Romanian maternal death rate fell by two-thirds after the 1989 revolution

Family Planning Perspectives, Nov 1995 by Remez, Lisa

Fertility in Romania has fallen below replacement level, to an average of just 1.6 lifetime births per woman. After restrictive policies outlawing abortion and contraception were repealed in December 1989, contraceptive prevalence increased by 20%, total induced abortion rates doubled and the maternal mortality rate fell by nearly two-thirds. The increase in contraceptive prevalence, however, was primarily caused by an increase in reliance on traditional methods, which account for three-quarters of all contraceptive use. These are some of the highlights of a 1993 survey of reproductive health conducted in Romania.(1)

The Romania Reproductive Health Survey, a national household probability survey of 4,861 women aged 15-44, was fielded between July and December 1993. The survey questionnaire covered a wide range of topics, including a complete history of the respondent's previous pregnancies, births and abortions; the women's knowledge and use of family planning; attitudes toward modern contraception; measures of maternal and child health; and knowledge about human immunodeficiency virus (HIV) transmission. A majority of the women surveyed were in a union (63% in a legal marriage and 4% in a consensual one), 5% were previously married and 28% had never been married. The sample was predominantly Eastern Orthodox (88%), and. a similarly high proportion was ethnic Romanian (90%). Results indicated that first sexual intercourse often coincided with marriage; as the median age at first union was 20.4 years and the median age at first intercourse was 20.2 years. However, 22% of 15-24-year-olds reported premarital sexual experience.

From 1966 through 1989, Romanians lived under one of the most strictly enforced pronatalist regimes in Eastern Europe, with contraception, abortion and sex education virtually outlawed. These restrictive laws were repealed in December 1989 in the wake of the revolution against Communism. To examine the effects of these changes, the researchers reported survey findings on fertility and abortion for two consecutive 36-month periods preceding and following the revolution--June 1987-May 1990 and June 1990-May 1993.

Fertility and Abortion

According to the 1993 survey, the total fertility rate (TFR) in Romania dropped abruptly by one-third following the 1989 revolution, from 2.3 lifetime births per woman in 1987-1990 to 1.6 per woman in 199-1993 (Table 1).(Table 1 omitted) The decline was sharpest (48%) for women aged 35-39, followed by a drop of 38% among women aged 30-34. Women aged 20-29, who accounted for the highest proportion of births (70%), had a 29-35% decline in fertility.

Over the period June 1990-May 1993, TFRs in Romania were extremely low among the most educated women (1.07 lifetime births per woman), among those of high or middle socioeconomic status (1.11 and 1.17 births per woman, respectively) and among urban women (1.21 per woman). Even the highest TFRs among Romanian women were only 2.26 lifetime births for those with a primary education (down from 3.47 in 1987-1990) and 2.15 births per woman among those of low socioeconomic status (down from 2.89 in 1987-1990).

One reason for these low fertility rates was the exceptionally high abortion rates that followed the legalization of abortion in 1989. The total induced abortion rate doubled over the study period, going from 1.7 lifetime abortions per woman in 1987-1990 to 3.4 per woman in 1990-1993. This rate was lowest among never-married women (1.0 abortions per woman), since abortions in Romania are obtained primarily by married women.

The overall doubling of the total abortion rate was accompanied by a one-third increase in the pregnancy rate over the period. One reason for this increase was that abortions return women to the risk of pregnancy sooner than when a pregnancy is carried to term, as the duration of pregnancy and postpartum infecundability are both shortened and the amount of time women are at risk of pregnancy increases.

The largest increase in abortion since legalization occurred among 15-19-year-olds, whose abortion rate tripled, from 10 abortions per 1,000 15-19-year-olds in 1987-1990 to 32 per 1,000 in 1990-1993. Abortion rates among women aged 20-34 (who are responsible for most childbearing) more than doubled in the period following legalization. For example, the abortion rate among 25-29-year-olds increased from 82 abortions per 2000 to 209 per 1,000.

Over the period 1990-1993, total abortion rates were especially high among women who had completed only primary school (4.7 lifetime abortions per woman), among those living in the capital, Bucharest (4.1 per woman), and among those of low socioeconomic status (3.7 per woman). The abortion ratio recorded in the survey was also extremely high: In 1992, 71% of known pregnancies in Romania were terminated by induced abortion. The reasons women gave for having an abortion indicate that the majority (67%) were performed to limit or space births, 20% were obtained for economic or social reasons, 4% were related to the woman's relationship with her partner, 4% were for health reasons and 5% were for other reasons.