Reproductive Health Survey 1993
Romania, 1993
Reference ID
ROU_1993_RHS_v01_M
Producer(s)
Romanian Institute for Mother and Child Care (IOMC)
Created on
Jan 05, 2012
Last modified
Mar 29, 2019
Page views
2220
Downloads
662
Identification
Survey ID Number
ROU_1993_RHS_v01_M
Title
Reproductive Health Survey 1993
Country
| Name | Country code |
|---|---|
| Romania | ROU |
Study type
Other Household Health Survey [hh/hea]
Abstract
The 1993 Romanian Reproductive Health Survey (RRHS-93) is a household-based survey designed to collect information from a representative sample of women of reproductive age throughout Romania. This nationwide probability survey of reproductive health is the first to be carried out in Romania since 1978.
During the previous regime, contraceptives and sex education were generally unavailable and importation and sale of contraceptives was forbidden; traditional contraceptive methods, with their high failure rates, were almost the only means to avoid unintended pregnancies.
In the absence of modern contraception, illegal abortions, most of them self-induced or induced by lay persons, were widely used to avert unwanted births. Although the extent of the prevalence of illegal abortions was impossible to assess, the dramatic effect on women's health was obvious to government officials but concealed from the public for many years. The true scope of the impact this policy had on reproductive health came to worldwide attention only after the December 1989 revolution and the change of government. During the last decade (1979-1989), Romania had the highest maternal mortality rate in Europe, a rate ten times higher than that of any other European country, and most of these maternal deaths were abortion-related (Stephenson et al., 1992). The magnitude of abortion complications is difficult to quantify but unofficial estimates suggest that nearly 20% of the 4.9 million women of reproductive age are thought to have impaired fertility (UNFPA 1990). The high number of unwanted pregnancies resulting in children abandoned in overcrowded orphanages by families who had been too frightened to attempt an illegal abortion, but who were too poor to afford to raise their child, was another shocking disclosure.
After revoking the restrictive law on abortion and contraception at the end of December 1989, the availability of safe abortion resulted in a drastic decline in me maternal mortality rate and improved women's health and their reproductive rights. However, the health planners who strived to design a family planning program were confronted with a difficult mission: to formulate and implement strategies aimed at improving family planning practices in a climate of economic and political changes and resistance to modern contraception by both the public and the health care providers. Also, insufficient infrastructure, absence of family planning logistics and managerial skills, and the shortage or uneven distribution of the contraceptive supplies were other critical factors that have diminished the impact of the newly founded
program.
The survey was specifically designed to meet the following objectives:
-to assess the current situation in Romania concerning abortion, contraception and various other reproductive health issues;
-to enable policy makers, program managers and researchers to evaluate and improve existing programs and to develop new strategies;
-to measure changes in fertility and contraceptive prevalence rates and study factors which affect these changes, such as geographic and socio-demographic factors, breastfeeding patterns, use of induced abortion, and availability of family planning;
-to identify and focus further reproductive health studies toward high risk groups.
During the previous regime, contraceptives and sex education were generally unavailable and importation and sale of contraceptives was forbidden; traditional contraceptive methods, with their high failure rates, were almost the only means to avoid unintended pregnancies.
In the absence of modern contraception, illegal abortions, most of them self-induced or induced by lay persons, were widely used to avert unwanted births. Although the extent of the prevalence of illegal abortions was impossible to assess, the dramatic effect on women's health was obvious to government officials but concealed from the public for many years. The true scope of the impact this policy had on reproductive health came to worldwide attention only after the December 1989 revolution and the change of government. During the last decade (1979-1989), Romania had the highest maternal mortality rate in Europe, a rate ten times higher than that of any other European country, and most of these maternal deaths were abortion-related (Stephenson et al., 1992). The magnitude of abortion complications is difficult to quantify but unofficial estimates suggest that nearly 20% of the 4.9 million women of reproductive age are thought to have impaired fertility (UNFPA 1990). The high number of unwanted pregnancies resulting in children abandoned in overcrowded orphanages by families who had been too frightened to attempt an illegal abortion, but who were too poor to afford to raise their child, was another shocking disclosure.
