Summary
When Nina became pregnant at 19, she wanted an abortion. Her family doctor told her that his hospital did not provide abortions on request, so she should search online for a provider. When she Googled “abortion,” the first result was “avort.ro.” Not knowing the organization was one that promotes anti-abortion rhetoric and works to prevent pregnant women and girls from going through with having an abortion, Nina called it. “They told me things that sounded sci-fi,” she recalled. “That doctors don’t use anesthesia, that the fetus would be handed to me all sliced up.”
The woman who she spoke to assured Nina that the state and church would help her if she kept the baby. But Nina still wanted an abortion, so the woman scheduled two appointments for her at the Giulesti Maternity Hospital in Bucharest. The doctor did not show up for either appointment. By then, Nina was already 12 weeks pregnant. Nina tried calling the woman again, but she never answered. After her son was born in 2020, Nina had to postpone her university education, quit her job, and leave the capital due to financial difficulties. “Being in this situation, it was like all my dreams went out of the window,” she said. “I experienced a major break in the perception that I could do anything. Maybe that is why I can’t bond with my son as well. It was really painful, and it still is.”
In theory in Romania, women and girls enjoy most sexual and reproductive health rights, including access to abortion and family planning methods. However, in practice, women and girls increasingly face barriers to accessing the healthcare resources necessary for the enjoyment of these rights.
In Romania, abortion on request—an abortion performed within a legally defined gestational limit at the request of a pregnant woman or girl, which does not require doctors or other professionals to attest to or certify the existence of a particular reason or justification for the abortion—is permitted until 14 weeks of pregnancy. At this stage article 201 of the Penal Code comes into play and punishes those who conduct or attempt to conduct an abortion on request after 14 weeks with imprisonment or by a fine and a “ban on the exercise of certain rights.” Physicians can also face a prohibition from practicing. The “pregnant woman” cannot be punished for terminating her pregnancy.
Doctors can perform abortions for up to 24 weeks of pregnancy if done for “therapeutic purposes,” and beyond 24 weeks for therapeutic purposes “in the interest of the mother or the fetus.” However, a growing number of doctors and public hospitals no longer provide legal abortion services for several reasons described in this report:
Hospital and clinic administrators have increasingly adopted policies, both formal and informal, that prohibit the provision of abortions on request and thus turn away patients seeking these services;
Doctors have frequently invoked conscientious objection when turning away patients, often without referring them to other medical facilities or doctors;
Some doctors cite concern about what they say is a lack of malpractice insurance provided to physicians working in public health care facilities, and how that might leave them without coverage for potential liability related to provision of abortion care;
Some doctors were unaware of, misunderstand, or misinterpret certain laws and guidelines concerning abortions on request, such as the recommended time limit for medication abortion (within 12 weeks of amenorrhea) and that 16- and 17-year-old girls do not require parental or legal guardian consent for non-emergency sexual and reproductive health services, including family planning services and abortion on request.
These barriers have had a significant impact on the availability of abortion services at public healthcare facilities across the country. Two Romanian nongovernmental organizations, FILIA Center, a feminist NGO based in the capital Bucharest, and the Euroregional Center for Public Initiatives, surveyed 242 public hospitals between February and May 2021 and found that of the 137 that provided the requested information, only 59 — less than half —provided both abortion procedures and medication abortions on request. According to the government’s Public Health Directorate, in 2021, 11 out of 41 counties in the country — over a quarter — recorded zero abortion procedures on request performed in public hospitals. Two of those eleven counties also recorded zero abortion procedures on request performed in private clinics.
Between November 2023 and February 2024, the Independent Midwives Association conducted another survey on access to abortion, analyzing 959 public and private medical facilities nationwide. 552 facilities stated that they do not provide abortion services (57.6%). Of these, 176 were public medical facilities, among which 111 (63.06%) did not provide any abortion services. The Association also found that 90% of the surveyed medical facilities that did not provide abortion services also did not refer women and girls requesting an abortion to other medical facilities or practitioners.
Such obstacles to accessing abortions on request in public hospitals often push women and girls to seek these services from private hospitals and clinics, which are not covered by Romania’s public health insurance system, National Health Insurance House, and must instead be paid for through out-of-pocket payments or private health insurance. Abortion on request services can cost about 150 Lei (about €30 or US$32) in public hospitals. In private clinics, however, abortion on demand can cost between 1,200 to 1,500 Lei (about €240 to €1,004 or US$247 to $1,030), which could be more than a month’s salary on the national minimum wage.
