Before the Russian Revolution in 1917, abortion was forbidden in all circumstances in line with the teaching of the Orthodox Church.

In 1920 Russia became the first country in the world to legalise abortion, when a decree from the commissariats of Health and Justice permitted free abortions at all Soviet hospitals. This law reflected the belief in female equality held by the Bolsheviks. Lenin stated that no woman should be forced to bear a child against her will.

In 1936, Stalin decreed that the Soviet Union needed more workers for industrialization. Abortion was prohibited except in the case of hereditary disease, or serious risk to the life of the woman.

In 1955, two years after the death Stalin, the 1936 prohibitions were ended.

In 1988, the Soviet Union further eased its abortion law. Abortion is available to all women in the first trimester. In the second trimester, abortions can be performed for medical reasons, or for social reasons, like rape or divorce. This change was made to limit illegal abortions as an estimated thirty to forty percent of abortions are illegal.

Many women pay for an illegal abortion, often performed after-hours at a state hospital or outpatient clinic, in order to be given enough anaesthetic, to avoid delays and a three-day hospital stay. Outdated abortion techniques cause a high number of complications, and as abortion is readily used as contraception, some Russian women have as many as twenty abortions. 

According to the World Health Organization abortion is the main cause of maternal mortality in Russia, accounting for 24.3% of all maternal deaths in 1997.

This high number of abortions results in widespread premature births. The level of abortion is the highest in the world (estimated to be double the number of births) and there are concerns about the seriously declining birth rate.

In 2003, the Russian government, concerned about the impending demographic disaster created by the low birth rate, narrowed the list of non-medical grounds for having a legal abortion after the first trimester of pregnancy, from thirteen to four: when a court rules the woman is unfit to be a mother; when a woman has been raped; when the father is severely disabled or has died; and when the mother has been sent to prison.