Women's health and reproductive rights: Romanian experience

The microeconomics of abortion: A scoping review and analysis of the economic consequences for abortion care-seekers

Background

The economic consequences of abortion care and abortion policies for individuals occur directly and indirectly. We lack synthesis of the economic costs, impacts, benefit or value of abortion care at the micro-level (i.e., individuals and households). This scoping review examines the microeconomic costs, benefits and consequences of abortion care and policies.

Methods and findings

Searches were conducted in eight electronic databases and applied inclusion/exclusion criteria using the PRISMA extension for Scoping Reviews. For inclusion, studies must have examined at least one of the following outcomes: costs, impacts, benefits, and value of abortion care or abortion policies. Quantitative and qualitative data were extracted for descriptive statistics and thematic analysis. Of the 230 included microeconomic studies, costs are the most frequently reported microeconomic outcome (n = 180), followed by impacts (n = 84), benefits (n = 39), and values (n = 26). Individual-level costs of abortion-related care have implications for the timing and type of care sought, globally. In contexts requiring multiple referrals or follow-up visits, these costs are multiplied. The ways in which people pay for abortion-related costs are diverse. The intersection between micro-level costs and delay(s) to abortion-related care is substantial. Individuals forego other costs and expenditures, or are pushed further into debt and/or poverty, in order to fund abortion-related care. The evidence base on the economic impacts of policy or law change is from high-income countries, dominated by studies from the United States.

Conclusions

Delays underpinned by economic factors can thwart care-seeking, affect the type of care sought, and impact the gestational age at which care is sought or reached. The evidence base includes little evidence on the micro-level costs for adolescents. Specific sub-groups of abortion care-seekers (transgendered and/or disabled people) are absent from the evidence and it is likely that they may experience higher direct and indirect costs because they may experience greater barriers to abortion care.

Lived Religion as Reproductive Decision-Making Resource Among Romanian Women Who Use Abortion as Contraception

This article draws upon qualitative ethnographic data collected between 2005 and 2013 in southern Romania among women who have been consistently using abortion as a contraceptive method. It particularly considers the role that lived religion might have played in some individuals' strategies to render abortion a justifiable practice. Over the last seven decades, Romanian women's experiences of abortion have often been at odds with both secular and religious regulations. This study shifts the perspective from the biopolitics and the bioethics of abortion toward women's own reproductive decision-making strategies in a context of enduring traditional patriarchy. It explores the fluid and pragmatic ways in which some Romanians use the notions of "God's will," "sin," "redemption," "afterlife," and "Godparenting" to redefine abortion as a partially disembodied reproductive event. As a reproductive decision-making resource, lived religion empowers women to navigate the lived complexities of conception and contraception.

"As if Nothing Happened": Experiences of Bereaved Parents in Romania

Prior research has found high levels of distress in parents who experience the death of a child; however, Romanian parents, whose experiences are influenced by the nation's shared historical trauma, have not been studied. This mixed-methods study found very high levels of distress in a sample of 237 bereaved parents in Romania, primarily women. Specifically, 89% of respondents scored above the clinical cutoff for trauma responses, 66% did so for anxious responses, and 82% did so for depressive responses. Qualitative analyses of respondents' narratives suggest that, through complex interactions between political, social, and medical systems, the lack of care after the death of a child seems to incite additional distress in parents. These findings warrant further exploration of traumatic grief in Romania, especially in the context of historical and political trauma, and of ways in which support can be provided to grieving parents in this unique cultural milieu.

The Winners of Socialism: Fighting Infertility in Pronatalist Romania

Drawing from interviews and life histories, I consider the singular reproductive trajectories of women who fought infertility during the enforced pronatalist policies of the late communist era in Romania. I aim to explore the role of fine-grained ethnography in revealing both the localized mechanisms of reproductive governance and the diverse subjectivities produced by citizens' encounters with biopower. I argue that, through an analysis of these ethnographic cases, we can further conceptualize reproductive vulnerability as an intersubjective notion. In addition, women's atypical stories give us a glimpse into the typical workings of the recording and reporting practices of the pronatalist regime.

Locating Purity within Corruption Rumors: Narratives of HPV Vaccination Refusal in a Peri-urban Community of Southern Romania

This article locates the symbolic construction of "corrupted purity"-as a key assertion in Romanian parents' HPV vaccination refusal narratives-within a multiplicity of entangled rumors concerning reproduction and the state. Romania's unsuccessful HPV vaccination campaign is not unique. However, the shifting discourses around purity and corruption-through which some parents conveyed anxieties about their daughters being targeted for the vaccine-place a particular twist on the Romanian case of resisting the HPV vaccination. Parental discourses took the form of clusters of rumors about state medicine's failure to provide adequate reproductive health care, additive-laden foods, and exposure to radioactive contamination. In these rumors, corruption becomes literally embodied, through ingestion, consumption, contact, or inoculation. Parental discourses about what is being injected into their daughters' pristine bodies express their uncertainty around navigating the unsettled post-socialist medical landscape.

Cervical cancer narratives: invoking 'God's will' to re-appropriate reproductive rights in present-day Romania

Drawing from ethnographic fieldwork in contemporary Southern Romania, this paper scrutinises local moralities governing some women's refusal to enrol in free reproductive healthcare initiatives targeting cervical cancer through primary and secondary prevention (human papillomavirus [HPV] vaccination and Papanicolaou [Pap] testing, respectively). Women backed up their rejection of participation in official reproductive care programmes by mentioning 'God's will' as the ultimate trigger of cervical cancer. They withheld their own and their daughters' bodies from biomedical intervention and used discursive references to divine logic to imbue their refusal with moral legitimacy. However, 'God's will' is not a mere rhetorical device, since it has a correlate in many of these women's embodied reproductive experiences. As this paper argues, religious narratives, far from stripping ordinary citizens of their reproductive choices, constitute the medium through which they display individual agency. In fact, invoking 'God's will' empowers Romanian women to challenge state control and it enables them to re-appropriate their bodies by making a counter-intuitive, yet bold, choice.

