The remarkable story of Romanian women's struggle to manage their fertility.

To cite: Horga M, Gerdts C, Potts M. Journal of Family Planning and Reproductive Health Care 2013, 39, 2–4. BACKGROUND In 1957, along with many countries in Eastern Europe, Romania liberalised its abortion law. The Soviet model of birth control made surgical abortion easily available, but put restrictions on access to modern contraceptives, leading to an exceptionally high abortion rate. By the mid-1960s there were 1 100 000 abortions performed each year in Romania, a lifetime average of 3.9 per woman, the highest number ever recorded. In October 1966, 1 year after coming to power, in an attempt to boost fertility, Romania’s communist leader Nicolae Ceausescu made abortion broadly illegal, permitting the procedure legally only under a narrow range of circumstances: for women with four or more children, over the age of 45 years, in circumstances where the pregnancy was the result of rape or incest or threatened the life of the women, or in the case of congenital defect. Just months after abortion was restricted, the number of safe, registered abortions had fallen 20-fold, and 1 year after the law took effect, the total fertility rate (TFR) nearly doubled (from 1.9 just before the restrictive law to 3.6 in 1967– 1968). As women gradually found solutions for regulating their fertility – either through contraceptives procured illegally or through illegal abortions – the TFR began to fall again, reaching 2.9 in 1970, 2.2 in 1980–1984 and stabilised around 2.3 births per woman during the period 1985–1989. 2 At the same time deaths from unsafe abortion rose rapidly. Between 1966 and 1989, while abortion was illegal in Romania, overall maternal mortality increased dramatically, from 85 per 100 000 live births in 1965 to a peak of 169 per 100 000 live births in 1989. Over the same period, maternal mortality from unsafe abortion skyrocketed to an incredible 147 per 100 000 live births, while maternal deaths from other obstetric causes continued to decline. Figure 1 illustrates the peak and plateau in total fertility, along with the striking rise in maternal mortality that was solely driven by abortion-related deaths, as maternal deaths from other obstetric causes continued to fall.