Reducing Maternal Mortality in Romania by Increasing Equitable Access and Use of Family Planning: An Update After Donors’ Withdrawal

Presentation at the Global Maternal Newborn Health Conference, October 19, 2015

Background: Before 1990, modern contraception methods and abortion were illegal in Romania while over 80% of maternal deaths were reportedly caused by illegal abortion. In 1990, both modern contraception and abortion were legalized, but access to contraceptives was limited especially in rural areas keeping maternal mortality ratio 170/100.000. In rural areas, Romania’s Ministry of Health (MOH) used a unique multi-tiered, stepwise strategy to integrate FP services into primary health care services with USAID and other donors support during 1999-2007.

Methodology: The 2008-2012 trends of key project indicators (public expenditures on FP commodities, contraceptive use, abortion & maternal mortality rates) plus fertility rate were investigated through publicly available data/reports. Data on contraceptive use are from DHS surveys 1999 & 2004 and later sub-national survey 2010.

Results:  By the end of 2007, the national FP program ensured a “safety net” by addressing women’s FP needs at all main entry points to the health system, and counseling on FP a was a routine in all client-provider interactions; not only at the PHC level, but also at the secondary and tertiary levels. Seven years after donors’ withdrawal, changes remain. Statistics demonstrate a sustainable decline of maternal mortality ratio from 52 per 100,000 death/live births in 2000 to 21.1 during 2008-2012, decline of abortion ratio from 1.11 abortions/live birth (1999), 0.88 abortions/live birth (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 modern contraception use continues to increase among rural women.

Conclusions: Increase equitable access to FP had a high impact on reducing maternal mortality in Romania and the results of the programs persist after donors’ withdrawal. Maternal Health remains a priority under the National Health Strategy 2014-2020.