A nationwide reproductive health survey had been conducted in Romania in 1993 (93RRHS), the first survey of reproductive age women since the 1978 World Fertility Survey.
The United States Agency for International Development (USAID) and other international donors sponsored two additional national reproductive health surveys in Romania: a Young Adult Reproductive Health Survey conducted in 1996 (96YARHS) and the 1999 Romanian Reproductive Health Survey (99RRHS); both are similar to the 93RRHS in design and content, but they also include a sample of men.
These surveys were specifically designed to meet the following objectives:
-to assess the current situation in Romania concerning fertility, 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 (a good example is use of 96YARHS data to provide data needed to develop sex education and health promotion programs);
-to measure changes in fertility and contraceptive prevalence rates and study factors that affect these changes, such as geographic and socio-demographic factors, breast-feeding patterns, use of induced abortion, and availability of family planning services;
-to measure the impact of public and private sector services over the past 6 years.
-to obtain data about knowledge, attitudes, and behavior of young adults 15-24 years of age;
-to provide data on the level of knowledge about transmission and prevention of AIDS;
-to identify high-risk groups and focus additional reproductive health studies toward them.
In all three surveys, the questionnaire covered a broad array of reproductive health topics, including a pregnancy history, abortion, childbearing, contraceptive use, maternal and child health, health behaviors and attitudes. These surveys had a similar design and methodology; however, in 1996 and 1999, the surveys employed two separate probability samples to allow independent estimates for males and females.
During the early 1990s Romania was faced with the reproductive health consequences of an aberrant pronatalist policy enforced for several decades by the Ceausescu's regime. Health policy makers tried to rapidly respond to these consequences by adopting new health strategies to reduce maternal and infant mortality. These strategies included development of the first national family planning program; introduction of new technologies in neonatal and maternal health services; implementation of active measurements to control the HIV/AIDS epidemic; and development of social programs for abandoned, institutionalized, and drug-using children and for domestic violence.
Such a rapidly changing array of critical reproductive health issues could not have been documented and addressed with only the help of vital records. More information was needed to assess the reproductive health status of the Romanian population during a period of rapid change in health care that influenced the health of women and children.
In 1993, the Romanian Ministry of Health, with technical assistance provided by the Division of Reproductive Health of the Centers for Disease Control and Prevention (DRH/CDC), conducted the first national population-based survey of women's reproductive health (93RRHS). The survey was designed to provide the Ministry of Health, international agencies, and nongovernmental organizations active in women's and children's health with essential information on fertility, women's reproductive practices, maternal care, maternal and child mortality, health behaviors, and attitudes toward selected reproductive health issues. The 93RRHS was instrumental in developing, evaluating, and fine-tuning the national family planning program and other reproductive health policies.
In 1996, a representative sample survey of women and men aged 15-24 was implemented to document young adult's sex education, attitudes, sexual behavior and use of contraception. Such survey had never before been carried out in Eastern Europe. Survey results were used to plan effective information campaigns, policies and programs targeting young people, and to monitor and evaluate the impact of programs already in place.
In 1999, a new nationwide reproductive health survey was designed and implemented in Romania (99RRHS) using the same methodology to allow for the study of reproductive health trends among the women aged 15-44 and to document the reproductive health of men aged 15-49. The surveys employed two separate probability samples to allow independent estimates for males and females. The survey's Final Report improves the already impressive contribution of the previous two studies because: a) documents reproductive health aspects among both women and men of reproductive age (men were selected from different households than women); and b) by oversampling three target judet (Constanta, Iasi and Cluj) documents the impact of region-wide interventions, implemented with USAID support, that consists of the establishment of modern women's health clinics, training of health professionals, development of IEC messages, social marketing, and provision of highquality contraceptive supplies.