As a result, many women and girls who are forced to seek out abortion services from private-sector providers are unable to access them because of cost or must face significant financial hardship to do so. This is particularly true for socially and economically marginalized communities in Romania that are more likely to experience poverty, including people from the Roma community, rural women and girls, and some adolescents.
Some women and girls also face financial barriers to accessing contraceptives, which are also not covered by the National Health Insurance House nor subsidized by any other state-funded program at time of writing. This challenge is not new: Since 2013, the Ministry of Health has not allocated funding for the acquisition and distribution of free contraceptives through any of its existing programs or the National Health Strategy.
Laws, policies, and the public perception of abortion, contraception, and sexuality education in Romania have been influenced in recent years by the anti-rights movement, which is a transnational campaign against legislative and policy developments on human rights issues, including gender equality. Proponents have built cross-border alliances under the banner of countering so-called “gender ideology”, a term used to portray efforts to advance gender equality—including those aiming to uphold sexual and reproductive health rights, combat gender-based violence, and eliminate discrimination based on sexual orientation and gender identity—as foreign ideas that supposedly threaten “traditional” values and families.
Furthermore, religious institutions and governmental officials have made efforts to block access to sexual and reproductive health services, provision of sexuality education, and lesbian, gay, bisexual, and transgender (LGBT) rights. Religious denominations, particularly the Romanian Orthodox Church and Protestant churches, have perpetuated and supported anti-rights rhetoric as well, and the influence of religious conservatism extends to healthcare provision. Public hospitals often have churches on their premises; priests employed by these churches sometimes use their location to propagate anti-abortion rhetoric to pregnant women and girls going to the hospital to obtain an abortion, as well as healthcare providers who work there.
A key manifestation of the anti-rights movement in Romania is the establishment of what are referred to as crisis pregnancy centers (CPCs), a model that originated in the United States and has now spread to some other countries. Although they may present as providing comprehensive information and support to pregnant women and girls, CPCs promote anti-abortion rhetoric and seek to block pregnant women and girls from obtaining abortions, including by making misleading offers of support and information and promising them resources such as housing and money if they do not obtain an abortion. Some public institutions, including General Directorates for Social Assistance and Child Protection and public maternity hospitals, have formally or informally collaborated with CPCs, providing them with significant access to public healthcare facilities and women and girls seeking abortion services. The Ministry of Labor and Social Protection provides accreditation as a social service provider to at least one major CPC in Romania called the Pulse Center (Centrul PULS).
In practice, some CPCs do not follow through on their promises at all, while others provide access to resources for a limited period after birth, leaving these women and girls and their young children on their own after at most a couple of years. Many CPCs in Romania are religiously affiliated and conduct their anti-abortion activities alongside the provision of other charitable social assistance, sometimes in collaboration with public institutions. CPCs in Romania have been established and/or supported by religiously affiliated anti-abortion organizations in other countries, particularly the United States, through funding, training, advocacy, and networking.
Human Rights Watch found that CPCs’ practices have significantly hindered access to abortion services at public healthcare facilities. While this is the overt goal of these private institutions, Romania’s failure to ensure the availability, accessibility, and quality of abortion services at public facilities, exacerbated by the failure to regulate these private entities in a way to prevent them interfering with women and girls’ right of access to abortion services constitute violations of the human right to the highest attainable standard of health as well as the principle of equality and non-discrimination.
Finally, adolescents in Romania do not have access to mandatory comprehensive sexuality education (CSE). While some important information regarding pregnancy, family planning, and sexually transmitted infections is included in the compulsory 7th grade biology curriculum, a CSE activist noted that many teachers avoid these topics with their students. Schools can offer “health education” as an option for students in year 1 to 12. The courses available in that curriculum include many topics that follow UN international guidance on sexuality education, providing age and stage-appropriate scientifically and evidence-based information about a full range of topics related to sexuality. But their optional nature allows teachers to avoid teaching certain topics they would deem inappropriate or controversial, such as sexuality and abortion. Participation rates have been consistently low over the years, which activists claim is due to the Ministry of Education’s failure to properly implement health education, combined with the effect of the anti-rights movement.
Due to the dearth of youth-friendly education services for sexual and reproductive health, adolescents who cannot access sexual and reproductive health in schools face difficulty seeking information directly from healthcare providers and instead turn to the internet. This forces them to navigate an abundance of online sources to find correct information, which may be challenging for adolescents. Romania has one of the highest adolescent birth rates among European Union member states. The lack of access to sexual and reproductive health information, including through CSE, contributes to adolescent pregnancy rates by depriving young people of information that could help them make informed choices about their health.