After revoking the restrictive law on abortion and contraception at the end of December 1989, the availability of safe abortion resulted in a drastic decline in me maternal mortality rate and improved women's health and their reproductive rights. However, the health planners who strived to design a family planning program were confronted with a difficult mission: to formulate and implement strategies aimed at improving family planning practices in a climate of economic and political changes and resistance to modern contraception by both the public and the health care providers. Also, insufficient infrastructure, absence of family planning logistics and managerial skills, and the shortage or uneven distribution of the contraceptive supplies were other critical factors that have diminished the impact of the newly founded
program.
The survey was specifically designed to meet the following objectives:
-to assess the current situation in Romania concerning abortion, contraception and various other reproductive health issues;
-to enable policy makers, program managers and researchers to evaluate and improve existing programs and to develop new strategies;
-to measure changes in fertility and contraceptive prevalence rates and study factors which affect these changes, such as geographic and socio-demographic factors, breastfeeding patterns, use of induced abortion, and availability of family planning;
-to identify and focus further reproductive health studies toward high risk groups.
Kind of Data
Sample survey data [ssd]
Unit of Analysis
Women of reproductive age
Scope
Notes
The RRHS questionnaire covered a wide range of topics related to reproductive health in Romania: a history of all pregnancies and births (including pregnancies ending in abortion) and the planning status of the pregnancies; family planning (knowledge and history of use of contraceptive methods, reasons for use of less effective methods of contraception, pregnancy intentions, and fecundity); maternal and child health (health information about the most recent pregnancy and birth and the use of maternal and child health services); young adult reproductive health (information about premarital sexual experience and pregnancy among women 15-24 years old); women's health (health behavior and use of women's health services); reproductive health knowledge and attitudes (especially regarding birth control pills and IUDs); knowledge about AIDs transmission and prevention; and socioeconomic characteristics of women and their husbands or families. The questionnaire also included a monthly calendar of pregnancies, segments of contraceptive use, and reasons for discontinuing use, over a 5-year period beginning in January 1988.
Coverage
Geographic Coverage
The 1993 RRHS was designed to collect information from a representative sample of women of reproductive age throughout Romania.
Universe
The universe from which the respondents were selected included all females between the ages of 15 and 44, regardless of marital status, who were living in Romania when the survey was carried out.
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| Romanian Institute for Mother and Child Care (IOMC) | Romanian Ministry of Health (MOH) |
Producers
| Name |
|---|
| Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention |
Funding Agency/Sponsor
| Name | Abbreviation |
|---|---|
| United States Agency for International Development | USAID |
| United Nations Population Fund | UNFPA |
| Romanian Ministry of Health | |
| United Nations Children's Fund | UNICEF |
Sampling
Sampling Procedure
The 1993 RRHS was designed to collect information from a representative sample of women of reproductive age throughout Romania. The universe from which the respondents were selected included all females between the ages of 15 and 44, regardless of marital status, who were living in Romania when the survey was carried out.
The survey employed a stratified sample with independent estimates for Bucharest, the capital city, and the 40 judets outside of Bucharest, or the Interior. Bucharest, together with its surroundings, the Agricultural Sector of Ilfov, is the equivalent of a judet. The 1992 census was used as the sampling frame (Comisia Nationala pentru Statistica, 1992). Since there were roughly equal numbers of urban and rural households in the Interior, the Interior sample was designed to be self-weighting. With a projected area probability sample of 5,000 women, 1,000 in Bucharest and 4,000 in the Interior, regional estimates are also possible for the Interior. Based on census data (percentage of households with at least one women 15-44 and unoccupied households) and a projected response rate of 90%, a total of 12,387 households were sampled to obtain complete interviews for approximately 5,000 women. Bucharest was oversampled and represents 22 percent of the sample, although it includes 11 percent of the total population.
