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

66.7 66.6 66.8

73.9

72.7

70.4

1970 1990 2000 men women

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 81

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 abortioncontraceptive use was not encouraged

1966-1989: women viewed as primarily reproductive resourcesaccess 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

0

20

40

60

80

100

120

140

160

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000

due to abortion due to obstetrical risk

Death

s p

er

100,0

00 liv

e

bir

ths

Number of abortions in Romania (1970-2000)

0

200000

400000

600000

800000

1000000

1200000

1970 1975 1980 1985 1990 1995 2000

Abortions

Nu

mb

er

of

ab

ort

ion

s

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

0

500

1000

1500

2000

2500

3000

3500

1989 1990 1995 2000

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)

01020304050607080

Ruralpoor

Urbanpoor

Lowermiddleclass

Middleclass

Wealthyrural

Uppermiddleurban

Urbanrich

Per

cen

tage

Women had two or more abortionsWomen who had one abortion

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)

0

2

4

6

8

10

12

14

16

1989 1990 1995 2000

Total Fertility Rate (per woman)

0

0.5

1

1.5

2

2.5

1989 1990 1995 2000

Current Contraceptive Use by Romanian Women (1999)

Non-users36%

Traditional35%

Modern29%

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)

0

2

4

6

8

10

12

14

16

1992 1993 1994 1995 1996

RomaniaEU averageCEE average

Note: EU=European Union; CEE=Central and Eastern Europe (excluding Romania)

Incidence of syphilis in Romania (1985-2000)

0

5

10

15

20

25

30

35

40

1985 1987 1989 1991 1993 1995 1997 2000

Syphilis

Nu

mb

er

of

cases

per

100,0

00

Physical and Sexual Abuse (%) 1999

05

1015202530354045

lifetime abuse abuse within thelast year

verbalphysicalsexual

Policy Barriers Inadequate resources

Inefficient procurement

Ineffective targeting

Limited access in rural areas

Limited sexual education

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

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

REFFERENCESBaban, A. and David, H.P. (1994) Voices ofRomanian 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 toContraception; 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.