In theory in Romania, women and girls enjoy most sexual and reproductive health rights, including access to abortion and family planning methods. However, in practice, women and girls increasingly face barriers to accessing the healthcare resources necessary for the enjoyment of these rights.
Research and Tracking Team
When Nina became pregnant at 19, she wanted an abortion. Her family doctor told her that his hospital did not provide abortions on request, so she should search online for a provider. When she Googled “abortion,” the first result was “avort.ro.” Not knowing the organization was one that promotes anti-abortion rhetoric and works to prevent pregnant women and girls from going through with having an abortion, Nina called it. “They told me things that sounded sci-fi,” she recalled. “That doctors don’t use anesthesia, that the fetus would be handed to me all sliced up.”
The woman who she spoke to assured Nina that the state and church would help her if she kept the baby. But Nina still wanted an abortion, so the woman scheduled two appointments for her at the Giulesti Maternity Hospital in Bucharest. The doctor did not show up for either appointment. By then, Nina was already 12 weeks pregnant. Nina tried calling the woman again, but she never answered. After her son was born in 2020, Nina had to postpone her university education, quit her job, and leave the capital due to financial difficulties. “Being in this situation, it was like all my dreams went out of the window,” she said. “I experienced a major break in the perception that I could do anything. Maybe that is why I can’t bond with my son as well. It was really painful, and it still is.”
In theory in Romania, women and girls enjoy most sexual and reproductive health rights, including access to abortion and family planning methods. However, in practice, women and girls increasingly face barriers to accessing the healthcare resources necessary for the enjoyment of these rights.
In Romania, abortion on request—an abortion performed within a legally defined gestational limit at the request of a pregnant woman or girl, which does not require doctors or other professionals to attest to or certify the existence of a particular reason or justification for the abortion—is permitted until 14 weeks of pregnancy. At this stage article 201 of the Penal Code comes into play and punishes those who conduct or attempt to conduct an abortion on request after 14 weeks with imprisonment or by a fine and a “ban on the exercise of certain rights.” Physicians can also face a prohibition from practicing. The “pregnant woman” cannot be punished for terminating her pregnancy.
Doctors can perform abortions for up to 24 weeks of pregnancy if done for “therapeutic purposes,” and beyond 24 weeks for therapeutic purposes “in the interest of the mother or the fetus.” However, a growing number of doctors and public hospitals no longer provide legal abortion services for several reasons described in this report:
- Hospital and clinic administrators have increasingly adopted policies, both formal and informal, that prohibit the provision of abortions on request and thus turn away patients seeking these services;
- Doctors have frequently invoked conscientious objection when turning away patients, often without referring them to other medical facilities or doctors;
- Some doctors cite concern about what they say is a lack of malpractice insurance provided to physicians working in public health care facilities, and how that might leave them without coverage for potential liability related to provision of abortion care;
- Some doctors were unaware of, misunderstand, or misinterpret certain laws and guidelines concerning abortions on request, such as the recommended time limit for medication abortion (within 12 weeks of amenorrhea) and that 16- and 17-year-old girls do not require parental or legal guardian consent for non-emergency sexual and reproductive health services, including family planning services and abortion on request.
These barriers have had a significant impact on the availability of abortion services at public healthcare facilities across the country. Two Romanian nongovernmental organizations, FILIA Center, a feminist NGO based in the capital Bucharest, and the Euroregional Center for Public Initiatives, surveyed 242 public hospitals between February and May 2021 and found that of the 137 that provided the requested information, only 59 — less than half —provided both abortion procedures and medication abortions on request. According to the government’s Public Health Directorate, in 2021, 11 out of 41 counties in the country — over a quarter — recorded zero abortion procedures on request performed in public hospitals. Two of those eleven counties also recorded zero abortion procedures on request performed in private clinics.
Between November 2023 and February 2024, the Independent Midwives Association conducted another survey on access to abortion, analyzing 959 public and private medical facilities nationwide. 552 facilities stated that they do not provide abortion services (57.6%). Of these, 176 were public medical facilities, among which 111 (63.06%) did not provide any abortion services. The Association also found that 90% of the surveyed medical facilities that did not provide abortion services also did not refer women and girls requesting an abortion to other medical facilities or practitioners.
Such obstacles to accessing abortions on request in public hospitals often push women and girls to seek these services from private hospitals and clinics, which are not covered by Romania’s public health insurance system, National Health Insurance House, and must instead be paid for through out-of-pocket payments or private health insurance. Abortion on request services can cost about 150 Lei (about €30 or US$32) in public hospitals. In private clinics, however, abortion on demand can cost between 1,200 to 1,500 Lei (about €240 to €1,004 or US$247 to $1,030), which could be more than a month’s salary on the national minimum wage.
As a result, many women and girls who are forced to seek out abortion services from private-sector providers are unable to access them because of cost or must face significant financial hardship to do so. This is particularly true for socially and economically marginalized communities in Romania that are more likely to experience poverty, including people from the Roma community, rural women and girls, and some adolescents.
Some women and girls also face financial barriers to accessing contraceptives, which are also not covered by the National Health Insurance House nor subsidized by any other state-funded program at time of writing. This challenge is not new: Since 2013, the Ministry of Health has not allocated funding for the acquisition and distribution of free contraceptives through any of its existing programs or the National Health Strategy.