As a party to the International Covenant on Economic, Social and Cultural Rights (ICESCR), Romania bears the legal obligations to respect, protect, and fulfil the right to the highest attainable standard of physical and mental health.
The Committee on Economic, Social and Cultural Rights (CESCR), which provides authoritative interpretations of the obligations of states parties enshrined in the ICESCR, explained in its general comment no. 14 that governments’ right-to-health obligations include the duty to ensure that access to healthcare resources is accessible without discrimination, especially for the most marginalized sections of the population, and without cost-based barriers. States parties must also ensure “the right to seek, receive and impart information and ideas concerning health issues.” The CESCR has also explained that “private health-care providers should be prohibited from denying access to affordable and adequate services, treatments or information,” and that “where health practitioners are allowed to invoke conscientious objection to refuse to provide certain sexual and reproductive health services, including abortion, they should refer the women or girls seeking such services to another practitioner within reasonable geographical reach who is willing to provide such services.”
Romania has Human Rights Obligations to Ensure Access to Safe Abortion, Contraception, and CSE
Access to abortion services is a necessary element for the exercise and enjoyment of health and other human rights and Romania should take all necessary steps to ensure that women and girls have informed and free access to safe and legal abortion services. Accordingly, Romanian authorities should review and amend relevant legislation to ensure that unmonitored and unregulated legal and institutional processes in the healthcare and education systems do not impede women’s and girls’ rights, including the right to legal abortion access, contraception, and CSE. They should take concrete measures to make sexual and reproductive health care and information widely available and affordable so women and girls can exercise agency and make the informed decisions about their health.
Glossary
Abortion on Request: Abortion performed within a legally defined gestational limit at the request of a pregnant woman or girl, which does not require doctors or other professionals to attest to or certify the existence of a particular reason or justification for the abortion.[1]
Amenorrhea: The absence of menstruation.[2]
Cisgender: Term that denotes or relates to a person whose sense of personal identity and gender corresponds with the sex assigned to them at birth.
Comprehensive Sexuality Education (CSE): An age and developmentally appropriate, scientifically accurate and evidence-based curriculum that encompasses the “cognitive, emotional, physical and social aspects of sexuality.”[3] It aims to equip children and young people with knowledge, skills, attitudes and values that will empower them to: realize their health, well-being and dignity; develop respectful social and sexual relationships; consider how their choices affect their own well-being and that of others; and, understand and ensure the protection of their rights throughout their lives.”[4]
Conscientious Objection: In the area of reproductive health, this refers to healthcare professionals’ refusal to provide certain services, such as legal abortion and contraception, “based on religious, moral or philosophical objections.”[5]
Consent: In the context of sexuality, consent is an agreement between participants to engage in sexual activity. Consent should be clearly and freely communicated.
Heterosexual: Sexual orientation of a person whose primary sexual and romantic attraction is toward people of a different sex.
Intersectional: Relating to the interconnected nature of social categorizations such as race, class, and gender as they apply to an individual or group, regarded as creating overlapping and interdependent systems of discrimination or disadvantage.
LBT (women and girls): Acronym for “lesbian, bisexual, and transgender”.
Medication Abortion: The use of pharmacological agents to terminate pregnancy. It is also called “medical abortion.”[6]
Power relations: In interpersonal interaction, the relative status, power, and/or dominance of the participants, reflected in whether expectations and behavior are reciprocal, and consequently in communicative style. Power relations are a key dimension in interpersonal communication.
Relational health: Establishing and maintaining meaningful relationships with self, other individuals, groups and communities and develops from our interactions and connections with others. Having a network, grounded in supportive relationships, can help create feelings of satisfaction and security.
Therapeutic Abortion: An induced abortion following a diagnosis of medical necessity.[7]
Transgender (also “trans”): Denotes or relates to people whose assigned sex at birth differs from their gender identity.
Unsafe Abortion: A procedure for terminating a pregnancy “carried out either by persons lacking the necessary skills or in an environment that does not conform to minimal medical standards, or both.”[8]
Recommendations
To the Parliament of Romania
Fully decriminalize abortion and protect the right of access to abortion on request in law.
Guarantee access to safe and legal abortions on request by promoting the availability of these services and eliminating discriminatory, cost-based, and informational barriers to access, including through:
Developing and enforcing clear guidelines for conscientious objection in healthcare settings to ensure that it does not impede access to abortion care. These guidelines should be aligned with Romania’s human rights obligations, and clarify that conscientious objection can only be invoked by individuals, not by institutions, and must be handled in a manner that does not create a barrier to a patient accessing care, including requiring that women or girls seeking such services be referred to another practitioner within reasonable geographical reach who is willing and able to provide such services in a timely manner.
