Russia will refer women who say they do not want children to psychologists under new reproductive health guidelines aimed at addressing the country’s deepening demographic crisis.

The policy, issued by the health ministry, instructs doctors conducting routine reproductive health assessments to ask women how many children they intend to have. If a patient responds that she does not want any, the guidelines recommend referring her for consultation with a medical psychologist to help foster a more positive attitude toward childbearing.

Although the recommendations were approved in late February, they only gained wider attention after being reported by state media this week.

Russia has been grappling with a steadily declining birth rate for years, a trend that has become a central concern for the Kremlin. The situation has been further exacerbated by the ongoing war in Ukraine, which has seen hundreds of thousands of men deployed to the front lines.

President Vladimir Putin has repeatedly described the country’s demographic decline as a matter of national survival. In 2024, he warned that Russia could face “extinction” if efforts to boost birth rates fail.

Current figures show Russia’s fertility rate at approximately 1.4 children per woman — a 200-year low and significantly below the 2.1 level widely considered necessary to maintain a stable population.

In response, authorities have introduced a range of measures in recent years, including tighter restrictions on abortion and legislation banning what officials describe as “child-free propaganda.” At the same time, the government has expanded financial incentives and social benefits for larger families, which are increasingly promoted as a patriotic ideal.

The new psychological referral guideline represents the latest effort in a broader state campaign to reverse Russia’s population decline.