Scenes like this, outside the Art-Strelka cultural center last week, have become increasingly common as the number of babies being born has climbed.
It is clear from statements by political leaders that the government is aware of the problem and the serious threat that it poses to future economic growth and security as the country's work force shrinks.
What is also clear, according to demographers and public health experts, is that the government hasn't made enough effort to get to the root of the problem or to measure whether the policies it has put in place to deal with the demographic crisis are really helping. Although some financial incentives have been created to help couples have more children, experts say a much more comprehensive approach is necessary.
Given existing trends, demographers say the population will shrink from the current level of 142 million to something between 125 million and 135 million by 2025, and could fall to as low as 100 million by 2050.
This demographic decline has serious economic consequences -- there will be as many as 8 million fewer people in the work force by 2015 and possibly 19 million less by 2025, according to study by a group of Russian demographers sponsored by the United Nations and released in late April.
Population change is dependent on three main factors: the birthrate, the death rate and immigration rates. Last October, then-President Vladimir Putin approved a government demographic strategy through 2025 that sets targets in each of these three categories. But while this strategy shows that the government is concerned about the current situation, the program's goals suggest that it has little interest in understanding the roots of the problem, preferring to throw money at it instead.
Demographers have calculated that, in Russia, the replacement fertility rate -- the number of births per woman necessary to maintain the current population -- is 2.15. In 2006, the fertility rate was 1.3 children for every woman.
The number of babies born last year jumped to about 2 million -- up 8.3 percent from the year before and a post-Soviet record. Still, the fertility rate rose only to 1.4 children per woman.
State officials wasted no time in claiming that government policy was to thank for a new baby boom, with Health and Social Development Minister Tatyana Golikova only the most recent example.
"It is a true demographic explosion that no other developed country has generated," Golikova said in a speech on April 26. "We are proud that ... Russians have had the right reaction to the measures to encourage births."
The measures introduced by the government included an increase in monthly social payments to mothers, making it easier for young families to get mortgages, and "mother's capital" -- a one-time payment of around $10,000 for those women giving birth to a second child. Access to the money comes only three years after the child is born, and it must be used for the child's benefit, such as improving the family's living conditions or paying for education.
Demographers doubt, however, that government perks were the sole or even the main cause of the rise in births.
Vladimir Arkhangelsky, of the Research Center for Population Problems at Moscow State University, said the latest spike in births is the result of an increase in the number of women reaching their peak childbearing years. These women were themselves products of an early 1980s baby boom, which followed increases in Soviet-era social payments and an anti-alcohol campaign.
Arkhangelsky and other demographers say the number of children being born will likely fall off again in about five years as the women of the 1980s baby boom move out of their most fertile years and are replaced by the much smaller generation born in the 1990s.
According to the State Statistics Service, in 2007 there were 24.1 percent fewer females from the age of 10 to 19 than in the 20 to 29 age group. There were 44.1 percent fewer females under the age of nine than in the 20 to 29 group.
An added concern is that, even if the new benefits are partially responsible for the increase in births, they may still have a negative effect on the country's wealth disparity in the future. Women living below the poverty rate experienced a more significant rise in birthrate than any other segment of the female population, said Valery Yelizarov, head of the Research Center for Population Problems.
According to the Social Insurance Fund, the government body that issues birth certificates, about half of the women who gave birth last year reported a monthly income below the poverty line for Russia -- 3,500 rubles ($150). About 70 percent of the mothers reported a monthly income of less than 7,000 rubles ($300).
"The government needs to think of how to stimulate [births among] those who are more successful in life," Yelizarov said.
According to the government demographic strategy, incentives designed to get families to have more than one child should boost the birthrate by 50 percent by 2025. But the global trend, and particularly in developed countries, has been away from larger families, leading some experts to express doubts that the target can be met.
Karl Kulessa, the UN's population agency chief in Russia, said there were many social and economic factors that work against bigger families.
Benefits for larger families introduced by the French government have played at least some part in a jump in the birthrate from 1.7 babies per woman in 1994 to almost 2.0 in 2006. But to achieve similar results in Russia, the government needs not only to provide families with the financial resources to provide for more children but also to influence attitudes in a country where one-child families are the norm, Arkhangelsky said.