Enacting or amending legislation to ensure that public hospitals provide abortions on request and cannot suspend abortion care services. This should include preventing public hospitals from using article 206 of Law 95/2006 as a justification for not providing abortions on request, and enacting binding requirements for public hospitals to have willing and trained staff available to perform abortions on request in a timely manner.
Removing the parental or legal guardian consent requirement so all persons under 18 can access sexual and reproductive health care, including abortion on request and contraception, without needing to involve a parent or guardian, in line with the recommendations of the UN Committee on the Rights of the Child.
Ensure adequate allocation of resources to fully implement the National Health Strategy for 2023-2030 as it relates to sexual and reproductive health and rights--with particular attention to the needs of people in rural or marginalized communities, including Roma people and people living in or at risk of poverty--including:
Specific Objective no. 1.4 on decreasing inequities in access to services;
Specific Objective no. 2.1 on health education; and
General Objective no. 4 on improving the availability of and accessibility to timely and cost-effective health services and technology for people in rural or marginalized communities, including Roma people and people living in or at risk of poverty.
To the Ministry of Health
Urgently implement the National Health Strategy for 2023 to 2030, including:
Specific Objective no. 1.4 on decreasing inequities in access to healthcare services;
Specific Objective no. 2.1 on promoting health education;
General Objective no. 4 on improving the availability of and accessibility to timely and cost-effective health services and technology for people in rural or marginalized communities, including Roma people and people living in or at risk of poverty; and
Coordinating with the Ministry of Education to achieve the strategy’s goal of making health education a compulsory school subject by 2030.
Guarantee universal and equitable access to sexual and reproductive health services and products by eliminating barriers to access and ensuring the full implementation of relevant laws and policies, including through enacting or proposing the amendments of relevant legislation to:
Regulate the use of conscientious objections by healthcare providers, including the establishment of a monitoring and oversight mechanism to ensure that the invocation of conscientious objection does not impede access to legal abortions on request in public health institutions. This should include clear guidelines on referring women and girls seeking the service to another practitioner within reasonable geographic reach in a timely manner.
Extend coverage of the National Health Insurance House (Casa Naţională de Asigurări de Sănătate, CNAS) coverage, ensuring equitable access to this reproductive healthcare for all women and girls, regardless of income.
Develop a centralized information system that provides clear and accessible information, based on national and international guidelines, on the availability of legal abortion care services in public and private health institutions.
Ensure access to free and/or subsidized provision of contraceptives at a level sufficient to fully meet the need, including through adequate allocation of funds to the National Health Strategy and the Women’s Health Subprogram.
Collaborate with the Ministry of Education, medical universities, and civil society organizations to develop and implement a public education campaign, in accessible and easy-to understand formats, to combat misinformation about sexual and reproductive health issues, including abortion, contraception, and comprehensive sexuality education (CSE).
Develop and implement measures, in collaboration with medical universities and civil society organizations, to combat the spread of misinformation by nongovernmental organizations (NGOs) and religious groups about abortion and contraception in hospitals, including the establishment of an oversight mechanism to ensure that NGOs’ and religious groups’ activities and information are evidence-based and aligned with international and national laws and guidelines on sexual and reproductive health.
Coordinate with the National Authority for Health Quality Management to develop standards and criteria for evaluating the quality of provision for comprehensive abortion care in all public hospitals and ambulatory care services.
Ensure all hospital managers, health professionals, and health system personnel receive regular and mandatory (at least annual) training on relevant laws, regulations, technical guidelines, and procedures on legal abortion and other sexual and reproductive health services.
Ensure that all obstetrician-gynecologists receive mandatory training on abortion procedures in the context of a comprehensive residency and through continuous medical education (at least once every two years).
Ensure all healthcare providers know, understand, and implement article 661(b) of Law No. 95/2006 on Healthcare Reform, which guarantees adolescents over 16 access to sexual and reproductive health care without parental or guardian consent.
Take measures to ensure that the sexual and reproductive health care provided is adolescent-responsive, confidential, non-stigmatizing.
Systematically gather, analyze, and report data and information on access to and provision of legal abortions, availability of contraceptives, and training of health professionals.
Include midwives in Law 95/2006 as medical professionals that provide reimbursed sexual and reproductive health care and services and expand to other medical professionals, including midwives, family doctors, school doctors, family planning doctors the competency for provision of medication abortion, in line with the World Health Organization guidelines on abortion care issued in 2022.
