Fertility in Russia has been adversely affected by the common practice of using abortion as a primary means of birth control. In 1920 the Soviet Union was the first country to legalize abortion. Sixteen years later it was prohibited, except in certain circumstances, to compensate for the millions of lives lost in the collectivization of agriculture and the widespread famine that followed in the 1930s. The practice was fully legalized once again in 1968, and an entire industry evolved offering abortion services and encouraging women to use them. Although abortions became easily available for most women, an estimated 15 percent of the Soviet total were performed illegally in private facilities. Because of the persistent lack of contraceptive devices in both Soviet and independent Russia (and the social taboo on discussion of contraception and sex in general, which continued in the 1990s), for most women abortion remains the only reliable method of avoiding unwanted pregnancy (see Health Conditions; Sexual Attitudes, ch. 5). Russia continues to have the highest abortion rate in the world, as did the Soviet Union. In the mid-1990s, the Russian average was 225 terminated pregnancies per 100 births and ninety-eight abortions for every 1,000 women of childbearing age per year--a yearly average of 3.5 million. An estimated one-quarter of maternal fatalities result from abortion procedures.