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Barriers to Reproductive Health in Post-Communist Romania
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Barriers to Reproductive Health in Post-Communist Romania

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Dr. Adriana Baban …

Dr. Adriana Baban
Visiting Professor, Romania
May 28, 2003

Published in: Health & Medicine

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  • 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.
  • 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.
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    • 1. Barriers to Reproductive Health in Post-Communist Romania Dr. Adriana Baban Professor, Babes-Bolyai University Cluj-Napoca, Romania  
    • 2. 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
    • 3. 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%
    • 4. 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
    • 5. 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
    • 6. Comparison of Child and Infant Mortality Rates (1997)
    • 7. 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
    • 8. 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).
    • 9. 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 Deathsper100,000l
    • 10. Number of abortions in Romania (1970-2000) 0 200000 400000 600000 800000 1000000 1200000 1970 1975 1980 1985 1990 1995 2000 Abortions Numberofabortions
    • 11. Abortion Rate in Romania, 1989-2000 (per 1,000 live births) 0 500 1000 1500 2000 2500 3000 3500 1989 1990 1995 2000
    • 12. 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).
    • 13. Romanian Women who had Abortions, by Socio-Economic Status (1999) 0 10 20 30 40 50 60 70 80 Rural poor Urban poor Lower middle class Middle class Wealthy rural Upper middle urban Urban rich Percentage Women had two or more abortions Women who had one abortion
    • 14. 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).
    • 15. Birth Rate by Years (per 1,000 population) 0 2 4 6 8 10 12 14 16 1989 1990 1995 2000
    • 16. Total Fertility Rate (per woman) 0 0.5 1 1.5 2 2.5 1989 1990 1995 2000
    • 17. Current Contraceptive Use by Romanian Women (1999) Non-users 36% Traditional 35% Modern 29% Condoms 9% Pills 7% IUD 7% Spermicides 3% Tubal ligation 3% Withdrawal 29% Rhythm 6%
    • 18. 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).
    • 19. Cervical Cancer Rates (per 100,000 women) 0 2 4 6 8 10 12 14 16 1992 1993 1994 1995 1996 Romania EU average CEE average Note: EU=European Union; CEE=Central and Eastern Europe (excluding Romania)
    • 20. 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 Numberofcasesper
    • 21. Physical and Sexual Abuse (%) 1999 0 5 10 15 20 25 30 35 40 45 lifetime abuse abuse within the last year verbal physical sexual
    • 22. Policy Barriers  Inadequate resources  Inefficient procurement  Ineffective targeting  Limited access in rural areas  Limited sexual education
    • 23. 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
    • 24. 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
    • 25. 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.