ROMANIA – Declining access to abortion services in Romanian hospitals: Independent Midwives Association Report – Part II

In the 5 April 2024 ICWRSA Newsletter, Daniela Draghici provided the background to the information in this report, based on research by the Independent Midwives Association. Below is a summary of just some of the details from their 70+ page report.

The Independent Midwives Association (IMA) is a point of contact between women and the medical system. Our medical expertise, together with the organization’s mission to fight for the rights of women, especially vulnerable women, places us in the front line of intervention to ensure the respect of the sexual and reproductive rights of girls and women in Romania.

Starting in the fall of 2023, the IMA opened a Youth Helpline to provide girls, women and young people with science-based information about their bodies, health and safety: information for sex education, reproductive health counseling, education on consent and abuse prevention, facilitating access to safe healthcare, including telemedicine, case management and scheduling, access to contraception and abortion. The helpline +40 722 265 269 is operated by staff with a medical background and training in beneficiary/patient-centered care according to World Health Organization standards, and with a gender-sensitive approach to the information they provide on gender equality and combating gender-based violence.

Their focus is on girls and boys aged 12-24 and vulnerable women over age 25, survivors of gender-based violence and intimate partner violence, women with disabilities, women with no income and other vulnerable groups.

The Youth Helpline is the only resource in Romania that provides information and solutions for navigating the reproductive health system and support for accessing health services and contraceptive and STI protection methods. As we aim to act as advocates for the rights and needs of young people, it is a priority to refer young people to medical units and doctors who will treat them with dignity and professionalism, while respecting safe medical standards.

Their research on access to abortion services has a dual role:

– To build a database for the IMA team that facilitates case management and referral of women to safe and verified medical services.

– To contribute to raising awareness of the increasing year-on-year restriction of access to abortion in Romania.

Women’s rights organizations are constantly raising alarm bells on this issue, and Centrul Filia started monitoring accessibility in 2019 and continued in 2020-2021. This report does not aim to analyze the causes of worsening access to abortion — these issues are the subject of much- needed, separate, extensive research — but to present the state of play: where and how we can have a safe abortion in Romania in 2024.

Research questions asked of 1,000 hospital-based clinics across Romania

– Is the abortion on request service available?

– If not, what is the reason for the refusal?

– What type of abortion is available?

– What is the number of weeks up to which it is offered?

– What type of anaesthesia is used for surgical abortion?

– What are the working hours of the doctors providing this service?

– What is the method by which a patient can be scheduled?

– What is the age of the patients accepted for termination of pregnancy?

– Is there willingness to collaborate with the IMA to pay for abortion services for our beneficiaries and provide the necessary medication?

Key findings

– More than 80% of the medical units in Romania do not offer abortion services or cannot be contacted.

– Only 7 public medical units (4%) provide medical or surgical abortion according to recommendations of medical guidelines, pharmaceutical prospectuses, and national legislation.

– 111 out of 176 public medical units (63.6% nationwide) do not provide abortion services.

– No public medical unit provides both types of abortion.

– 26 medical units (14.77%) provide pregnancy termination services up to fewer weeks than the recommendations in medical guidelines, prospectuses, and national legislation.

– 32 medical units (18.18%) did not answer the phone.

Much of the remainder of the report, a total of 70 pages, provides the same types of details for each of the local counties across the country.

Barriers and conclusions

All patients, and especially those who need to travel to another county for this service, need clear information about the number of weeks of pregnancy up to which medical units provide abortions and about prices, but over 70 of Romania’s hospitals and clinics do not provide this information over the phone. Some clinics and hospitals are unaware that the legal upper time limit in Romania is 14 weeks and misinform patients about this.

Of the clinics and hospitals that agree to provide abortions, only 17 accept people aged between 16 and 18 without a legal guardian. 73 of the units do not accept and are not informed or do not comply with the age of consent legislation for reproductive health.

Some medical units told us that they do not want to work with vulnerable people because they are more at risk…. “You can refer patients, but we reserve the right to choose or refuse certain clients.”

There are many risks related to consultations in a doctor’s office or hospital where the data are not available: targeted counselling offered by some of the medical professionals who abusively urge women to keep the pregnancy, forcing the woman to listen to the embryonic or fetal heart, extremely high costs of the consultation not previously disclosed, giving false information about the legal limit of pregnancy termination in Romania, directing women to “pregnancy crisis centres” with which some of the medical units collaborate.

The conscience clause is not the main reason for refusing to provide abortions, as some of the public hospitals reported that doctors in those hospitals provide this medical service, but in a private setting.

We are also aware, from discussions which we will keep anonymous, of the inability of many doctors to provide abortion services in public hospitals because of restrictions imposed by the management of the medical units.

III. The underlying issues

by Daniela Draghici

The shift in abortion access has been driven by several factors. While it’s possible the severity of the situation has always existed but previously lacked adequate research, recent revelations have shed light on previously overlooked barriers. Many people mistakenly equate legality of abortion with accessibility, a misconception prevalent in various countries, including Romania. When the International Midwives Association did an immersive exhibition in 2022, people who visited it realised for the first time that there are many barriers to abortion access, even if the procedure is legal.

Lobbying efforts by the Orthodox Church and anti-abortion centres, funded by groups from the United States, have gained traction, influencing medical professionals to refrain from performing abortions. The Church has also established a partnership with the Ministry of Health to assist patients in hospitals. However, this arrangement, purportedly under the guise of religious freedom, grants priests more leverage to influence doctors in the field of gynaecology. Additionally, the privatization of the healthcare system has made abortions more expensive, leading many doctors to prioritize procedures in private practices over providing affordable services in public hospitals.

Women primarily access abortions through NGOs and Abortion Without Borders, especially when they exceed the 14-week legal limit in Romania. Another significant issue is the inadequate care provided when abortion services are available, with doctors often overlooking women’s pain and well-being.

Addressing these issues requires new, comprehensive approaches, including legislative reforms, increased public awareness campaigns, and training for medical professionals on reproductive health and rights.