Countries Abortion Profile

Romania

1. Law related to Abortion

Brief history:

Abortion on request was first legalized in Romania in 1957. The abortion had to be performed during the first trimester of pregnancy in a hospital.  The Law was enacted by the Government for several reasons in order to protect women’s health and to support reproductive self-determination. 
 
In 1966, the Government dramatically altered its policy. Concerned about the low rate of population growth, it introduced a number of measures to increase the fertility rate. These measures made abortion legally available only in certain limited circumstances, restricted access to contraception, and increased allowances for large families.  Council of State Decree No. 770 of 29 September 1966 restricted abortion to the following situations: the continuance of the pregnancy posed a serious danger to the life of the pregnant woman that could not otherwise be prevented; one parent suffered from a serious hereditary disease or a disease likely to cause serious congenital malformations; the pregnant woman suffered from a serious physical, mental, or sensory disorder; the pregnancy resulted from rape or incest; the pregnant woman was over age 45 (subsequently lowered to age 40 in 1972 and raised to 42 in 1984); or the pregnant woman had given birth to at least four children that were under her care.
 
Except for abortions performed to save the life of the pregnant woman, a legal abortion had to be performed within the first trimester of pregnancy by a specialist in obstetrics and gynaecology in a specialized health-care unit, with the approval of a medical board. Women who obtained an illegal abortion, as well as the persons performing it, were subject to fines and imprisonment.
 
Sensing that its demographic policies had been ineffective, the Government of Romania commenced a new campaign in 1984 to increase the birth rate and restrict abortion. A directive issued by the Central Committee of the Romanian Communist Party in March 1984 included systematic control systems and severe measures. In practice this meant that women of reproductive age were required to undergo regular gynaecological examinations at their place of employment.  Pregnant women were monitored until delivery, doctors were required to report all women who became pregnant and gynaecological wards were under continuous surveillance.  A special tax was levied on unmarried persons over 25 years of age, as well as on childless couples that did not have a medical reason for being childless. Investigations were carried out to determine the cause of all miscarriages. 
 
In 1985, access to abortion was further restricted. The age required for a legal abortion was increased from 42 to 45 years or older.  Similarly, having four children was no longer considered sufficient grounds for obtaining an abortion on request.  Decree Number 411 of 26 December 1985 provided that to qualify for an abortion, a woman must have given birth to a minimum of five children that were currently under her care. 
 
On 26 December 1989, one of the first acts of the new transitional Government of Romania was to repeal restrictive abortion legislation.  Shortly thereafter, it also repealed restrictions on sterilization and the use of contraception.  Romania, however, did not enact new abortion legislation until 1996.  Under Law No. 140 of 5 November 1996, an abortion can be freely performed during the first 14 weeks of pregnancy so long as it is carried out with the pregnant woman’s consent in a medical institution or surgery approved for that purpose by a physician. An abortion may be performed later in pregnancy if absolutely necessary for therapeutic reasons, according to legal provisions.  Abortions performed after 14 weeks with the consent of the pregnant woman are punishable by six months’ to three years’ imprisonment.  If the woman does not consent, the punishment is two to seven years’ imprisonment and the suspension of other rights.  A physician who performs an illegal abortion is subject to suspension from practising his or her profession. (Population Policy Data Bank maintained by the Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat.)
 
Since 1989 elective abortion has been a primary method of fertility regulation in Romania.  This is due in part to a perceived lack of affordable, high-quality contraceptive services, the absence of post-abortion contraceptive services, the lack of incentives to doctors who are paid for performing abortions but not for providing contraception, and an abortion culture that developed out of years of draconian, pronatalist politics that banned contraceptives and heavily restricted access to, and availability of safe abortion services.  Following the demise of Nicolae Ceausescu in 1989, one of the first acts of the new government was to overturn the restrictive abortion law. 
During the early 1990s, Romania had the highest abortion rate in Europe, but abortion-related deaths had dropped dramatically from pre-1990 levels.  Over the past decade official figures show that contraceptive prevalence has increased and abortion rates have dropped considerably, although underreporting, especially in the private sector, remains a problem.  The MOH considers that the number of abortions remains unacceptably high, resulting in unnecessarily high costs, both to women and the health-care system.  Also, due to a number of social, educational, and economic reasons Romania continues to have a relatively high number of illegal (and unsafe) abortions as evidenced by the high number of hospital admissions for abortion complications. 
(Abortion and Contraception in Romania-A Strategic Assessment of Policy, Program and Research Issues-2004)
 
Current situation:     
 
According to the legal provisions in force elective pregnancy termination (requested by pregnant women) may be performed up to a 3 month gestation (12 weeks from conception date or 14 weeks from the first day of the last menstruation). According to the Criminal Code (article 185) pregnancy termination is illegal if performed in one of the following circumstances:

  • outside the medical institutions or the medical practices authorized for this purpose
  • by a person who doesn’t qualify as a specialist physician
  • if the pregnancy age has exceeded 14 weeks.

