Ipas > Women’s stories, needs for comprehensive care in Moldova

Women’s stories, needs for comprehensive care in Moldova

February 9, 2006

Assessing abortion and contraception services is the first step toward better reproductive-health options, including woman-centered abortion care, in Moldova.

Photo courtesy of Jon Spaull, Panos Pictures.

Somewhere in the Eastern European country of Moldova, a 23-year-old woman enters a gynecology department for a third abortion. She is 12 weeks pregnant and already has two children that her mother raises. She is from the countryside but works in a city bar for a salary of 300 lei (US$ 23) per month; her job often exposes her to sexual violence. She pays 260 lei ($20) for the abortion. Her mother helps scrape together the cash by selling apples. No one in the gynecology department discusses contraception with the young woman, and even if she knew about various methods, she couldn’t afford them on her meager earnings.

This is just one of the true stories collected during Moldova’s “Strategic Assessment of Policies, Quality of and Access to Contraception and Abortion Services,” conducted in August 2005. Ipas consultant Daniela Draghici participated in the fieldwork and the late January conference where its preliminary findings were released.

The strategic assessment was initiated by the Ministry of Health and Social Protection, and the National Scientific & Applied Center of Reproductive Health, Medical Genetics and Family Planning. The assessment is part of a strategy championed by the World Health Organization (WHO) to help countries address challenges in providing high-quality reproductive-health services. WHO, Ipas and the East European Institute of Reproductive Health (Romania) provided technical and financial assistance.

This look at Moldova’s services aims to identify the most effective ways to improve the access to and quality of contraception and abortion services; lower the number of unwanted pregnancies and abortions; and decrease abortion-related death and injuries.

A multidisciplinary team of interviewers from the health sector and NGOs spoke to almost 600 people about the status of abortion and contraception in the country. They talked to hospital directors, service providers and patients (some of whom had had abortions); students and teachers; and church, business or other community figures.

The young woman whose story was told above is not an isolated case. The assessment concluded that women still resort to abortion rather than contraception, though abortion services are often low quality — a legacy of the Soviet system in which abortion was often seen as an alternative to contraception.

Manual vacuum aspiration (MVA)— a safe, effective, and affordable abortion technology — is not widely used despite a recommendation from the Ministry of Health and Social Protection, and the availability of equipment and trained providers. Where electric vacuum aspiration is being used, old equipment is the norm. And for the majority of Moldovans — who still live in rural areas — finding abortion services near their homes can be challenging.

One woman who had undergone an abortion in a public health-care facility talked about what she saw as the typical abortion experience: “You go to the doctor, pay beforehand, the doctor tells you to lie down, and he’s the only one who knows what he’s doing to you. …”

Counseling and nonjudgmental care, part of Ipas’s woman-centered abortion-care model, could have made a difference in this woman’s abortion experience. Armed with the report, key Moldovan institutions can implement changes to their reproductive-health services — so when a woman considers ending a pregnancy, she doesn’t have to wonder blindly what the doctor will do, but will have the information she needs to make a decision and safe, up-to-date options for high-quality care.

For more information, contact:
Kirsten Sherk
Senior Associate, Media Relations
e-mail: sherkk@ipas.org
phone: 919.960.5612
fax: 919.929.0258