Aggressive beer advertising has raised consumption among the young, compounding the country's alcohol problem.
Medvedev himself has only one child, a son, while Putin has two daughters.
Other demographers agree that the government has done little, if anything, to influence public opinion about larger families.
Another issue is whether the facilities exist for a baby boom of the magnitude the government would like to see.
The infant mortality rate in the country jumped from .88 percent for children born in January 2007 to almost 1 percent for those born in January of this year, a fact Yelizarov suggested may be a sign that maternity hospitals and their staff were unable to deal with the increased workload.
To meet the challenge of the growing number of births, the government plans to spend 20 billion rubles ($850 million) from 2008 to 2010 to build 23 new perinatal centers in Russia, said Olga Sharapova, head of the Health and Social Development Ministry's department for medical and social problems related to pregnant women and children.
"This will help save the lives of hundreds of mothers and children every year," she said.
Prevention Is Key
"The birthrate is a very difficult thing to increase quickly, so the state and the people can achieve much more by addressing deaths," said Natalya Rimashevskaya, a demographer with the Russian Academy of Sciences.
One out of three Russians dies before reaching retirement age -- 55 for women and 60 for men -- and 80 percent of those dying early are men, according to data from the Health and Social Development Ministry.
Russia is one of the few countries in the world where life expectancy has declined since the 1960s. In 2006, the life expectancy for Russian men was 60.6 years, about 15 years less than that in most developed countries.
The number for women is higher, at 73.1, but still almost 10 years below that in most developed countries.
Experts agree that a large share of early deaths in Russia, particularly among men, are preventable. Cardiovascular diseases account for 55 percent of all deaths, four times the rate in Western Europe.
The government has made cutting the death rate among the working-age population by 38 percent by 2025 one of its targets, with the ultimate goal of raising average life expectancy to 75 years -- the current figure for Mexico.
"The biggest reason the mortality rate is so high rate is the very low value placed on life by the state and people themselves," said Alla Ivanova, chief statistician at the Health and Social Development Ministry's Central Scientific Research Institute for Health Care Information.
Over the past two decades, state spending on health care has remained meager and people have failed to develop healthier lifestyles, she said.
When asked what the state's focus should be under Medvedev to raise life expectancy, most experts named poverty and heavy drinking.
Most demographers agree that the government needs to find ways to lower alcohol consumption and especially the abuse of cheap, low-quality alcohol that kills thousands every year.
Battling low-quality alcohol will be a challenge, however, as the state surrendered its monopoly on alcohol production in 1992 and corrupt law enforcement bodies have failed to crack down on illegal producers of alcohol in the years since. Additionally, ubiquitous and aggressive television advertising has made beer an integral part of Russian teen culture.
Alexander Nemtsov, a senior researcher at the Scientific Research Institute of Psychiatry, has calculated that annual alcohol-related deaths averaged about 426,000 over the past 20 years, or almost 30 percent of deaths among men and 17 percent for women.
Studies show that mortality rates have risen or fallen in tandem with alcohol consumption rates in the country, and both rose in the 1990s.
Some experts say this was the result of despair generated by economic problems. Long-term poverty often produces a vicious cycle, in which a lack of economic prospects leads to alcoholism and drug abuse, which in turn keep people impoverished, Ivanova said.
Fortunately, income levels among Russians have risen in recent years, and this may have been the main factor behind a 1.3-year jump in male life expectancy and 0.8-year rise for women from 2006 to 2008. Interestingly, the death rate among people under 40 remained basically unchanged from that in the turbulent 1990s.
The Best Medicine
In addition to fighting alcohol abuse and providing better opportunities for those marginalized in the course of the drastic economic reforms of the 1990s, Ivanova said the government needed to improve medical care and make it more accessible.
"This can prevent another 200,000 deaths every year that occur because of the poor organization of preventative medicine services and because, for various reasons, people just don't turn to doctors in time," she said.
Meanwhile, Health and Social Development Minister Golikova has named heart disease and traffic accidents as the two major preventable causes of death in Russia.
Senior ministry official Sharapova said the government was set to spend an additional 10 billion rubles ($420 million) from 2008 to 2010 to improve care at regional health facilities for people being treated for heart disease and injuries sustained in car accidents.
She said the ministry was also working to develop a program to decrease alcohol-related deaths.