Is there a universal understanding of vulnerability? Experiences with Russian and Romanian trainees in research ethics

Vulnerability of participants in research and the provision of special protections for vulnerable research participants are key concepts in research ethics. Despite international consensus requiring special protections for vulnerable research participants, both the concept of vulnerability and the nature and adequacy of strategies to reduce vulnerability remain vague and, consequently, are subject to varying interpretations. We report on observations of the challenges faced in understanding this key concept by 20 Russian and Romanian trainees participating in a one-year M.A. training program in research ethics from 2000 through 2011. We describe how trainees' understanding of and appreciation for the need for special protections of vulnerable research participants was nurtured. This paper is part of a collection of papers analyzing the Fogarty International Center's International Research Ethics Education and Curriculum Development program.

Les nouvelles techniques médicales de reproduction en Roumanie : entre autonomie des femmes et inégalités socioéconomiques

L'Europe de l'Est est fréquemment perçue comme un vaste marché libéralisé de la procréation assistée pour les femmes venant de l'Ouest, allant jusqu'à l'accès à des corps reproducteurs. Mais que se joue-t-il dans les pays de cette partie orientale de l’Europe, pour les femmes et les hommes qui y vivent? Mon propos, dans cet article, sera centré sur la Roumanie et analysera le champ de la procréation assistée, son insertion et son développement dans une société marquée, d’une part, par la politique pronataliste de l’ère communiste, et, d’autre part, par l’absence d’encadrement législatif sur les techniques médicales de reproduction (Cutas, 2008). Dans un contexte fortement patriarcal (Kaser, 2008), je tenterai de montrer que la procréation médicalement assistée (PMA) – mais aussi l’avortement – représentent des vecteurs de réappropriation de leur corps par les femmes roumaines. Ce processus de réappropriation des corps permet de recouvrer une autonomie, qui s’articule avec celle des médecins pour qui les techniques médicales de reproduction représentent un moyen d'exploration et d’excellence biomédicales. S’engageant dans des parcours de PMA qui entraînent des grossesses tardives, parfois postménopausiques, les femmes roumaines remettent également en cause – presque incidemment – les cadres sociaux de biologisation des différences femmes-hommes (Engeli, 2010; Théry, 2010). Cette autonomie a un prix, néanmoins, car l’État n’impose certes pas de limites juridiques aux pratiques médicalisées de procréation, mais il ne couvre pas non plus les frais afférents (à l’exception d’un programme-pilote du ministère de la Santé en 2011-12), exacerbant ainsi les inégalités socioéconomiques. Ce sont ces inégalités et la distorsion des droits individuels qu’elles créent qui sont à l’origine d’une mobilisation de femmes roumaines sur la problématique de l’infertilité et de sa prise en charge par l’État roumain. Pour contrer une dimension d’injustice reproductive (Bretonnière, 2013), l’État roumain est interpellé par les actrices sociales qui l’invitent à réinvestir le champ de la procréation pour garantir des droits effectifs à ses citoyennes, et non pas pour contrôler les paramètres de la reproduction humaine.

Contraceptive behaviour of Czech and Romanian women: comparison of representative national samples

OBJECTIVE

To investigate the contraceptive behaviour of Czech and Romanian women and their attitudes towards different forms of contraception.

STUDY DESIGN

Anonymous questionnaire research among 1011 Czech and 1001 Romanian women between 15 and 50 years of age. The samples were representative of both the Czech and Romanian female populations with respect to age, education and the size of their place of residence.

RESULTS

The majority of women use contraception when in a stable sexual relationship. We found a higher percentage of women using contraception among Czech women. Romanian women more often use less reliable methods in a stable relationship, and condoms. Czech women use hormonal contraception much more. Women in the Czech Republic would more often agree to use a condom and, in particular, to use hormonal and intrauterine contraception. More Romanian women than Czech women prefer the method of infertile days. The use of contraception is influenced by the factors of age, education and size of the place of residence.

CONCLUSION

The majority of Czech and Romanian women protect themselves against unwanted pregnancy. Czech women are more frequent users of contraceptives in general and, in particular, of hormonal contraception. Romanian women tend to use less reliable methods of contraception but on the other hand, they more often use condoms as a means of protection.

What is the desired menstrual frequency of women without menstruation-related symptoms?

INTRODUCTION

This study aimed to investigate the desired menstrual frequency of subjects without menstruation-related symptoms.

MATERIALS AND METHODS

The study included 270 women of reproductive age. Women with menstrual headache, dysmenorrhea, hypermenorrhea and/or premenstrual syndrome were excluded. The study subjects completed a standardized questionnaire.

RESULTS

Of the women, 75.6% declared that menstrual periods interfere with their sexual life, 28.8% preferred not having their menstrual period when at work and 48.4% reported that menstrual periods interfere with practicing sports. Given the choice, 28.5% of the women would desire amenorrhea and 27.8% would prefer a reduction in the frequency of menstrual periods. Of the 152 women desiring to reduce menstrual frequency, 73.0% declared that they would accept to use a drug to reduce menstrual frequency.

CONCLUSIONS

Over 50% of women without menstruation-related symptoms would like to lessen the frequency of menstrual periods and about 50% of them would desire amenorrhea.