ROMANIA

General characteristics: the country population is characterised by the predominant feminine population reported to the total, especially in the 45-50 years and 80- 85 years age groups.

The population of fertile women, having an increasing trend during 1990 – 1998 has not determined an increase of the birth rate. On the contrary, the birth rate has continuously diminished (reaching the minimum quota in 1996 – 10.2 living new-borns to 1000 inhabitants). The feminine mortality rate is twice lower than the masculine mortality rate for ages between 15 - 64 due to the increase of stress, injuries, alcoholism, tobacco addiction and suicide among men. The feminine mortality rate was higher for the circulatory system diseases, as well as for endocrine, nutrition and metabolism diseases.

Reproductive health status (Sources: Romania Reproductive Health Survey, 1999 and Maternal Mortality Analysis in Romania in 1989-99)

Mean age at first intercourse: 19.5 years

Total fertility rate: 1.3

Total induced abortion rate: 2.2 (decreased from nearly 1.000.000 abortions in 1990 to approximately 300.000 in 1999). Abortions are performed on request until 12 weeks of gestation and on medical reasons only after 12 weeks. Abortions are performed only in outpatient hospital facilities and private practices (low risks for infectious and haemorrhagic complications, but quality of care still needs improvement in public settings in terms of personnel). Main technique used is vacuum aspiration plus curettage.

Contraception use: modern methods 29.5%, traditional methods 34.3% (mostly withdrawal). Reasons for non-use of modern methods: lack of knowledge on modern contraception methods and socio-economic (mainly lack of money), poor access to FP in rural areas.

Sexual transmitted diseases have increased in the last decade (syphilis incidence increased 5 times in the ‘90s comparing to ‘80s; 3300 HIV positive individuals out of which 95% are children under age of 13 infected via medical care, but infection acquired via sexual path is increasing in the recent years).

Maternal mortality rate: 40 maternal deaths/100.000 live births (22.3 deaths /100.000 live births through obstetrical risks and 18.2/100.000 live births through abortions). Comparing to 1989, the maternal mortality rate dropped 4 times, exclusively due to the decrease of the maternal mortality through abortion, after abortion liberalisation in early 1990.

Maternal care: services are in place through a network of dispensaries, polyclinics, hospitals and private practices. There are Ministry of Health’s guidelines for prenatal and maternal care and the access is free of charge and available at the primary and secondary care level. According to the Ministry of Health guidelines, healthy pregnant women should receive 10 pre-natal ambulatory consultations, of which 3 are obstetrical exams. Women with risk factors or complications may receive more consultations, lab tests etc. All women must receive at least one home visit during pregnancy (by a nurse). However, gypsies, teenagers and women with low education and poor socio-economic status do not present themselves to the ambulatory consultations and are very difficult to influence to comply with the pre-natal consultation calendar. Therefore, they make the groups most likely to have poor pregnancy outcomes.

At the general level the Romanian legislation guarantees equality between men and women (legal framework of the Constitution, the Labour Law, and the Family Law). There are some particular problems:

1. Problems regarding the minimum age for marriage in terms of gender differences. Girls could marry at 16 years old. This has a negative impact on women’s education and economic independence, and reflects the paternalistic stereotype of the family.
2. Law regarding marriage also includes several obligations, including those of loyalty and fulfilment of marital duties. So, it treats spouses, including women, as sexual partners, objects acquired in contractual terms. It brings in discussion the problem of marital rape and the fact that women can not exercise the right to decide freely and responsibly on the number of children.
3. Maternal leave provides payment for 2 years (85% of wage/month). The situation of women is dramatic within the private sector, where employers avoid to hire women because they would have to pay them for a maternal leave. So, women are sometimes employed without a labour contract, which means that they loose all the rights provided by law: health insurance, pensions etc.

Another problematic issue is related to the article of Criminal Code regarding rape. So, the rape is not sanctioned if the victim due to family (or involved families) pressure marries the victim; it is reached to the so-called “reparatory marriage” and this way the aggressor avoids the justice.

Women have legally equal opportunities to education and culture as men have. Traditionally, men are the ‘leaders’ of the families, and women are expected to fulfil all household-related duties. There is no fundamentalist discrimination and no religious intolerance of women within the society.

Women’s access to health services and information is equal with men’s access and is fairly good, but is restricted by a number of reasons, especially financial reasons. Proper care is also affected by transportation problems, the distance to services, clinic hours, and women’s multiple roles and responsibilities within the family. The access to and the quality of health services available to urban and rural areas is different. Women in rural areas have increasingly less access to high-quality medical services, mainly because of resources’ distribution, such as the “migration” of doctors from rural medical dispensaries, insufficient funds and poor emergency services.

Overall, women trust in medical system and in medical professionals, both physicians and nurses. Still, there is a need of quality of care improvement in Romania. On one hand resources should be improved but on the other hand the human aspects of care could also be enhanced. A recent assessment of the impact and acceptability of a new technology (a medical abortion protocol) performed in one hospital abortion clinic showed that women highly appreciated the caring attitude of the study team instead of the new technology itself.

In a national survey of health services for safe motherhood, 20% of women who received pre-natal care had never had a test for anaemia, 12% were missing an ABO blood type test and 32% were missing an Rh- type test. There were incomplete histories and physical exams. A large number of women could not recall having been advised about lifestyle factors (e.g. smoking, drinking, drug use), baby care, breastfeed, preparation for delivery, or the possible signs of complications during pregnancy that would need immediate help.

Source: Romania Reproductive Health Survey, 1999

Sexual activity: 13% of girls aged 15-17 years and less than 1 in 2 girls aged 18-19 years are sexually active

Premarital sex incidence: 21.5%.

Number of teenage births: 36 births per 1000 women aged 15-19

Induced abortions: 26 abortions per 1000 women aged 15-19

Contraception use at first intercourse: 50.6%; most adolescents use the condom or withdrawal.