NORFOLK, VA. -- Stephen Beebe knew the Soviets wanted better birth control, but he was a little nervous about presenting an American-made pack of condoms to his host last year on his first visit to Tbilisi, the capital of the Soviet Republic of Georgia.
One night, his host, a Soviet doctor, led him to a wine cellar to show off several rows of homemade Georgian wine. The host reached up and pulled a box of Soviet condoms from the top shelf, smiled broadly at his American guest and tossed the package to his 19-year-old son.
With the host's permission, Beebe said, he offered his pack of American condoms to the Soviet teenager, who walked away "beaming," with box in hand.
Providing effective and safe birth control challenges doctors in the Soviet Union, said Beebe, who visited Tbilisi as part of a team of doctors and researchers from the Jones Institute for Reproductive Medicine in Norfolk.
During the visit, he and others heard Soviet doctors bemoan the results of government control, inadequate funding and widespread ignorance about health issues, which have relegated condoms and other contemporary methods of birth control to the back burner.
Instead of using birth control, women have numerous abortions, one of the highest known rates in the world, according to the Alan Guttmacher Institute, a nonprofit reproductive health research institute based in New York. The Soviet Ministry of Health says that more than 7 million abortions are performed each year in the Soviet Union, a country with a population of 287 million. In the United States, with a population of 247.1 million, there are nearly 1.6 million a year.
The number of abortions in the Soviet Union may be even greater than the health ministry reports, said Gary D. Hodgen, scientific director of the Jones Institute, which is known for achieving the birth of America's first test-tube baby in 1981.
Hodgen, an organizer of the trip to Tbilisi, said Soviet doctors at Zhordaniya Institute of Human Reproduction report that a more realistic figure -- which includes illegal abortions in private homes -- is much closer to 20 million per year.
"It's unofficial, but they believe it to be true," Hodgen said. "They don't like abortion at all; they simply have no means to prevent unwanted conception. They are extremely eager to reduce the abortion rate."
Beebe said Soviet doctors indicated that couples primarily rely on the rhythm method and withdrawal for contraception.
Women in the Soviet Union have an average of eight abortions by the time they reach age 40, Hodgen said.
The abortion rate is a "grave ethical concern" in the Soviet Union, Hodgen said. "The abortions are done in such large numbers on the same individual that it ultimately impairs" a woman's ability to reproduce.
The director of Zhordaniya Institute, Archil Khomassuridze, has been a leader in efforts to establish family planning programs throughout the Soviet Union. His visit last year to the Jones Institute to discuss contraceptive technology, as well as infertility diagnosis and treatment, spurred the return visit by the American team .
Hodgen said Khomassuridze blames the Soviet government -- which until recent reforms unofficially but absolutely opposed contraception -- for inadequate funding and the low priority given health care for women and children.
In an article published last February in the New Yorker magazine, Khomassuridze was quoted as accusing prominent members of the Soviet Ministry of Health of being "criminals" and "murderers," who "should serve time for ruining the lives of millions" because of their opposition to birth-control programs.
Half the condoms manufactured in the Soviet Union break, he said. In addition, Beebe said, several other doctors he talked to complained about Soviet physicians who oppose birth control programs because they reap large profits by performing abortions in private homes.
Hodgen said that during the visit, Soviet and American doctors discussed plans to co-host a conference in Norfolk during the fall of 1991 or the spring of 1992, and for two Soviet doctors, sponsored by federal and private grants, to study and train at the Jones Institute.
Charles Coddington, associate professor at the department of obstetrics and gynecology at Eastern Virginia Medical School in Norfolk, said he was impressed by the Soviet doctors' willingness to discuss problems openly. "Until you've been there, it's very hard to have a mindset about what they need," he said.
Even at Zhordaniya Institute, where medical care is more advanced than at the typical Soviet hospital, Hodgen said the facilities had not reached the level of care at U.S. hospitals in the 1950s.
Soviet hospitals, lacking adequate space, often have beds in the corridors, Hodgen said. In addition, Soviet clinics have outdated equipment, and there are few technicians trained to use sophisticated technology. "Even if we were to give them equipment," said Hodgen, "they don't have the people to operate and maintain it."
The lack of medical technology contributes to the low live-birth rate of 4 to 5 percent in the Soviet Union's three in-vitro fertilization programs, Coddington said. He noted that the in-vitro process, which entails fertilizing an egg in a laboratory and then allowing it to grow inside a woman's uterus, requires following numerous steps in a "very meticulous manner."
The U.S. has about 175 clinics, with a nationwide success rate of about 8 percent. Jones Institute claims a live-birth rate near 23 percent.
Notwithstanding the dedication of Soviet doctors, Hodgen said, it may be 20 years before Soviet doctors achieve a level of training, education and equipment to match the United States. If the Soviets get sufficient economic support, Hodgen said the Soviets eventually would become "powerful collaborators" in research and clinical trials.