The history of fertility regulation in Romania illustrates the complex interactions between politics, women's reproductive health and rights and access to high quality care. This paper describes the current situation of abortion and contraception in Romania, based on national statistics, recent reproductive health surveys and the findings of a strategic assessment led by the Ministry of Health in late 2001. This rapid assessment employed a participatory, qualitative methodology. Over 500 people were interviewed from 145 institutions in 25 cities, towns and villages in Romania, about the range of actions needed to prevent unwanted pregnancies, reduce abortion-related morbidity and mortality and improve the quality, accessibility and availability of abortion and contraceptive services. Although much progress has been made in contraceptive services over the past ten years, improvements in abortion care have lagged considerably The assessment played an important role in raising team members' awareness and motivation to take action. Some of the issues identified are already being addressed by the institutions that took part. National standards and guidelines for comprehensive abortion care have been developed, contraceptive services have been expanded at primary health care level, sexual and reproductive health education provided by classroom teachers has been introduced in schools, and a study to test a model of comprehensive abortion care services for Romania is planned.