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The remarkable story of Romanian women's struggle to manage their fertility
Open accessAbstract
In 1957, along with many countries in Eastern Europe, Romania liberalised its abortion law. The Soviet model of birth control made surgical abortion easily available, but put restrictions on access to modern contraceptives, leading to an exceptionally high abortion rate. By the mid-1960s there were 1 100 000 abortions performed each year in Romania, a lifetime average of 3.9 per woman, the highest number ever recorded.1 In October 1966, 1 year after coming to power, in an attempt to boost fertility, Romania's communist leader Nicolae Ceausescu made abortion broadly illegal, permitting the procedure legally only under a narrow range of circumstances: for women with four or more children, over the age of 45 years, in circumstances where the pregnancy was the result of rape or incest or threatened the life of the women, or in the case of congenital defect.1 Just months after abortion was restricted, the number of safe, registered abortions had fallen 20-fold, and 1 year after the law took effect, the total fertility rate (TFR) nearly doubled (from 1.9 just before the restrictive law to 3.6 in 1967–1968). As women gradually …
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In the paper
“Within the span of 1 year, the maternal mortality rate fell by half to 84 per 100 000 live births.”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
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In the paper
“1 year after the law took effect, the total fertility rate (TFR) nearly doubled (from 1.9 just before the restrictive law to 3.6 in 1967-1968).”
§ The remarkable story of Romanian women's struggle to manage their fertility > Abstract
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In the paper
“Just months after abortion was restricted, the number of safe, registered abortions had fallen 20-fold”
§ The remarkable story of Romanian women's struggle to manage their fertility > Abstract
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In the paper
“Initially, contraception use was slow to catch on.6”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [6] Romanian Ministry of Health, Institute for Mother and Child Care, Division of Reproductive Health, Centers for Diseases Control and Prevention. Romania: Reproductive Health Survey, 1993. Final Report. 1995.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“In the absence of contraceptive services, commodities and information, the number of safe, registered abortions again rose dramatically.3 4”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not checked — no full text of the sourcecites [3] Johnson, 1993, Contraception and abortion in Romania, Lancet source
- Not checked — no full text of the sourcecites [4] Serbanescu, 1995, The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania, Stud Fam Plann source
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In the paper
“However, although we cannot directly attribute causality, we have no data to suggest that there was a decline in the completeness of reporting abortion experiences in successive surveys.”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
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In the paper
“Family planning services were included in primary health care, and modern contraceptives were made available free of charge to vulnerable groups of the population, resulting in increased contraceptive use.7 8”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [7] Romanian Association of Public Health and Health Management, School of Public Health, University of Medicine and Pharmacy “Carol Davila”, National Commission for Statistics, Division of Reproductive Health, Centers for Diseases Control and Prevention, USAID, UNFPA, UNICEF. Romania: Reproductive Health Survey, 1999. Final Report. 2001.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [8] Romanian Ministry of Health, World Bank, UNFPA, USAID, UNICEF. Romania: Reproductive Health Survey, 2004. Summary Report. 2005.
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In the paper
“The marked rise in contraceptive prevalence coinciding with a dramatic decline in the abortion rate makes increased modern contraceptive use the most likely explanation for the steeply falling abortion rate in Romania.”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
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In the paper
“Between 1966 and 1989, while abortion was illegal in Romania, overall maternal mortality increased dramatically, from 85 per 100 000 live births in 1965 to a peak of 169 per 100 000 live births in 1989. 1”
§ The remarkable story of Romanian women's struggle to manage their fertility > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] Teitelbaum, 1972, Fertility effects of the abolition of legal abortion in Romania, Popul Stud source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“This rise in contraceptive use has been accompanied by a decisive fall in the induced abortion rate from 163.6 per 1000 women in 1990 to 10.1 in 2010 and in the abortion-related maternal mortality rate from 147 per 100 000 live births in 1989 to 5.2 in 2010.5”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [5] Romanian Ministry of Health, National Institute for Public Health, National Center for Statistics and Informatics in Public Health. Yearly bulletins on main health indicators and on maternal mortality. http://www.ccss.ro/public_html/?q=content/date-statistice-0 [accessed 2 September 2012].