Laws, policies, and the public perception of abortion, contraception, and sexuality education in Romania have been influenced in recent years by the anti-rights movement, which is a transnational campaign against legislative and policy developments on human rights issues, including gender equality. Proponents have built cross-border alliances under the banner of countering so-called “gender ideology”, a term used to portray efforts to advance gender equality—including those aiming to uphold sexual and reproductive health rights, combat gender-based violence, and eliminate discrimination based on sexual orientation and gender identity—as foreign ideas that supposedly threaten “traditional” values and families.
Furthermore, religious institutions and governmental officials have made efforts to block access to sexual and reproductive health services, provision of sexuality education, and lesbian, gay, bisexual, and transgender (LGBT) rights. Religious denominations, particularly the Romanian Orthodox Church and Protestant churches, have perpetuated and supported anti-rights rhetoric as well, and the influence of religious conservatism extends to healthcare provision. Public hospitals often have churches on their premises; priests employed by these churches sometimes use their location to propagate anti-abortion rhetoric to pregnant women and girls going to the hospital to obtain an abortion, as well as healthcare providers who work there.
A key manifestation of the anti-rights movement in Romania is the establishment of what are referred to as crisis pregnancy centers (CPCs), a model that originated in the United States and has now spread to some other countries. Although they may present as providing comprehensive information and support to pregnant women and girls, CPCs promote anti-abortion rhetoric and seek to block pregnant women and girls from obtaining abortions, including by making misleading offers of support and information and promising them resources such as housing and money if they do not obtain an abortion. Some public institutions, including General Directorates for Social Assistance and Child Protection and public maternity hospitals, have formally or informally collaborated with CPCs, providing them with significant access to public healthcare facilities and women and girls seeking abortion services. The Ministry of Labor and Social Protection provides accreditation as a social service provider to at least one major CPC in Romania called the Pulse Center (Centrul PULS).
In practice, some CPCs do not follow through on their promises at all, while others provide access to resources for a limited period after birth, leaving these women and girls and their young children on their own after at most a couple of years. Many CPCs in Romania are religiously affiliated and conduct their anti-abortion activities alongside the provision of other charitable social assistance, sometimes in collaboration with public institutions. CPCs in Romania have been established and/or supported by religiously affiliated anti-abortion organizations in other countries, particularly the United States, through funding, training, advocacy, and networking.
Human Rights Watch found that CPCs’ practices have significantly hindered access to abortion services at public healthcare facilities. While this is the overt goal of these private institutions, Romania’s failure to ensure the availability, accessibility, and quality of abortion services at public facilities, exacerbated by the failure to regulate these private entities in a way to prevent them interfering with women and girls’ right of access to abortion services constitute violations of the human right to the highest attainable standard of health as well as the principle of equality and non-discrimination.
Finally, adolescents in Romania do not have access to mandatory comprehensive sexuality education (CSE). While some important information regarding pregnancy, family planning, and sexually transmitted infections is included in the compulsory 7th grade biology curriculum, a CSE activist noted that many teachers avoid these topics with their students. Schools can offer “health education” as an option for students in year 1 to 12. The courses available in that curriculum include many topics that follow UN international guidance on sexuality education, providing age and stage-appropriate scientifically and evidence-based information about a full range of topics related to sexuality. But their optional nature allows teachers to avoid teaching certain topics they would deem inappropriate or controversial, such as sexuality and abortion. Participation rates have been consistently low over the years, which activists claim is due to the Ministry of Education’s failure to properly implement health education, combined with the effect of the anti-rights movement.
Due to the dearth of youth-friendly education services for sexual and reproductive health, adolescents who cannot access sexual and reproductive health in schools face difficulty seeking information directly from healthcare providers and instead turn to the internet. This forces them to navigate an abundance of online sources to find correct information, which may be challenging for adolescents. Romania has one of the highest adolescent birth rates among European Union member states. The lack of access to sexual and reproductive health information, including through CSE, contributes to adolescent pregnancy rates by depriving young people of information that could help them make informed choices about their health.
As a party to the International Covenant on Economic, Social and Cultural Rights (ICESCR), Romania bears the legal obligations to respect, protect, and fulfil the right to the highest attainable standard of physical and mental health.
The Committee on Economic, Social and Cultural Rights (CESCR), which provides authoritative interpretations of the obligations of states parties enshrined in the ICESCR, explained in its general comment no. 14 that governments’ right-to-health obligations include the duty to ensure that access to healthcare resources is accessible without discrimination, especially for the most marginalized sections of the population, and without cost-based barriers. States parties must also ensure “the right to seek, receive and impart information and ideas concerning health issues.” The CESCR has also explained that “private health-care providers should be prohibited from denying access to affordable and adequate services, treatments or information,” and that “where health practitioners are allowed to invoke conscientious objection to refuse to provide certain sexual and reproductive health services, including abortion, they should refer the women or girls seeking such services to another practitioner within reasonable geographical reach who is willing to provide such services.”
Romania has Human Rights Obligations to Ensure Access to Safe Abortion, Contraception, and CSE
Access to abortion services is a necessary element for the exercise and enjoyment of health and other human rights and Romania should take all necessary steps to ensure that women and girls have informed and free access to safe and legal abortion services. Accordingly, Romanian authorities should review and amend relevant legislation to ensure that unmonitored and unregulated legal and institutional processes in the healthcare and education systems do not impede women’s and girls’ rights, including the right to legal abortion access, contraception, and CSE. They should take concrete measures to make sexual and reproductive health care and information widely available and affordable so women and girls can exercise agency and make the informed decisions about their health.