This document discusses barriers to reproductive health in post-communist Romania. It provides background information on Romania's demographics, economy, and healthcare system. Under socialism from 1957-1989, the government viewed women as economic or reproductive resources and restricted access to contraception and abortion. This led to high rates of unsafe, illegal abortion and maternal mortality. Since 1989, abortion rates have declined but modern contraceptive use remains low. Barriers to improving reproductive health include inadequate resources, inefficient procurement, limited access in rural areas, and limited sexual education. The document recommends improving access to family planning services, education, and targeting resources to increase reproductive autonomy and health.

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.