To the Ministry of Education
Ensure schools provide inclusive, age and stage-appropriate, accessible, scientifically accurate and non-discriminatory CSE by:
Adhering to international, evidence-based technical guidelines on CSE;
Reinstating the requirement for all schools to provide health education with a CSE component for students of all grades and ages, without requiring parental or legal guardian consent.
Engaging young people, in all their diversities, and civil society organizations working on sexual health education, women’s rights, children’s rights, LGBT rights, Roma rights, disability rights, and gender equality to review the sexual health education component of the health education curriculum and ensure it is comprehensive, inclusive, age-appropriate, non-discriminatory and available in easy-to-understand formats.
Developing and implementing a training program, including on gender equality, for health education teachers, in collaboration with the aforementioned civil society organizations.
Establishing a national mechanism to regulate, monitor, and report data on the implementation of the health education curriculum, including CSE, and to prevent the spread of misinformation and disinformation about sexual and reproductive health in schools throughout Romania.
To the Romanian Society of Obstetrics and Gynecology
Develop and implement a nationwide program to educate all obstetricians and gynecologists on World Health Organization (WHO) abortion care guidelines and on relevant national legislation and guidelines on the provision of abortion care, including:
the legal timeframe for abortions on request (14 weeks of pregnancy);
the recommended timeframe for medication abortion (12 weeks of amenorrhea);
the legal age at which adolescents can receive sexual and reproductive health care without parental or legal guardian consent (16 years old); and
that adolescents under 16 can receive sexual and reproductive health care with parental or legal guardian consent; and
the obligation under the Romanian College of Physician’s Code of Medical Deontology for doctors invoking conscientious objection to refer patients to other medical facilities or practitioners who can provide the service.
To the Council of Europe’s European Committee of Social Rights
Continue urging Romania to submit information on access to modern contraception and legal abortion, including on its measures and actions taken to ensure that conscientious objections by healthcare providers do not hinder access.
Request information on the backlash against abortion providers and civil society activists advocating for sexual and reproductive health rights.
To the Council of Europe’s Parliamentary Assembly
Publicly condemn the spread of misinformation by anti-rights organizations that stigmatize and obstruct access to legal abortion care in Romania, as well as in other member states, in violation of women’s and girls’ sexual and reproductive health rights.
Urge Romania to implement Resolution 2439 (2022), which includes measures to combat the spread of misinformation and obstructions to legal abortion by anti-rights organizations and measures to ensure evidence-based abortion care information is available through information campaigns and CSE.
Urge Romania to implement Resolution 2331 (2020), which includes measures to introduce contraceptive methods in the national health insurance and introduce CSE.
To the European Commission
Publicly condemn retrogressive measures by Romania, as well as other European Union member states, which violate women’s and girls’ sexual and reproductive health rights.
Improve access to abortion care in Romania by providing funding for abortion care services.
Urge and assist member states to develop a mechanism to facilitate access to abortion care for people living in EU countries where access is limited or blocked, including Romania.
To the European Parliament
Urge Romania to uphold its international and regional human rights obligations to respect, protect, and fulfill sexual and reproductive health rights, which include the rights to abortion, contraception, family planning, and CSE.
Publicly condemn all forms of threats, intimidation, and harassment directed against the civil society organizations and activists in Romania working to combat misinformation about abortion care and advance the sexual and reproductive health rights of women and girls.
Ensure that the European Union budget prioritizes sexual and reproductive health rights and includes funding specifically targeted at ensuring access to abortion for all women, girls, and pregnant people, including adolescents, living in member states, including Romania, where access to abortion is limited.
To the European Parliament’s Committee on Women’s Rights and Gender Equality
Recommend measures to prevent any further retrogression of women’s and girls’ sexual and reproductive health rights.
Continue to publicly condemn retrogressive measures on sexual and reproductive health rights and the spread of misinformation on abortion and contraception perpetuated by anti-rights organizations in Romania, as well as in other EU member states.
To the UN Committee on the Elimination of Discrimination against Women
Urge Romania to implement the recommendations in the 2017 concluding observations, including on sexual and reproductive health rights, specifically abortion, contraception, and CSE.
Carry out a country visit to investigate women’s and girls’ access to sexual and reproductive health services, specifically abortion and contraception, and students’ access to CSE.
To the UN Special Rapporteur on the Right to Health
Carry out a country visit to investigate women’s and girls’ access to sexual and reproductive health services, specifically abortion and contraception, and young peoples’ access to CSE.