Pregnancy termination can be performed later by a specialist physician only if this is necessary for therapeutic reasons.
Although not specifically mentioned, the term specialist physician can be assimilated to physician
of obstetrics and gynaecology specialty and the gestational age of 14 weeks can be assimilated to 14 weeks of amenorrhea (or 12 weeks of gestation).
Pregnancy termination performed in any conditions without consent of the pregnant woman is punishable, in if the deed results in serious injuries or the woman’s decease it is considered to be even more serious.
Pregnancy termination performed by a specialist physician is not punishable if

  • it is necessary in order to save the life, health or physical integrity of the pregnant woman from a serious and imminent danger and which cannot be otherwise removed
  • if the pregnant woman was unable to express her will, and pregnancy termination is necessary for therapeutic reasons. 

(MOH Standards and practice recommendations for performing elective pregnancy termination-June 2003).

2. Policy

Elective abortion is legal in Romania if it is performed by a gynecologist, upon a woman’s request, up to 12 weeks from the date of conception (or up to 14 weeks from the last menstrual period). (Abortion and Contraception in Romania-A Strategic Assessment of Policy, Program and Research Issues-2004)
 
The conditions in which elective pregnancy termination is performed, the fees that are charged and the categories that are exempt from paying these fees were repeatedly regulated in time by Order of the Minister of Health Nr. 605 from December 12th 1989, Order of the Minister of Health Nr. 619 from May 10th .1991, Order of the Minister of Health Nr. 206 from February 17th 1997. (MOH Standards and practice recommendations for performing elective pregnancy termination-June 2003).

3. Second Trimester Abortion

4. Practice

No recent data available at the moment.

5. Reproductive Health Perspective

Signatory to ICPD, CEDAW: Yes

6. Abortion Statistics

Induced abortion rate among women aged 15-44 years
Total abortion rate per woman  = 0.8  (under-reported by approximately 25-30% and the true level should be approximately 1.2 - 2004 Reproductive Health Survey)                                                                                     
General abortion rate per 1,000 women = 0.844

7. Public sector

Abortion services available:
1st Trimester = Yes

8. Private sector

Abortion services available:
1st Trimester = Yes

9. Methods used

Dilatation and curettage is the main method used (over 50% of all cases) for elective abortion, in both public and private facilities.  There are some hospitals, even at the tertiary health-care level or in university clinics where vacuum aspiration is completely unavailable; in other sites vacuum aspiration equipment is available only to select specialists and their clients.  Even in facilities where vacuum aspiration equipment is available to all personnel it was not routinely used for all patients.  Depending on their experience and personal preferences, some gynaecologists, especially older ones, prefer to use dilatation and sharp curettage.  Electric aspiration equipment is old, improperly maintained, and faulty. 
The majority of gynecologists using vacuum aspiration are still using metal curettes to check and finalize the procedure. 
 
A small number of doctors have aspiration syringes, but use them sporadically, if at all, either due to lack of appropriate training or to a lack of interest.  Nevertheless, gynaecologists who use MVA think it is better, easier for patients to bare, and cheaper than traditional curettage.  Another advantage is that the use of manual vacuum aspiration is not restricted to the procedure room where the electric vacuum aspiration (EVA) machine is kept, which is often in high demand where EVA is used.
Medical abortion technology with mifepristone and misoprostol was first introduced in Romania in 1999 as part of a multi-centre study conducted by the World Health Organization. 
 
(Abortion and Contraception in Romania-A Strategic Assessment of Policy, Program and Research Issues-2004)
 
Mifepristone not registered
Misoprostol registered only for ulcer therapy and for RH-related pre-marketing study
Mifepristone and misoprostol regimen was available only within WHO trials conducted by the East European Institute for Reproductive Health (Presentation by Daniela Draghici at ICMA Meeting 2004)
 
The first private medical clinic where Mifegyne is used is in Bucharest as of 2008. Mifegyne may be delivered to any clinic in Romania. Mifegyne is found at MBCAL in Bucuresti @ www.mbcal.ro. Authorization for Mifegyne sale no.780/2008 - 01 - 02 price 48,86 euro per box of 3 tablets. Owner: Josef Kopp. (http://www.romedic.ro/MBCAL/medici/Josef_Kopp ).

10. Provider level allowed for surgical and medical abortion

Only Ob/Gyn.

11. Abortion related morbidity mortality statistics

No recent data.

12. Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment)

Originally MVA supplied by Ipas through distributor, but activity discontinued; no recent data available at the moment.

13. Manufacture/ import of Mifepristone, Misoprostol

14. Facility and provider certification norms in brief

15. Information available in national service delivery standards

Guide to Providing Abortion Care
Technical MVA Plus Booklet

16. Informal / illegal providers – if present who are they

17. Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population

18. Role of government

Supportive, enabling, creating barriers, provides adequate funding to run training and service delivery programmes
 
None of the above; just ZERO.

19. Role of religion/ religious leaders

Restrictive.

20. Local Ob Gyn societies

Supportive.

21. Current status and potential of research

22. Awareness amongst community members

23. Role of member organization/ individual

Represented Ipas in Romania since 2002, with focus on abortion assessment, operations research,  and MVA promotion; Ipas Europe program closed in 2008; currently on a 10-day consultancy for Ipas Medical Abortion unit.