Barriers to Reproductive Health in Post-Communist Romania Dr. Adriana Baban Professor, Babes-Bolyai University Cluj-Napoca, Romania  

Romania: Country Profile (1) Capital: Bucharest Land area: 92,043 sq miles Population: 22,430,500 (2000) Urban population: 57% Ethnic groups: Romanian, Hungarian, German, Romany Religion: Orthodox, Catholic, Protestant Literacy rate: 97% women; 99% men

Romania: Country Profile (2) Working population: 46% women; 54%men GDP per capita: 3970 USD Health care expenditure: 2.6% of the GDP Population per doctor: 554 Hospital beds per 100,000 population: 728 Inflation rate: 60% Unemployment rate: 11.3%

Life expectancy of Romanians at birth (in years), 1970-2000

Mortality by main death causes and gender (per 100,000 population) Women Men Cardiovascular diseases 714 689 Cancer 151 218 Respiratory diseases 52 81 Digestive diseases 48 External causes 30 100 Infectious diseases 7 21

Comparison of Child and Infant Mortality Rates (1997)

Population Policies and Reproductive Rights under Socialist State 1957-1966: women viewed as primarily economic resources: free access to abortion contraceptive use was not encouraged 1966-1989: women viewed as primarily reproductive resources access to legal abortion restricted to: - women over 45 years of age, or women who had at least five children - modern methods of contraception banned - taxes on childless couples/unmarried people

WOMEN NARRATIVES (1) “As a woman I had to learn not only to cook, to sew, and to raise my children, but also how to induce an abortion” (unskilled worker, mother of three).  “I made a catheter using an electric cable from which I extracted the metal wires. I tried several times to insert it by myself and finally succeeded” (kindergarten teacher, mother of three).   “Nobody and nothing could stop me in my making the decision to get rid of my pregnancy. I assumed all risks involved; I did what I felt I should do for my family, to bring up my children” (factory worker, mother of two).

Maternal mortality, 1989-2000 Deaths per 100,000 live births

Number of abortions in Romania (1970-2000)

Abortion Rate in Romania, 1989-2000 (per 1,000 live births)

WOMEN NARRATIVES (2) “The right to abortion was gained at the expense of thousands of women’s lives, who died during the Ceausescu regime, as well as with the blood of those who died during the December 1989 revolution” (37-year-old, engineer, mother of one).   “I do not make a plea for abortions, but it is a human right that must be respected. Especially in Romania! The young generation does not know what it was like, to be afraid every time you made love” (46-year-old, physicist, mother of one).

Romanian Women who had Abortions, by Socio-Economic Status (1999)

WOMEN NARRATIVES (3) ”It is better to choose abortion over abandoning a child you cannot afford to bring up" (33-year-old, nurse, mother of two). “I never thought I did something wrong when aborting. I am confident that God understands what I was doing and I am not afraid of His curse” (49-year-old, factory worker, mother of three). “Abortion is a necessary evil” (33-year-old, homemaker, mother of two). “There is a big difference between wanting children and being able to provide them with a decent living” (37-year-old, chemist, mother of two).

Birth Rate by Years (per 1,000 population)

Total Fertility Rate (per woman)

Current Contraceptive Use by Romanian Women (1999) Condoms 9% Pills 7% IUD 7% Spermicides 3% Tubal ligation 3% Withdrawal 29% Rhythm 6%

WOMEN NARRATIVES (4) “These modern pills never interested me; they do good in one respect and they are harmful in 10 others” (29-year-old, married mother of two, factory worker).   “I don’t believe that modern contraception methods are as efficient as they are said to be. If it’s given that you should have a child, you cannot get rid of it, regardless of all these modern methods” (42-year-old, office clerk, mother of two).

Cervical Cancer Rates (per 100,000 women) Note: EU=European Union; CEE=Central and Eastern Europe (excluding Romania)

Incidence of syphilis in Romania (1985-2000) Number of cases per 100,000

Physical and Sexual Abuse (%) 1999

Policy Barriers Inadequate resources Inefficient procurement Ineffective targeting Limited access in rural areas Limited sexual education We have ascertained that there are 5 important policy barriers to the implementation of Romania’s contraceptive security policies. These barriers are: inadequate funding, inefficient procurement, ineffective targeting, unsustainable revolving funds, and limited access to government subsidized contraceptives in rural areas.

Improving reproductive health (1) Improve targeting of the public sector FP services and commodities Include low cost contraceptives in the health insurance Train and allow family doctors to provide FP commodities, particularly in rural areas Support the growth of NGOs for wider coverage We have ascertained that there are 5 important policy barriers to the implementation of Romania’s contraceptive security policies. These barriers are: inadequate funding, inefficient procurement, ineffective targeting, unsustainable revolving funds, and limited access to government subsidized contraceptives in rural areas.

Improving reproductive health (2) Promote male as well as female rights to RH services Design RH education programs for female and males In school In health centers In the community Strengthen male component of FP services

REFFERENCES Baban, A. and David, H.P. (1994) Voices of Romanian Women: Perceptions of Sexuality, Reproductive Behavior and Partner Relations During the Ceausescu Era. Bethesda, MD: Transnational Family Research Institute. David, H.P. (1999) From Abortion to Contraception; a Resource to Public Policies and Reproductive Behavior in Central and Eastern Europe from 1917 to the Present. Westport: Greenwood Press. Gal, S. and Kligman, G. (2000) Reproducing Gender; Politics, Publics and Everyday Life after Socialism. Princeton: Princeton University Press. Johnson, B.R., Horga, M. and Andronache, L. (1993) Contraception and abortion in Romania. Lancet, 341: 875-78. Lindmark, G., Horga, M., Campana, A. and Kasonde, J. (1999) Towards Better Reproductive Health in Eastern Europe. Budapest: CEU Press. Kligman, G. (1998) The Politics of Duplicity: Controlling Reproduction in Ceausescu’s Romania. Berkeley: University of California Press. Serbanescu, F., Morris, L. and Marin, M. (2001) Reproductive Health Survey: Romania, 1999. Atlanta: DHR/CDC. XXXX (2001) Policy Report: A Family Planning Market Segmentation Analysis. Bucharest XXXX (2001) National Center of Statistics Report. Bucharest. XXXX (1999) Highlights on Health in Romania. WHO Report.