Family Planning in Romania: An Update after Five Years of Donors' Withdrawal

Background: Before 1990, modern contraception methods and abortion were illegal in Romania while over 80% of maternal deaths were caused by illegal abortion. In 1990, both contraceptives and abortion were legalized, but access to contraceptives was limited. Abortion remained the most widespread birth control method. During 1999-2007, Romania’s Ministry of Health (MOH) used a unique multi-tiered strategy to integrate FP services into primary health care with USAID and other donors support.

Methods: Trends in maternal mortality, contraceptive use, induced abortion, fertility rate and budget allocations for the national program were analyzed to examine whether changes achieved during the program persisted beyond donors’ withdrawal in 2007.  Data on contraceptive use are from DHS surveys 1999 & 2004 and later sub-national survey. Abortion data sources from routine national statistics. Budget allocation information was collected from MOH.

Results: By the end of 2007, the national FP program ensured a “safety net” addressing women’s FP needs at all main entry points to the system. Six years after donors’ withdrawal, changes remain. Statistics demonstrate a decline of abortion ratio from 2.33-abortions/live birth (1993) to 1.11 in 1999, 0.88 in 2004, and eventually to 0.55 abortions/live birth in 2011, while fertility rate remained constant since 1999 (1.3 children/woman). Recent evidence suggests increasing use of modern contraception.

The MOH allocations for contraceptives procurement steadily increased from US$100,000 in 2001 to over US$1.7 million in 2006, and US$2.56M in 2013. By 2014, eligible population has free access to MOH-procured contraceptives and FP services, regardless their health insurance status.