To the UN Working Group on Discrimination against Women and Girls
Urge Romania to implement the recommendations from its 2020 visit, including on sexual and reproductive health rights, specifically on issues related to abortion, the monitoring and regulation of conscientious objection, contraception, and CSE.
Request permission from Romania to carry out a follow-up visit to investigate whether the recommendations given after the 2020 visit are being implemented.
Methodology
This report is based on in-person and video interviews that Human Rights Watch conducted between December 2022 and May 2023. Interviewees were in Brașov, Bucharest, Hunedoara, Iași, Suceava, and Timișoara.
Human Rights Watch interviewed 31 activists, journalists, and experts working on rights issues concerning women and girls in Romania, including sexual and reproductive health rights, sexuality education, sexual and gender-based violence, lesbian, gay, bisexual, and transgender (LGBT) rights, and Roma rights. Human Rights Watch also interviewed 27 healthcare providers and experts in Romania, including doctors, a medical resident, hospital and clinic managers, community medical assistants, medical students, and a lecturer of medical law. We interviewed six women about their experiences accessing sexual and reproductive health care, including abortion on request and crisis pregnancy centers, since 1995. We communicated with some interviewees more than once for updates or clarifications.
In addition, Human Rights Watch contacted 11 anti-abortion organizations in Romania: the founders of four of these organizations spoke with us, but seven declined. We spoke with one archbishop and two priests from the Romanian Orthodox Church and one priest from a Greek Catholic Church who were involved in the provision of social services and/or counseling to women and girls, either through charities they established or through their work in public hospitals. Human Rights Watch also contacted three anti-abortion organizations in the United States, but they had not responded at time of writing.
Finally, we met with several national- and local-level government officials. We interviewed three representatives of the Ministry of Health and four from the National Agency for Equal Opportunities between Women and Men (ANES). We also interviewed four representatives from the political party Reper, including three members of parliament (MPs) and one legal advisor. At the local level, we spoke with the General Directorate of Social Services and Child Protection (DGASPC) and the County School Inspectorate in Brașov as well as the Public Health Directorate in Iași. We also wrote to the Ministries of Health, Education, Labor and Social Protection, and Family, Youth and Equal Opportunities, but did not receive responses.
Some interviewees’ names and identifying details have been withheld at their request to protect their privacy and security, given the politicization of these topics in Romania and the evolving political context.
Researchers explained the research and purpose of the interviews to all interviewees, as well as how Human Rights Watch would use the information, and offered interviewees the option of anonymity in any written materials. Where the report uses names and identifying details, interviewees gave informed consent for Human Rights Watch to do so. Researchers also explained that interviewees could pause or stop the interview at any time or elect not to respond to specific questions. All interviewees gave verbal consent to participate in interviews.
Researchers conducted the interviews in English or in Romanian with English interpretation. Most were conducted individually, but several were group interviews with more than one representative of a group or organization. In-person interviews occurred in the offices of organizations or institutions or in public spaces, such as cafés, selected by interviewees. No financial compensation was paid to interviewees.
Finally, as this research documents the experiences of women and girls who identified as heterosexual, cisgender, and non-Roma, it does not necessarily reflect the intersectional experiences of particular groups who are also affected, such as LBT, Roma, or migrant women and girls. These intersectional experiences are also key to fully understanding this issue. Two Roma activists told us that racism permeated the provision of health care to Roma women and girls; we tried to find Roma interviewees without success.
I. Background
Romania’s widely criticized abortion ban (Decree No. 770 of 1 October 1966), which caused tens of thousands of women and girls to suffer or even die, ended in 1989, and the country enjoyed a period of greater respect for reproductive rights in the years that followed.[9] However, in recent years access to key sexual and reproductive health services, such as abortion, contraception, and sexuality education, is increasingly declining in Romania, partly fueled by a transnational anti-rights movement that undermines women’s and girls’ rights. This has pushed some women and girls toward what are referred to as “crisis pregnancy” services, typically modeled after right-wing anti-abortion centers in the United States, that offer pregnancy related information but proactively seek to prevent pregnant women and girls from obtaining abortions.
According to 2022 data, the country had the highest adolescent birth rate for girls ages 10 to 14, and the second highest adolescent birth rate for girls ages 15 to 19, of all EU member states.[10]
Legislative Framework on Abortion, Contraception, and Sexuality Education
Romania’s legal framework on abortion, contraception, and sexuality education impacts access.
