Romania: Improving Reproductive Health One District at a Time

BRANCENI, Romania — It is just 10 a.m., but the reception hall of the Family Doctor Clinic in the village of Branceni – some 80 kilometers west of Bucharest in the Teleorman District – is filled with women and their children. They have come for contraceptives, for check-ups and to have their children examined and treated for coughs and other minor complaints.

Mihaela Brinceanu, 30, sits in the hall with her two lovely daughters. "I come here regularly now to get contraceptive pills," says Mihaela. "Before this clinic opened, we had no choice at all. Abortion was our only method of contraception."

Most of the women of reproductive age in this village now practice family planning. "I've been coming here for three years," says Mihaela. "I feel comfortable here, the services are good and it's close to home. This clinic provides complete family medicine in one stop, and the services are free."

Mihaela does not want more children. "This region is very poor," she says nodding her head. "My husband does not have a steady job, and I don't work. So we are always fighting off the wolf at the door."

" I like the friendly atmosphere. There are no gaps in services. We can get the health care we need. "

--Virginia Mirea

The Family Doctor Clinic "has really improved the health of this community," confirms Virginia Mirea, the mother of a five-year-old boy. "I like the friendly atmosphere. There are no gaps in services. We can get the health care we need."

This clinic, like others in poor areas of Romania, has been upgraded and supplied thanks to "Support for Reproductive and Sexual Health in Romania", a project funded by UNFPA, the United Nations Population Fund. The purpose of this project is to "provide better reproductive and sexual health care services to women, men and adolescents in the districts where we work," says Peer Sieben, UNFPA Representative for Romania. "It has also enhanced the managerial and coordination capacity of the Ministry of Health and our NGO partners to design and implement integrated sexual and reproductive health services."

The head of the Family Doctor Clinic in Branceni, Dr. Gabriela Rosu, was trained by one of UNFPA's partner organizations, Society for Education on Contraception and Sexuality to deliver better, more client-friendly family planning services. "The training I received through the UNFPA-sponsored programme has certainly improved my capacity to deliver quality services to my clients," she says with a broad grin. "It was a very interactive learning experience for me, and I received a complete training regime on family planning, an area that I didn't know much about before."

By the end of March 2005, the project had trained 65 family doctors in Teleorman District, along with 54 family nurses. Nearly all of the doctors, like Gabriela, also provide family planning services, including the distribution of contraceptives, free of charge under a Government-subsidized programme initiated by UNFPA, together with other international donors.

Health indicators for the Teleorman District, of which Branceni is a part, show consistent improvement over the past four years. The abortion rate has dropped dramatically, from 7,185 cases in 1999 to 2,892 in 2004. Similarly, the rate of sexually transmitted infections has also gone down, from 242 cases in 2000 to 163 cases in 2004. At the same time contraceptive use has increased (from 2,765 to 3,034 'couple years' since 2002).

Currently, 70 per cent of the entire population of this district has access to modern contraceptives," says out Dr. Rosu. "As here in my clinic, the most popular form of contraception is the oral pill."

The only problem is that some of the clinics that offer family planning services have only one type of oral pill available. "Some of my patients want to switch pills because they are having reactions, but I can't provide alternatives right now because of the shortfall in supplies," observes Gabriela. "The women can buy other varieties of pills from our dispensary, but unfortunately most of them are too poor to pay for them."

As demand increases for contraceptives, the main challenge facing the Family Doctor Clinics is how to provide them fast enough. "The Health Ministry is aware of the problem," says Dr. Sieben, "and we are working with them and with other partners to solve the supply bottleneck."

But even with the shortfall in supplies, "we have improved the health and well-being of thousands of women, adolescents and men in this district," says Dr. Rosu. "And that is priceless."

-- Don Hinrichsen