BOGRAD, Russia -- Obstetrician Vladimir Vinter has been delivering babies in this small Siberian town for more than four decades.
Today, his maternity ward, once echoing with the clamor of crying newborns, is eerily silent. Authorities in the southeastern Siberian republic of Khakassia shut down the facility on January 1 despite angry protests by local residents.
"I am barred from practicing my profession," Vinter sighs as he strides down the hospital's empty corridors.
Women in Bograd, a town of 15,000 inhabitants, are equally distressed.
To give birth they must now travel to the city of Chernogorsk, 76 kilometers away. Some villages in the Bograd district lie as far as 150 kilometers from Chernogorsk, although expectant mothers can in certain cases request to give birth in another, closer city in a neighboring district.
Those are considerable distances for a woman in labor, especially during Siberia's harsh winters when snow and ice can slow traffic or make stretches of road impassable.
While most pregnant women in Russia don't have to travel this far to reach a maternity hospital, the demise of Bograd's ward is not an isolated case.
"This is Russia," cautions Aleksandr Saversky, the head of Russia's League for the Protection of Patients' Rights. "Traveling 150 kilometers in winter there is not the same as on European roads."
In recent years, Russian health workers have been denouncing a controversial reform to "optimize" health care that has dramatically slashed the number of state-run medical facilities across the country, particularly in rural areas, and left thousands of doctors without a job.
According to government statistics, the number of health facilities in rural areas fell by 75 percent from 2005 to 2013, from 8,249 to 2,085.
Health experts say patients are paying the price.
"In 2015, the mortality rate in Russia rose for the first time in 10 years," says Saversky. "In the absence of any new factors that could affect people's health, we see this as a result of the health-care system's optimization."
Bograd residents have fought hard to preserve their maternity ward.
Protests began as soon as the decision to close it was announced last summer.
In January, about 200 residents of Bograd again took to the streets to protest the closure, holding banners with slogans such as "The maternity ward's optimization is an affront to women," or "Don't touch rural medicine!"
Raisa Frolova, the driving force behind the rallies, says the town's administration simply chose to ignore the protests. Pointing to a thick pile of papers, she says a petition to the Russian government in Moscow signed by more than 1,000 residents has also gone unanswered.
"No one pays heed to the population's opinion nowadays," she says gloomily. "There are spheres of medicine where no one should be counting money and deciding whether or not it's unprofitable -- otherwise we simply become biological waste."
Bograd is not a wealthy town.
Many women there work throughout their pregnancies, and few can afford to wait for their baby's arrival at a hospital in Chernogorsk.
Vinter warns that expectant mothers living in villages around Bograd are particularly unlikely to travel all the way to Chernogorsk to give birth.
"They don't even come to our district hospital for their scheduled checkups," he says. "When we ask them why they don't come, they say they have no means of transportation or no money. As a rule, they arrive here only once labor has begun."
Vinter says some of the women who risk the trip to Chernogorsk may not get there in time, especially those who have already had children and can expect a quicker childbirth.
Doctors can still examine patients and follow their pregnancies at Bograd's gynecological ward, which remains open, but they can only deliver the babies in emergency cases when the life of the mother or child is at risk.
Vinter worries that women will endanger themselves trying to obtain emergency births in Bograd. He and his team have already performed three emergency deliveries since the maternity ward's closure.
"They will find ways to give birth here, they will wait until the last moment," he says. "This will end badly."
According to Vinter, the hospital has not actually been paid for January's emergency deliveries. He says officials have told the doctors that from now on they should regard deliveries in Borad as "humanitarian help to women."
Vinter is also concerned that he and his colleagues in Bograd could be held responsible if a woman in labor comes to harm on her way to Chernogorsk.
"Let's say that I examine a woman, that it looks like I shouldn't send her there because she might not make it in time but that I do so anyway, and something happens," he says. "In the criminal code, this is called leaving a patient in danger or failure to render assistance to a person in danger."
There are currently three pregnant women on bedrest at the Bograd hospital.
One of them, Tatyana Azhirevich, gave birth to both her sons here. She says she has no intention of trusting the life of her third child to anonymous doctors in Chernogorsk.
Azhirevich is determined: She won't trade "her Vinter" for any other obstetrician.
"I will wait until the last moment at home," she pledges. "I don't care if they bring me in an ambulance and if I have to lie on some couch, I want to give birth in our Bograd hospital."
Like Azhirevich, many of Vinter's patients are wary of giving birth in Chernogorsk's maternity ward, where they believe doctors will be too busy to offer them quality care.
The Bograd hospital, in contrast, used to deliver an average of two babies per week.
"A lot depends on the situation, if you are alone or if there's someone to support you," she explains. "Here, the doctor pats us on the back and reassures us."
The quiet pace at Bograd's maternity ward is precisely the reason cited by Khakassia authorities for its closure. Officials have branded the ward "unprofitable." Others have pointed to its higher-than-average infant mortality rates.
This claim riles local doctors, who say the rates include babies up to 12 months of age who die at home, as a rule in underprivileged rural families.
As an inspector for juvenile welfare, Azhirevich knows about the situation firsthand and hotly defends Vinter and his team.
"I see how these doctors chase alcoholic pregnant women," she explains. "They bring them to the maternity ward so they can sober up a little before giving birth."
With the maternity ward now officially closed, she fears Bograd's obstetricians will leave the town for good.
"Women will give birth at home," she warns. "And then you just watch what kind of infant mortality rates we will have."