Abortion
Romania’s Penal Code provides that those who carry out abortions on request when the pregnancy has exceeded 14 weeks are punishable with a fine, up to 3 years imprisonment and a ban on the exercise of certain rights.[11] Physicians can also face a prohibition from practicing.[12] However it also provides that physicians specializing in obstetrics and gynecology (ob-gyns) who perform abortions for “therapeutic purposes” for up to 24 weeks of pregnancy or, if necessary, even later if “in the interest of the mother or of the fetus”, shall not commit an offence.[13] While the Penal Code does not define “therapeutic purposes,” Romania’s Law on Patients’ Rights states that a woman’s right to life prevails “if the pregnancy represents a major and immediate risk factor” to her life.[14] Under the Penal Code, a “pregnant woman” cannot be punished for terminating her pregnancy.[15]
In line with guidance of the World Health Organization (WHO), the Romanian Society of Obstetrics and Gynecology recommends medication abortion within 12 weeks of amenorrhea.[16] WHO-recommended medications for medication abortion are available in Romania, although women’s and girls’ access depend on the location or doctor’s knowledge about medication abortion, as well as their financial situation.[17]
Romanian law requires doctors, dentists, nurses, and midwives to accept patients “when the lack of medical assistance may seriously and irreversibly endanger the patient’s health or life.”[18] Such healthcare providers must also provide health care within medical institutions, according to legal regulations.[19]
Romania has no legislation indicating that abortions are considered “medical assistance,” or a “medical act,” which would obligate doctors to perform them.[20] However, there is guidance on when doctors may refuse to perform abortions on request. Under the Romanian College of Physicians’ Code of Medical Deontology, there are legal parameters that permit a doctor to refuse to provide medical services that would “undermine his professional independence, affect his image or moral values,” or violate “the fundamental principles of the practice of the medical profession.”[21] This allows doctors to deny services on grounds of so-called conscientious objection. Although the code obligates doctors invoking conscientious objection to refer patients elsewhere, a 2024 telephone survey conducted by the Independent Midwives Association found that 90% of hospitals and clinics (out of 959) refused to provide referrals for women and girls requesting abortion.[22]
Contraception
The Law on Patients’ Rights guarantees the right to effective and safe family planning methods.[23] Emergency contraceptives do not require a prescription and are available over the counter in pharmacies.[24]
Legal Restrictions for Adolescents Under 16
Adolescents under 16 must obtain parental or legal guardian consent to obtain non-emergency sexual and reproductive health services, including contraception and abortion on request.[25] According to some of the young people Human Rights Watch spoke to, this restriction contributes to them being reluctant to access reproductive health services.[26]
Sexuality Education
In 2001, Romania’s Ministry of Education and Ministry of Health signed a protocol establishing the National Health Education Program.[27] Based on the foundational framework provided by the protocol, the Ministry of Education approved the curricula of a discipline called “health education” in 2004—a broad, optional discipline under which various subjects concerning sexual and reproductive health are subsumed. The curriculum offers teachers guidelines on which subjects are considered appropriate to teach at each educational level. The curriculum comprises nine “compulsory themes,” from which teachers may choose age-appropriate “sub-themes.” For instance, the curriculum recommends that students in grade 7 be taught about topics such as nutrition, reproductive health, family, and substance abuse. From grade 8 onwards, the curriculum recommends going into topics such as social relationships, unwanted pregnancy, and abortion.[28]
Also in 2004, the parliament passed Law No. 272 on the Protection and Promotion of the Rights of the Child, which included a specific reference to sexuality education in article 46(3(i) that required specialized government institutions at all administrative levels to provide the “systematic implementation” of sexuality education in order to prevent the transmission of sexually transmitted infections and underage pregnancies.[29] This article was supplemented in April 2020 by an amendment stipulating that such sexuality education must be offered at least once a semester in schools.[30]
Anti-rights actors pushed back.[31] Parliamentarians from the Social Democrat Party (PSD) and the National Liberal Party (PNL) drafted an amendment making the sexual education subject optional in grades 8 and higher while requiring parental or legal guardian consent for students under 18. This draft was adopted by the Chamber of Deputies in June 2020 and sent to President Klaus Iohannis for promulgation.[32] Meanwhile, over 50 NGOs supportive of universal and comprehensive CSE mobilized to push back against these changes.[33]