The first stage of the three-stage sample design was a selection of "Census Sectors" with probability proportional to the number of households recorded in the 1992 Census. This was accomplished using a systematic sample with a random start in both strata or domains. In the second stage of sampling, clusters of households were randomly selected in each Census Sector chosen in the first stage. Cluster size determination was based on the number of households required to obtain 15 interviews per cluster, on average, in Bucharest, and 20 in the Interior. To obtain an average of 15/20 interviews, cluster sizes varied from 39 to 50 households due to different proportions of unoccupied household and variations in the proportion of households containing females 15-44 years of age by geographic area. Finally, one woman between the ages of 15 and 44 was selected at random for interviewing in each of the households.
Since only one woman was selected from each household containing women of reproductive age, all results have been weighted to compensate for the fact that some households included more than one eligible woman. Survey results are also weighted to adjust for the oversampling of households in Bucharest.
The survey employed a stratified sample with independent estimates for Bucharest, the capital city, and the 40 judets outside of Bucharest, or the Interior. Bucharest, together with its surroundings, the Agricultural Sector of Ilfov, is the equivalent of a judet. The 1992 census was used as the sampling frame (Comisia Nationala pentru Statistica, 1992). Since there were roughly equal numbers of urban and rural households in the Interior, the Interior sample was designed to be self-weighting. With a projected area probability sample of 5,000 women, 1,000 in Bucharest and 4,000 in the Interior, regional estimates are also possible for the Interior. Based on census data (percentage of households with at least one women 15-44 and unoccupied households) and a projected response rate of 90%, a total of 12,387 households were sampled to obtain complete interviews for approximately 5,000 women. Bucharest was oversampled and represents 22 percent of the sample, although it includes 11 percent of the total population.
The first stage of the three-stage sample design was a selection of "Census Sectors" with probability proportional to the number of households recorded in the 1992 Census. This was accomplished using a systematic sample with a random start in both strata or domains. In the second stage of sampling, clusters of households were randomly selected in each Census Sector chosen in the first stage. Cluster size determination was based on the number of households required to obtain 15 interviews per cluster, on average, in Bucharest, and 20 in the Interior. To obtain an average of 15/20 interviews, cluster sizes varied from 39 to 50 households due to different proportions of unoccupied household and variations in the proportion of households containing females 15-44 years of age by geographic area. Finally, one woman between the ages of 15 and 44 was selected at random for interviewing in each of the households.
Since only one woman was selected from each household containing women of reproductive age, all results have been weighted to compensate for the fact that some households included more than one eligible woman. Survey results are also weighted to adjust for the oversampling of households in Bucharest.
Response Rate
Of the 12,387 households selected, 5,283 included at least one 15- to 44 year-old woman. Of this number, 4,861 were successfully interviewed, for a response rate of 92.0%. Only 1.1% the of selected women refused to be interviewed, while another 6.1% could not be located. Response rates were slightly better in Bucharest and other urban areas (93%) than in rural areas (89%).
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 1993-07 | 1993-12 |
Data Collection Mode
Face-to-face [f2f]
Data Collection Notes
The Romanian Reproductive Health Survey (RRHS) was conducted during July-December 1993, among 5,283 women of childbearing age. Interviews were administered at the homes of respondents by 20 intensively trained female interviewers, most from the Institute of Mother and Child Care (IMCC) and the CHS/MOH. Interviews generally lasted 30 to 50 minutes.
There were five survey teams, each headed by a fieldwork supervisor and one field work coordinator. Training was carried out immediately before the survey field work began and lasted six days. Interviewer training was organized and conducted by staff from the IMCC and DRH/CDC. In parallel with the first two weeks of field work, a DRH/CDC computer specialist installed data entry/edit software and trained the Romanian staff in its use.
There were five survey teams, each headed by a fieldwork supervisor and one field work coordinator. Training was carried out immediately before the survey field work began and lasted six days. Interviewer training was organized and conducted by staff from the IMCC and DRH/CDC. In parallel with the first two weeks of field work, a DRH/CDC computer specialist installed data entry/edit software and trained the Romanian staff in its use.
