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The Reproductive Health Crisis in Kazakhstan 253

of nearly two abortions (1.8) in their lifetimes. In the capital city of Almaty, the num-
ber of abortions was almost double the national rate, with women there having a life-
time average of three (USAID/Macro International, 1995; see Table 11-1).
The data also indicated a strong desire for family planning and need for con-
traceptives. More than half of all married Kazakhstani women reported they
wanted no more children (59.4 percent said they had already reached the ideal
family size), while an additional 20.2% said they wanted to space the births of their
children (USAID/Macro International, 1995). It was this mismatch between de-
sired behavior and a method to achieve it that the SOMARC Red Apple Program
was charged with helping to resolve (see Figures 11-1 and 11-2).

TABLE 11-1 Abortions in Kazakhstan in the Mid-1990s
Abortions per lifetime per woman (nationwide) 1.8
Abortions per lifetime per woman (urban) 3.0 (Almaty)

Source: USAID/Macro International, Demographic and Health Survey: Kazakhstan,
1995.

Kazakhstan
Other
17%
Undecided
3%
Spacers Limiters
20% 60%
FIGURE 11-1 Need for Contraceptives (Married Women, Ages 15–49)
Courtesy of USAID/Macro International

CASE STUDY
The “Red Apple”

Krasnoye Yabloko (“Red Apple” in Russian) was the evocative name proposed by
the local advertising firm, favored by focus groups, and chosen for the USAID-
funded SOMARC Kazakhstan Social Marketing Project. The Red Apple pro-
gram was focused on ending the near-critical reliance on abortion by women of
Kazakhstan because of the virtual collapse of the Soviet pharmaceutical supply
system along with a medical establishment that de facto discouraged nonclinical
methods of birth control.