In conclusion, the results of these large nationwide cross-sectional studies implemented in 1993 (sample size of 4,861 women aged 15-44), 1996 (sample size of 2025 women and 2047 men aged 15-24), and 1999 (sample size of 6,888 women aged 15-44 and 2,434 men aged 15-49), allow for generalizing the results to the entire reproductive age population of Romania. Although the surveys did not interview the same households, by applying similar questionnaires, the same sampling and field work methodology, they allow for a) a longitudinal examination of reproductive health issues among women, b) a detailed image of specific aspects of reproductive and sexual behaviors among men and c) a programmatic evaluation of reproductive health services in three regions.
Kind of Data
Sample survey data [ssd]
The 99RRHS was designed to collect information from a representative sample of women and men of reproductive age throughout Romania.
Producers and sponsors
Association of Public Health and Health Management (ARSPMS)
Commission for Statistics
School of Public Health
University of Medicine and Pharmacy "Carol Davila"
United States Centers for Disease Control and Prevention (CDC)
Technical assistance in survey design, sampling, questionnaire development, training, data processing, and report writing
United States Agency for International Development
United Nations Population Fund
United Nations Children's Fund
The 99RRHS was designed to collect information from a representative sample of women and men of reproductive age throughout Romania. Respondents were selected from the universe of all females aged 15-44 years and all males aged 15-49 years, regardless of marital status, who were living in Romania when the survey was conducted. The desired sample for females was 6,500, including an oversample of women in the three US AID priority judets (Cluj, Constanta, and Iasi).
The desired sample size for males was 2,500. The female and male samples were selected independently.
The survey used a three-stage sampling design, which allows independent estimates for the female and male samples. An updated master sampling frame (EMZOT), based on the 1992 census enumeration areas, was used as the sampling frame (National Commission for Statistics, 1996). The EMZOT master sample represents 3% of the population in each judet. In the female sample, the US AID priority judets were oversampled in both urban and rural areas to allow for independent estimates with adequate precision for women's health behaviors in these judets.
Except for the three oversampled judets (in which all available census sectors in the sample were retained), the first stage of the sample design was a selection of census sectors with probability proportional to the number of households recorded in the EMZOT. This step was accomplished by using a systematic sample with a random start for the female sample. A 50% subsample of the census sectors selected in the female sample (not including the oversample in the priority judets) constituted the first stage of the male sample. Thus, the first-stage selection included 317 sectors for the female sample and 128 sectors for the male sample. In the second stage of sampling, clusters of households were randomly selected in each census sector chosen in the first stage (separate households were selected for the female and male samples). Finally, in each of the households in the female sample, one woman aged 15—44 years was selected at random for interviewing and in the male sample one man aged 15-49 years was randomly selected in each household.
Because only one woman was selected from each household with women of reproductive age, and one male was selected from households with men of reproductive age, all results have been weighted to compensate for the fact that some households included more than one eligible female or male respondent. Survey results were also weighted to adjust for oversampling of households in the three US AID priority judets, and two more weights were added to adjust for non-response and for urban-rural distribution of the population.
Cluster size was determined based on the number of households required to obtain an average of 20 completed interviews per cluster. The number of households in each cluster took into account estimates of unoccupied households, average number of women aged 15-44 per household (men aged 15-49 for the male sample), the interview of only one respondent per household, and an estimated response rate of 90% in urban areas and 92% in rural areas for women and of 85% overall for men. Cluster size was determined to be 51 households in urban areas and 59 households in rural areas for the female sample and 49 and 55 households, respectively, for the male sample.
Of the 17,349 households selected in the female sample and 6,310 households selected in the male sample, 7,645 and 2,812 included at least one eligible respondent (a woman aged 15-44 or a man aged 15-49). Of these, 6,888 women and 2,434 men were successfully interviewed, yielding response rates of 90% and 87%, respectively. As many as four visits were placed to each household with eligible respondents who were not at home during the initial household approach.