Questionnaires
Questionnaires
The questionnaire was first drafted by CDC/DRH consultants based on a core questionnaire used in the 1993 Czech Republic RHS. This core questionnaire was modified, including adding modules targeted to explore important issues for Romania, such as induced abortion and maternal mortality. The survey instrument was then reviewed by Romanian experts in reproductive health and family planning, as well as by AID and AID cooperating agencies who have worked in Eastern Europe. Based on these reviews, a pretest questionnaire was developed and field tested in April 1993.
The RRHS questionnaire covered a wide range of topics related to reproductive health in Romania. The specific areas included were:
- Social, economic and demographic characteristics
- Pregnancy history
- Knowledge and use of contraceptive methods
- Sexuality and contraception among young adults
- Use of maternal and child health services
- Morbidity during pregnancy
- Women's health issues
- Knowledge and attitudes about contraception
- Knowledge about HIV/AIDS
The questionnaire had two components: (1) A short household module that was used to collect residential and geographic information, as well as selected characteristics about all women of childbearing age living in sampled households, and information on interview status. This module was also used to select a respondent randomly when there was more than one eligible woman in the household. (2) The longer individual questionnaire collected information on reproductive health topics discussed below. For Hungarian language speakers, the interview was conducted in their native language.
The major subjects on which information was collected are: pregnancies and childbearing (a history of all pregnancies and births, including use of abortion and planning status of pregnancies); family planning (knowledge and history of use of methods of preventing pregnancy, reasons for use of less effective methods of contraception, pregnancy intentions, and fecundity); maternal and child health (health information about the most recent pregnancy and birth and the use of services); young adult reproductive health (information on sexual relations and pregnancy among females 15-24 years old); women's health (health behavior and use of women's health services); reproductive health knowledge and attitudes (especially regarding birth control pills and IUDs); knowledge about HIV/AIDS transmission and prevention; and socioeconomic characteristics of women and their husbands/families. The sisterhood module to estimate maternal mortality was also part of the questionnaire.
The RRHS questionnaire covered a wide range of topics related to reproductive health in Romania. The specific areas included were:
- Social, economic and demographic characteristics
- Pregnancy history
- Knowledge and use of contraceptive methods
- Sexuality and contraception among young adults
- Use of maternal and child health services
- Morbidity during pregnancy
- Women's health issues
- Knowledge and attitudes about contraception
- Knowledge about HIV/AIDS
The questionnaire had two components: (1) A short household module that was used to collect residential and geographic information, as well as selected characteristics about all women of childbearing age living in sampled households, and information on interview status. This module was also used to select a respondent randomly when there was more than one eligible woman in the household. (2) The longer individual questionnaire collected information on reproductive health topics discussed below. For Hungarian language speakers, the interview was conducted in their native language.
The major subjects on which information was collected are: pregnancies and childbearing (a history of all pregnancies and births, including use of abortion and planning status of pregnancies); family planning (knowledge and history of use of methods of preventing pregnancy, reasons for use of less effective methods of contraception, pregnancy intentions, and fecundity); maternal and child health (health information about the most recent pregnancy and birth and the use of services); young adult reproductive health (information on sexual relations and pregnancy among females 15-24 years old); women's health (health behavior and use of women's health services); reproductive health knowledge and attitudes (especially regarding birth control pills and IUDs); knowledge about HIV/AIDS transmission and prevention; and socioeconomic characteristics of women and their husbands/families. The sisterhood module to estimate maternal mortality was also part of the questionnaire.
Data Appraisal
Data Appraisal
The age distribution of the RRHS sample closely reflected that of the female population as a whole (Comisia Nationala pentru Statistica, 1993A). The sample population is essentially within two percentage points of the census population in each age group. In urban areas there is a slight overrepresentation of women 15-19 years old and slight underrepresentation of women 20-24 years of age. This is probably due to the greater difficulty in finding 20-24 year old women at home, since they are more likely to work or be attending University level classes.
Disclaimer and copyrights
Disclaimer
The user of the data acknowledges that the original collector of the data, the authorized distributor of the data, and the relevant funding agency bear no responsibility for use of the data or for interpretations or inferences based upon such uses.
Metadata production
DDI Document ID
DDI_ROU_1993_RHS_v01_M_WBDG