Targeting health inequalities and improving reproductive health care for Romanian women

D. Iancu, N. Murgea, K. Farnsworth

JSI Research & Training Institute, Inc., Bucharest, Romania

Romania has made strides tackling reproductive health issues during recent years. These efforts include confronting low levels of contraceptive use and high rates of abortion and maternal mortality, increasing access to services for early detection of breast and cervical cancer.

The Romanian Family Health Initiative (RFHI), a 5-year program funded by the United States Agency for International Development (USAID) and managed by JSI Research & Training Institute, Inc. (JSI), works to expand access to reproductive and women's health services to all Romanians, with an emphasis on underserved populations.

The Government of Romania has begun to implement health sector reforms, including the bolstering of a decentralized primary health care system and encouraging civil society organizations to play an active role in expanding reproductive health services nationwide. In this context, RFHI is working to improve health services provision and availability through a strategy of training, capacity building, health promotion, and improving the legislative environment. RFHI supports the Ministry of Health and a number of NGOs in improving the effectiveness of family planning, pre/post-natal care, early detection of breast and cervical cancer, and Sexually Transmitted Infections services. 

In the first two years, the project was implemented in 18 districts (out of the 42) with very good results: the number of service providers increased from 260 urban Family Planning Clinics to 1,080 Primary Health Care Centres, mainly in rural areas; the Modern Contraceptive Prevalence Rate, measured by the Couples Years of Protection raised from 19,000 in 2001 to 61,000 at the end of 2002. In the third year, the project was extended throughout the country. As a consequence, the contraceptive use dramatically increased during last years.

According to the Romanian Reproductive Health Survey performed in 2004, the Modern Contraceptive Prevalence Rate increased, from 29.5% in 1999 to 38.2% in 2004; the increase was even more significant in rural areas: 33% in 2004, as compared to 20.9% in 1999. Correspondingly, abortion rate decreased from 2.2 in 1999 to 0.84 in 2004. As a result of project successes, complementary interventions were initiated, addressing urban poor, Roma population, and Post-Partum and Post-Abortion clients. More data will be gathered in the coming months.