divorce.
The Moscow News reported in January that 600 to 700 women die each year as a result of abortions in the Russian Republic alone, which has slightly more than half the national population. Soviet officials also say the high abortion rate has contributed to high rates of infertility and premature births. Promise of More Contraceptives.
The Health Ministry has promised to increase production of intrauterine devices and condoms, and to import more birth control pills, which are not manufactured in the Soviet Union.
The Government offers financial incentives designed to encourage women to have more children. These originally were intended to increase low birth rates among Russian and Slavic women, and there is some statistical evidence that the incentives are beginning to work. But there has been no organized effort to discourage abortion, and rates remain high in the Russian Republic.
Still, there is no national debate here about the morality of abortion.
''We are basically an atheist society,'' said Svetlana I. Markovich, an obstetrician-gynecologist at the Family and Marriage Clinic in Moscow. ''Of course it would be better to prevent pregnancy rather than to have an abortion. But I can't think of abortion as murder, because at the stage when abortions are permitted, this is not a person.''
https://www.nytimes.com/1989/02/28/w...-abortion.html