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
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In the paper
“In 1990, 913 973 registered abortions were performed, and 314 746 births were recorded: a three to one ratio.5”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [5] Romanian Ministry of Health, National Institute for Public Health, National Center for Statistics and Informatics in Public Health. Yearly bulletins on main health indicators and on maternal mortality. http://www.ccss.ro/public_html/?q=content/date-statistice-0 [accessed 2 September 2012].
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“As women gradually found solutions for regulating their fertilityeither through contraceptives procured illegally or through illegal abortionsthe TFR began to fall again, reaching 2.9 in 1970, 2.2 in 1980-1984 and stabilised around 2.3 births per woman during the period 1985-1989.1 2”
§ The remarkable story of Romanian women's struggle to manage their fertility > Abstract
What the sources say
- Not checked — no full text of the sourcecites [1] Teitelbaum, 1972, Fertility effects of the abolition of legal abortion in Romania, Popul Stud source
- Not matchedcites [2] Romanian National Institute of Statistics. Statistical Yearbook 2010. 2012. http://www.insse.ro/cms/rw/pages/anuarstatistic2010.en.do [accessed 2 September 2012].
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“According to the latest survey, contraceptive prevalence in Romania is above 70%, modern contraceptive prevalence accounts for 61.1% and the most used methods are condoms (27.6%), pills (22.8%) and intrauterine devices (7.0%).9”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [9] UNFPA, Max Plank Institute for Demographic Research, National Institute of Statistics. Romania Gender and Generations Survey. First Wave Report. 2007.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plain- Asserted: passes — The authors put it forward as true.
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A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Figure 1 illustrates the peak and plateau in total fertility, along with the striking rise in maternal mortality that was solely driven by abortion-related deaths, as maternal deaths from other obstetric causes continued to fall.”
§ The remarkable story of Romanian women's struggle to manage their fertility > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim could be matched to a paper in Crossref, so there is nothing to check it against.
In the paper
“Family planning services were included in primary health care, and modern contraceptives were made available free of charge to vulnerable groups of the population, resulting in increased contraceptive use.7 8”
§ The remarkable story of Romanian women's struggle to manage their fertility > SHIFT IN FAMILY PLANNING POLICY
What the sources say
- Not matchedcites [7] Romanian Association of Public Health and Health Management, School of Public Health, University of Medicine and Pharmacy “Carol Davila”, National Commission for Statistics, Division of Reproductive Health, Centers for Diseases Control and Prevention, USAID, UNFPA, UNICEF. Romania: Reproductive Health Survey, 1999. Final Report. 2001.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [8] Romanian Ministry of Health, World Bank, UNFPA, USAID, UNICEF. Romania: Reproductive Health Survey, 2004. Summary Report. 2005.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
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It may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“And second, increased access to modern contraception in Romania over the last 15 years has not reduced fertility in the country, but instead has reduced the need for women to resort to abortion.”
§ The remarkable story of Romanian women's struggle to manage their fertility > LESSONS LEARNED
plaindirect- Asserted: passes — The authors put it forward as true.
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The paper relies on this without support.
Within days of the fall of Ceausescu's regime in December 1989, the antiabortion law was abolished and abortion made available on request in Romania.
“Within days of the fall of Ceausescu's regime in December 1989, the antiabortion law was abolished and abortion made available on request.”
The paper relies on this without support.
Traditional contraceptive methods were common in Romania, but modern methods became quickly and widely available through international donations and in pharmacies.
“Traditional contraceptive methods were common, but modern methods became quickly and widely available through international donations and in pharmacies.”
The paper relies on this without support.
A network of family planning clinics was developed in Romania in the mid-1990s and physicians were trained to provide family planning.
“A network of family planning clinics was developed in the mid-1990s and physicians were trained to provide family planning.”
The paper relies on this without support.
Few countries in history have made such dramatic shifts in family planning policy or availability that would allow the study of causal links between access to contraception and abortion and changes in reproductive outcomes.
“Few countries in history have made such dramatic shifts in family planning policy or availability that would allow the study of causal links between access to contraception and abortion and changes in reproductive outcomes.”
