Reproductive Health in Romania: Reversing the Ceausescu Legacy

Abstract

As a result of the restrictive reproductive health policies enforced under the 25-year Ceausescu dictatorship, Romania ended the 1980s with the highest recorded maternal mortality of any country in Europe--159 deaths per 100,000 live births in 1989. An estimated 87 percent of these maternal deaths were caused by illegal and unsafe abortion. Under the Ceausescu regime, all contraceptive methods were forbidden and induced abortion was available only for women who met extremely narrow criteria. Immediately after the December 1989 revolution that overthrew Ceausescu, the new government removed restrictions on contraceptive use and legalized abortion. This legislative change has had beneficial effects on women's health, seen in the drop in maternal mortality in 1990 to 83 deaths per 100,000 live births--almost half the ratio in 1989. In addition, changes instituted since the revolution have led to the improved availability of reproductive health services and to the creation of new educational and training opportunities related to reproductive health services and to the creation of new educational and training opportunities related to reproductive health. The newly created contraceptive and abortion services have presented health system managers and policymakers with many challenges as they work to expand the availability of high-quality, comprehensive reproductive health care in a setting of economic hardship, political unrest, insufficient infrastructure, and outdated medical knowledge and practice.

Conceptualising abortion stigma

“…Legal restrictions on abortion jeopardise women's health and lives, but their relationship to societal climates of secrecy, denial and discrimination deserves scrutiny. In countries like Romania and South Africa, liberalisation had a direct and positive impact on maternal mortality (Hord et al 1991, Jewkes et al 2005. However, whether the levels of felt and enacted abortion stigma have also declined is an open question.…”

Is There a Universal Understanding of Vulnerability? Experiences with Russian and Romanian Trainees in Research Ethics

“…Following World War II, the government and communist party extended the traditional patriarchal attitudes that had prevailed in more rural areas (Gilberg, 1979). These newly fashioned measures included: the prosecution and conviction of unmarried women as prostitutes for any participation in sex outside of marriage (Harsanyi, 1993); the inculcation of the belief that sex without procreation as its objective was both immoral and a cause of insanity (David & Baban, 1996); a progressive increase of restrictions in the availability of birth control and abortion (Ceauşescu, 1966, 1985), cessation of the importation of contraceptives (David & Wright, 1971), and the eventual banning of birth control altogether (Hord et al, 1991); imposition of disincentives on childless couples and unmarried adults; lengthening of the divorce process; imposition of monthly birth quotas on physicians and other employees; conduct of investigations by the Securitate of alleged abortions; posting of agents in all maternity wards and obstetrical-gynecological clinics; and imposition of prison terms on physicians who violated the abortion restrictions (David, 1990a,b). Ceauşescu declared “the fetus [to be] the socialist property of the whole society.…”

Population, health and risk factors in a transitional economy

“…The limited access to ambulatory emergency intervention (McKee & Shkolnikov, 2001) in CEEC enhances the risk of disease from accidents and fatal injuries. The problems of out-of-date equipment and inadequate infrastructure (Hord, David, Donnay, & Wolf, 1991) are compounded by the legacy of mistrust in the health care system (see the lack of use of services during the repressive reproductive health policies of Ceausescu described in Kligman, 1998).…”

“…This draconian policy led to an increase in illegal and unsafe abortions, with many women falling victims. Maternal deaths were largely accounted for by such abortions (Hord et al, 1991). The severe anti-abortion regime during Ceausescu led not only to a large number of orphans but contributed to increased mortality and morbidity.…”