New health guidelines urge doctors to counsel women who reject motherhood as Putin ramps up measures to reverse population decline

Russia is escalating its response to a deepening population crisis, introducing new health guidelines that recommend psychological counseling for women who say they do not want children.

Under the directive from the Health Ministry, doctors conducting routine reproductive health checks are now expected to ask women how many children they plan to have. Those who indicate zero may be referred to a medical psychologist, with the stated aim of encouraging a more positive outlook toward childbirth.

The policy marks a striking shift in how the state approaches personal reproductive choices, as President Vladimir Putin intensifies efforts to combat what he has repeatedly described as a national emergency.

Russia’s declining population has been a persistent concern throughout Putin’s 25-year leadership, but the situation has worsened significantly in recent years. The ongoing Russia-Ukraine war has further strained demographics, with hundreds of thousands of young men lost to the conflict.

Although the guidelines were approved in late February, they only drew widespread attention after being reported by state media this week.

The Kremlin has framed the demographic downturn as a threat to national survival. In 2024, Putin warned that Russia could face “extinction” if birth rates continue to fall.

Current figures underline the urgency: Russia’s fertility rate stands at roughly 1.4 children per woman — the lowest level in two centuries and far below the 2.1 threshold required to sustain population levels.

In response, authorities have rolled out a series of increasingly assertive pro-natalist measures. These include tighter restrictions on abortion, a ban on so-called “child-free propaganda,” and expanded financial incentives and social benefits for larger families.

While government officials defend the policies as necessary to secure the country’s future, critics argue they blur the line between public policy and private life, raising concerns over individual rights and state intrusion into deeply personal decisions.