After the downfall of the Ceausescu regime in December, 1989, the new Government of Romania abolished the law that prohibited abortions on request. Subsequently, the rate of legally induced abortions increased significantly while the rate of maternal mortality declined dramatically. Despite the large number of women who request induced abortions, most women and gynaecologists say that they would prefer to prevent unwanted pregnancies through the use of modern contraception. In this paper we examine factors that contribute to the disparity between women's desire to use modern contraception to prevent unwanted pregnancies and their practice of having induced abortions to prevent unwanted births. The results show that women (and suggest that men) need a wide choice of dependably available high-quality contraceptives; they need to be able to obtain information, counselling, and methods from a wide range of sources/health-care providers; both women's and men's perceptions about, and use of, modern contraception could be positively affected through sexual education started in secondary school; and, to reduce repeat abortions, women's post-abortion family-planning needs must not be neglected.
PIP: The factors that contribute to the disparity between women's desire to use modern contraception and the practice of induced abortions to prevent unwanted births are examined. Structured interviews of 1000 women were conducted in 5 hospitals located in 3 culturally different regions of Romania--Bucharest, Moldova (2 sites), and Transylvania (2 sites). All data were collected between November 1991 and April 1992. At each site structured interviews were conducted over 4-6 weeks with a random sample of 200 women who were either waiting for or recovering from an induced abortion, and 80 semi-structured client interviews were conducted among the 5 sites. There were 35 semi-structured provider interviews in the 5 sites, and one group interview was conducted with clients and one with providers of abortion services in each location. In 1991 there were 789,096 reported legal abortions compared with about 275,000 live births. 47% of the women said that they had had a previous legally induced abortion and 25% reported a previous illegal abortion. 31% of the women said that they would have an illegal abortion if they were unable to have one legally. The choice of contraceptive methods was often limited to 1 type available (condoms or Depo Provera). Women and gynecologists reported that modern contraceptive methods are rarely available from pharmacies. Some contraceptive services were available in most hospitals, but women had to take the initiative. 69% of gynecologists responded that women who want information about contraception wait for the gynecologist to offer it. 72% of the women thought that other women gave gifts to the gynecologist who performed their abortion; 39% did not think a gift would ensure better treatment and enthusiasm to counsel women about contraception. Many women and most gynecologists believed that sexual and contraceptive educations should begin early in the schools involving both sexes. 52% of clients and 75% of providers said that sexual and contraceptive education should begin in secondary schools.