Citations
Cites
Induced abortion: incidence and trends worldwide from 1995 to 2008
Sedgh, G., Singh, S., Shah, I. H., Åhman, E., Henshaw, S. K., & Bankole, A. (2012) · The Lancet · doi:10.1016/s0140-6736(11)61786-8 · Cited by 607
Sedgh, G., Singh, S. D., Shah, I., Åhman, E. L., Henshaw, S. K., & Bankole, A. (2013) · Obstetric Anesthesia Digest · doi:10.1097/01.aoa.0000426072.79456.73 · Cited by 90
The impact of recent policy changes on fertility, abortion, and contraceptive use in Romania
Serbanescu, F., Morris, L., Stupp, P., & Stanescu, A. (1995) · Studies in Family Planning · doi:10.2307/2137933 · Cited by 58
Fertility effects of the abolition of legal abortion in Romania
Teitelbaum, M. S. (1972) · Population Studies · doi:10.1080/00324728.1972.10405910 · Cited by 38
Contraception and abortion in Romania
Johnson, B. R., Horga, M., & Andronache, L. (1993) · The Lancet · doi:10.1016/0140-6736(93)93074-b · Cited by 34
Self-citationFertility effects of the abolition of legal abortion in Romania
Teitelbaum, M. S. (1973) · Population Studies · doi:10.1080/00324728.1973.10405505 · Cited by 30
Romania Reproductive Health Survey, 1999
Serbanescu, F., Morris, L., & Marin, M. (2001) · Cited by 4
Sedgh, G., Singh, S. D., Shah, I., Åhman, E. L., Henshaw, S. K., & Bankole, A. (2012) · Obstetrical & Gynecological Survey · doi:10.1097/ogx.0b013e31825bbd34 · Cited by 4
Cited by
Sorted by citations
Beyond Abortion: The Consequences of Overturning Roe
Paltrow, L. M., Harris, L. H., & Marshall, M. F. (2022) · The American Journal of Bioethics · doi:10.1080/15265161.2022.2075965 · Cited by 78
“The return of birthrate to preabortion ban rates was historically accompanied by a rise in maternal mortality from complications of unsafe self-managed or clandestine abortion (Benson, Andersen, and Samandari 2011; Cates and Rochat 1976; Hord et al. 1991; Horga, Gerdts, and Potts 2013).”
BackgroundScientists' warning on population
Crist, E. L., Ripple, W. J., Ehrlich, P. R., Rees, W. E., & Wolf, C. (2022) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2022.157166 · Cited by 50
“Sexuality education initiatives may be most empowering when they are holistic and provide historical context about struggles bywomen tomanage their fertility (e.g., Horga et al., 2013).”
BackgroundSafe abortion: The public health rationale
Fathalla, M. F. (2019) · Best Practice & Research Clinical Obstetrics & Gynaecology · doi:10.1016/j.bpobgyn.2019.03.010 · Cited by 42
Sarvestani, K. A., & Sobotka, T. (2023) · Sexual and Reproductive Health Matters · doi:10.1080/26410397.2023.2257075 · Cited by 43
Lauria, L., Donati, S., Spinelli, A., et al. (2014) · PubMed · doi:10.4415/ann_14_01_09 · Cited by 29
Metadata
- Authors
- Horga, M., Gerdts, C., & Potts, M.
- Affiliations
- European Institute of Women's Health (IE)
- University of California, San Francisco (US)
- University of California System (US)
- Corresponding author
- Horga, Mihai
- ORCID
- Gerdts, Caitlin
- Venue
- Journal of Family Planning and Reproductive Health Care
- Publisher
- BMJ
- Published
- 2013-01
- Volume
- 39
- Issue
- 1
- Pages
- 2-4
- ISSN
- 1471-1893 (ISSN-L)
- 2045-2098
- OpenAlex
- W2013598404
- Cited by
- 32
- References
- 7
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 2 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 4 · 2015: 1 · 2014: 3 · 2013: 2
- FWCI
- 3.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Family Planning and Reproductive Health Care (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Social Sciences › Arts and Humanities › History › Historical Studies on Reproduction, Gender, Health, and Societal Changes
- Social Sciences › Political Science and International Relations › International Human Rights and Reproductive Law
- Keywords
- abortion law, illegal abortion, unsafe abortion, maternal mortality, fertility control, contraceptive access, Nicolae Ceaușescu, Romania, communist-era Romania, women's reproductive rights
- MeSH terms
- Abortion, Induced, Abortion, Legal, Contraception, Family Planning Services, Female, Humans, Romania, History, 20th Century, Policy
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