Throughout the 20th century, access to quality reproductive health services and sex education in Russia has been limited, and unsafe abortion was the main method of birth control. Education reforms in the 1990s allowed new opportunities for sex education in schools and promotion of sexual and reproductive health.

After the Revolution in 1917, the Soviet Union had the most progressive abortion law in the world. Upon request, a woman could have a safe abortion in a state hospital, free of charge. In 1936, however, abortion and other types of birth control were forbidden by Stalin, as the country needed more children for a strong army and as labourers. Illegal, unsafe abortion became rife. In 1956 abortion was legalised again. By the early 1990s, Russia had the world's highest abortion rate (181/1000 women aged 15-44, per year): the average woman would have had about five abortions in her lifetime.

However, as reproductive health services were below standards and no longer free of charge, most abortions were done in an unofficial and unsafe way. A few different types of contraceptives were available, but most were of poor quality, and awareness about contraceptive methods among women and medical staff was very low. In addition, medical staff had an economic incentive to continue performing abortions rather than prevent pregnancy. The most popular contraceptive methods used by women in Moscow in the early 1990s were rhythm, withdrawal and the condom. Only 12% of them used intrauterine devices (IUD) or birth control pills, compared to 73% in Northern Europe.

In addition to the limited access to contraceptive methods, sex education had never been a public issue, least of all a subject in the school curriculum. New opportunities developed in 1987, when the top-down school management system was decentralised. The Russian government began to encourage innovative, experimental schools at regional and territorial centres. In 1992, the Ministries of Education of the former Soviet Union (now Russia) and the Netherlands agreed to collaborate on an experimental sex education programme, based on an approach adapted by the Dutch Ministry of Education and CROSS (Coordination Educational Cooperation with Russia), a Dutch agency responsible for cooperative educational programmes in Central and Eastern Europe. Some Russian experimental secondary schools, assisted by CROSS, introduced sex education into their curriculum in 1994: an innovative concept for Russian schools. One of these schools is School 106, Univers, in the Krasnoyarsk region of Siberia, which has 1700 students from pre-school to senior secondary school. Univers became the teacher-training centre for the region. Teachers from more than 40 innovative schools in the region attended a two-day course on how to teach sex education. Many of the female teachers involved in the programme had had more than three abortions themselves and they were highly motivated to inform students about other choices. Although they were unaccustomed to talking about sexual matters openly, they faced their embarrassment and openly discussed this topic in their seminars, with students and even in the context of their own families. Many men however, felt it unnecessary to start this programme. As one male gynaecologist said: "Abortion is the result of an act also enjoyed by the female, so what's the problem?"

For teacher training, Dutch trainers brought videos and other teaching materials, such as plastic models to illustrate male and female anatomy. After the course, the teachers discussed the material again amongst themselves and wrote their own curriculum in Russian. They shared their experiences in seminars with their colleagues. Some biology teachers now incorporate sex education in their regular curriculum. Before the programme began in the schools, parents were informed about the reasons for introducing it. In some parts of the country the programme encountered resistance from the Russian Orthodox Church.

The sex education programme, which began in single-sex classes, is now given in mixed groups to junior and senior secondary school students. Teams consisting of biology teachers, school psychologists and school medical doctors teach the students. The sessions cover material ranging from anatomy lessons to discussions on psycho-sociological aspects, gender differences and the use of contraceptives. After the formal programme, students are encouraged to come forward with unasked questions.

The schools' goals are to ensure a healthy new generation by giving students the facts so they can make the right decisions for safer sex. Unfortunately, health clinics are no longer offering free pills, and while condoms and other contraceptives are easily available in clinics and pharmacies, prices are high. The initiative has, however, been taken up by schools in different parts of the country and sex education has been integrated into the curriculum.

At a seminar in St. Petersburg, the Krasnoyarsk programme experiences were shared. Although the participants were positive about the programme and asked for a follow-up a year later, this did not happen because "the noses of all people involved were not looking into the same direction." Sex education does not receive priority attention in Russia. Recently, however, the governor of Krasnoyarsk decided to support a large school health education programme, to answer existing information needs regarding love, sexuality and contraception. The governor has gone beyond promises: he has actually made funding available. This has encouraged individuals and CBOs to continue their sexual health programmes with young people. Abortion rates among 15-19 year old youth in the Krasnoyarsk region have declined by 15% over the last three years. This might indicate the start of a changing mentality on sexuality among boys and girls.