After the collapse of the Soviet Union, immigration became the only immediate solution to Russia's demographic catastrophe. From 1992 to 2007, 5.5 million people immigrated to the country, with 4.5 million of those gaining Russian citizenship.
It is impossible to say how many people move to Russia annually because of the difficulties of tracking illegal migrants and the complex registration system for those entering the country legally.
In 2007, the Federal Migration Service issued more than 2.1 million work permits for foreigners but only 194,000 temporary residence permits. These numbers indicate that only a fraction of those who come to work are able to gain, or are even interested in, citizenship.
The service plans to issue 350,000 residency permits in 2008.
There is only one state program aimed at attracting Russian-speaking people from former Soviet republics into the country, but in order to be eligible for Russian citizenship and financial benefits, potential immigrants have to settle in remote and sparsely populated areas, like the Far East.
This program focusing on these "fellow countrymen" was established by then-President Vladimir Putin in June 2006 and was to kick into action in 2007. Viktor Ivanov, the Putin aide appointed to oversee the program, said in an interview with German newspaper Die Welt in 2006 that the country was ready to welcome the 25 million ethnic Russians living in other former Soviet republics.
So far, however, the results have been very modest. In 2007, only 2,100 immigrants were resettled in Russia as part of this program, said a source in the Federal Migration Service who spoke on condition of anonymity because he was not authorized to talk to the media. The service is currently reviewing 8,500 applications, covering 23,000 potential immigrants.
The challenges are even more severe for potential immigrants who are not ethnic Russians. Isolation, the lack of social infrastructure, xenophobia and salary discrimination all make life for immigrants difficult.
Olga Chudinovskaya, an immigration expert at Moscow State University, said migrant workers are paid on average half of what Russian citizens receive for the same job.
She added that the public perception of immigrants as criminals is an extreme exaggeration. In 2007, migrants accounted for only 1.5 percent of the crimes registered by the Interior Ministry.
Chudinovskaya said the program of resettling "fellow countrymen" in Russia is based on "false priorities," since the government would face a struggle keeping immigrants in far-flung and economically depressed regions.
It will be far more logical for the government to grant citizenship to immigrants who already have jobs in Russia, have come with a strong motivation to stay and who would not ask the government for help, she said.
One of the biggest problems in the policy area is that no one has any real idea of how programs will work, as demographers have not been given much of a consultative role in their formation.
"When officials speak of billions of rubles spent on demographic projects, I only shrug, because there was no serious scientific examination of them," said Anatoly Vishnevsky, a leading expert in the field and head of the Center for Demography and Human Ecology at the Russian Academy of Sciences.
For example, it is impossible to determine whether the recent spike in births is because Russians are developing a preference for bigger families, as the government says, or because the baby boomers of the 1980s have reached childbearing age. There are no statistics being collected on whether new babies are second -- or even third -- children; they are just being counted, Yelizarov said.
The government is not only failing to collect the necessary information on the problem, but it has also not invested in any real analysis of the results.
"We need to understand what factors influence birthrates and death rates and how, as well as what money needs to be spent to achieve the desired results," Yelizarov said.
In another telling example of how government priorities are mismatched, the Health and Social Development Ministry's own figures show that there were far fewer deaths from traffic accidents last year than from poisoning, even though Golikova called traffic accidents one of Russia's two leading causes of preventable deaths.
Increased social payments notwithstanding, very little is being done to alleviate the most pressing problems facing young families. Svetlana Misikhina, a demography researcher at the Institute of Urban Economy, pointed to the government's mortgage policy as an example.
Citing a lack of adequate housing as a major obstacle for younger families wanting to have more children, the government created a program to provide greater access to mortgages. The problem is that few effective measures have been put in place to increase the rate of new home construction. The result has been a further increase in real estate prices, putting new or bigger apartments out of reach for the majority of young families.
The government has also done nothing to develop programs that would allow nursing mothers to work from home or work part time.
"The biggest problem of all is that our presidents -- Putin and Medvedev -- are misinformed about the demographic situation, and this is the first thing that needs to be dealt with," Vishnevsky said.
Editor's Note: This is the sixth in a series of reports about the key challenges facing Russia today. Previous reports can be found at www.moscowtimes.com.