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  • Title: The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania.
    Author: Serbanescu F, Morris L, Stupp P, Stanescu A.
    Journal: Stud Fam Plann; 1995; 26(2):76-87. PubMed ID: 7618197.
    Abstract:
    A national household survey of 4,861 women aged 15-44 on reproductive health issues was conducted in Romania in 1993. The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. After abortion became legal, the total fertility rate dropped to below replacement level, while the induced abortion rate doubled. Contraceptive prevalence increased 20 percent, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70 percent of the increase. Limited sex education and contraceptive information, mistrust and misinformation about modern methods, a lack of adequately trained providers, and a shortage or uneven distribution of contraceptive supplies are major reasons for the continued high rates of unintended pregnancy. After the restrictive abortion law was abolished in 1989 during the Romanian revolution, the legal abortion rate reached almost 200/1000 women 15-44 years old, the highest in the world. A national household survey of 4861 women 15-44 years old on reproductive health issues was conducted in Romania in 1993 (RRHS). The survey provided the opportunity to study the impact of policy changes by comparing selected aspects of fertility, abortion, and contraceptive use before and after the December 1989 revolution, when the laws restricting abortion and contraceptive use were abolished. Two 36-month periods, from June 1987 to May 1990 and from June 1990 to May 1993, were analyzed to calculate age-specific fertility, induced abortion, and pregnancy rates. 12387 households were selected where 4861 women were successfully interviewed on pregnancy history and births, planning pregnancies, family planning, maternal and child health, and knowledge about reproductive health. After abortion became legal, the total fertility rate (TFR) dropped to below replacement level, while the induced abortion rate doubled. The TFR dropped from 2.3 live births per woman for 1987-90 to 1.5 for 1990-93. The total induced abortion rate doubled from 1.7 to 3.4 abortions per woman for the same periods. In the second period the pregnancy rate was also 30% higher. Almost 70% of the TFR could be attributed to women 20-29 years old in both periods. Both mistimed and unwanted pregnancies increased by 1/3 after the repeal of the restrictive abortion law. More than 95% of women who had undergone induced abortion reported their pregnancy to be unintended. Contraceptive prevalence increased 20%, but augmentation of the use of traditional methods, rather than the change in legislation, accounted for 70% of the increase. IUD use increased from 0.6% to 1.7% and condoms from 1.8% to 2.7%, while the use of oral contraceptives remained unchanged at 2.3%. 41% of all women reported contraceptive usage, while the rate for those in union was 57%. Limited sex education, mistrust about modern methods, a lack of adequately trained providers, and a shortage of contraceptives are major reasons for the continued high rates of unintended pregnancy.
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