Almost all respondents who were selected to participate and who could be reached agreed to be interviewed. Only 2% of respondents (regardless of gender) refused to be interviewed, and 7% of women and 11% of men could not be located. Response rates were not significantly different by residence, except for Bucharest, where the participation rate was slightly lower. Even though the overall response rate was similar in urban and rural areas, eligible respondents in urban areas were somewhat more likely to refuse to be interviewed; in rural areas eligible respondents were more likely to not be found at home.
Because the sample design is not self-weighting, it was necessary to weight observations for data analysis. The initial two of four weights represented the differential selection of households in each judet and the selection of one eligible respondent per household.
The number of households in each judet selected in the survey was compared with the number of households per judet estimated in the 1998 census projections (National Commission for Statistics, 1999). The ratio between the estimate of all existent households and sample-selected households in each judet represents the judet-specific household expansion factor. This factor was later normalized so that the sum of the household weights was equal to the total number of households in the sample. The variation in this weight reflects variation in the selection probability of the households within each judet.
These two weights (judet-specific household weight and one-respondent selection weight) were used to compare demographic characteristics of respondents with completed interviews with the 1999 population projections for Romania by age group, sex, and place of residence. The age distribution of the 99RRHS sample closely reflected that of the female population as a whole but overrepresented adolescent women (15-19 years old) and underrepresented women aged 25-29 years residing in urban areas. The age distribution of the male sample overrepresented adolescent men (15-19 years old) in urban areas and men 45-49 years of age in both urban and rural areas, whereas 20- to 24-year-old men in rural areas and 35- to 44-year-old men in urban areas were underrepresented (National Commission for Statistics, 1999). If percent distributions of the respondents in the two samples were calculated by urban-rural residence (not shown), both the female and male samples underrepresented the urban population of reproductive age according to the 1999 population projections estimated by CNS. Thus, an adjustment factor for non-response and a post-survey adjustment for the urban-rural distribution of the population were added to the two weights mentioned above.
The non-response adjustment weight was based on information gathered in the household questionnaire concerning background characteristics (residence, age, education and marital status) of those who refused to participate or who could not be found in up to four separate household visits.
Because information on education and marital status was not available for a substantial number of potential respondents, non-response rates we calculated by taking into account only age, sex, and residence. The non-response weight was the ratio of the proportion of all respondents selected in the sample and grouped in sub-classes (composed of five-year age groups and residence for each sample) to the proportion of respondents in each sub-class who completed interviews.
The post-survey adjustment for the urban-rural distribution was based on the 1999 CNS projections of the Romanian population by sex, age, and residence (National Commission for Statistics, 1999). For each sub-class, the post-survey adjustment factor was the ratio of the known national value to the sample estimate of that value. Thus, the final survey weight is the product of four weights: a household weight, a onerespondent-per-household weight, a non-response weight, and a post-stratification weight.
Dates of Data Collection
Data Collection Mode
Data Collection Notes
Data collection for the 99RRHS was carried out by 30 female interviewers for the women's sample and 10 male interviewers for the male sample, most of whom had experience conducting interviews in other household surveys, including the two previous national reproductive health surveys. Fieldwork was managed by staff of the Romanian Association of Public Health and Management (ARSPMS).
Interviewer training was managed by the ARSPMS. Interviewer training took place at the ARSPMS headquarters just before data collection began and consisted of one week of classroom training in fieldwork procedures and proper administration of the questionnaire, and one week of practical training in the field with close monitoring by the trainers.
At the end of training, six female teams and two male teams were selected, each consisting of four interviewers and one supervisor. The overall fieldwork implementation was supervised by two fieldwork coordinators. Fieldwork lasted from July through October 1999. Each team was assigned to visit a number of census sectors in all regions of the country. Interviews were conducted at the homes of respondents and lasted an average of 60 minutes for women and 32 minutes for men. Completed questionnaires were reviewed in the field by team supervisors, then taken by the fieldwork coordinators to the Romania's National Commission of Statistics (CNS) headquarters for data processing.
Disclaimer and copyrights
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.