The president submitted a complaint of unconstitutionality in response, referring to procedural inconsistencies, contesting the requirement for parental consent, and criticizing the removal of the “once a semester” requirement.[34] The Constitutional Court overruled the president’s complaint in October 2020, noting that the legislation still provided for sexuality education. The next month, the president submitted a request to the Constitutional Court for re-examination.[35] Meanwhile, anti-abortion civil society organizations continued lobbying for the adoption and promulgation of the amendments. For example, in February 2021, the Federation of Orthodox Pro Vita Organizations in Romania, an anti-rights umbrella group that includes the PRO VITA Bucharest Association, published an open letter to parliament, the President, and civil society calling for “the promotion of the moral values of chastity, abstinence, and love as the basis of sexual activity.”[36]
Over the next two years, political parties debated the adoption of these retrogressive amendments to Law No. 272 of 2004.[37] Right-wing politicians took issue with and misinterpreted the phrase “sexual education”; one described it as “child masturbation, gender ideology, teenage abortions, in a word: sexualization.”[38] One member of parliament, Simina Tulbure from the political party Reper, who supported the bill, was threatened. “I got death threats from the extremist, ultra-religious groups,” she said. “The groups also went after my family’s Facebook and messaged them saying how bad of a daughter I was.”[39]
Ultimately, politicians opposed to mandatory CSE succeeded at pushing back: in June 2022, parliament readopted the retrogressive amendments and President Iohannis promulgated them by Decree no. 927/2022.[40]
While the health education curriculum as a whole contains crucial information, teachers may pick and choose from the pool of designated age-appropriate sub-themes and teach only some of them.[41] This allows them to bypass and avoid topics at their liking, such as abortion and sexual orientation.[42] Although the June 2022 amendments did not change the content of the health education curriculum, civil society organizations have raised concerns that the erasure of the term “sexual education” can, in practice, encourage teachers to limit the sections of the curriculum that they choose to teach to personal hygiene topics while excluding important issues for young people “such as relational health, consent, power relations or gender equality.”[43]
Members of the Standing Committee on Sexual & Reproductive Health including HIV/AIDS (SCORA), a medical students’ association with provincial branches that some public schools contracted to provide health education, said some school directors were reluctant to allow the inclusion of topics such as abortion and contraception. The Local Officer of Reproductive Health of SCORA’s Brașov branch said she reached out to at least eight public schools to seek a contract to teach sexual and reproductive health to 9th and 12th grade students but faced difficulties:
One [school] said no at first, and it took three months of convincing to get a contract with them…. Initially, we did not tell the school about the subject we wanted to teach. When the school found out that it was about sexual and reproductive health, they didn’t want to let me in.[44]
Of the 10 adolescents and young adults across four counties interviewed by Human Rights Watch all said their health education was limited to lessons on basic anatomy.[45] In 2021, the Ministry of Education reported that only 7% of students across Romania had attended health education classes.[46] According to one student volunteer: “There is a cloak of invisibility around girls. You are not supposed to discuss things such as their sexual health.”[47]
Pushback from the Anti-Rights Movement
The anti-rights movement has further shaped the abortion, contraception, and sexuality education landscape. This movement is a transnational campaign against legislative and policy developments on human rights issues, including gender equality.[48] Proponents have built cross-border alliances under the banner of countering so-called gender ideology, a term used to portray efforts to advance gender equality—including those aiming to uphold sexual and reproductive health rights, combat gender-based violence, and eliminate discrimination based on sexual orientation and gender identity—as foreign ideas that supposedly threaten “traditional” values and families.[49]
In Romania, religious institutions and government officials have attacked sexual and reproductive health services, sexuality education, and LGBT rights. The Romanian Orthodox Church has objected to abortion on request, contraception, and CSE.[50] For instance, when parliament made “sexual education” mandatory in April 2020, the church called it an “attack on the innocence of children.”[51] Vasile Bănescu, spokesperson of the church, criticized “gender ideology” as being the “progressive demolition of the society.”[52] This church’s stance is relevant since 85.3 percent of the population is Romanian Orthodox as of 2021.[53]
Members of Protestant churches have also participated in anti-rights activities, including key politicians who expressed their anti-abortion, CSE, and/or LGBT stances through interviews, social media posts, and legislative initiatives. For example, former Baptist pastor and current politician Ben-Oni Ardelean called the “Matić Report”—a groundbreaking report on sexual and reproductive health rights in the European Union—“a project that promotes the idea that the woman does not have to be a mother.”[54] In addition, Pentecostal pastor and politician Robert Sighiartău and Pentecostal politician Titus Corlăţean authored the 2022 regressive amendments on sexuality education in schools.[55]
Moreover, the government has taken an anti-LGBT rights stance. In October 2018, the government, with the support of US-based anti-rights organizations, Alliance Defending Freedom and Liberty Counsel, held an unsuccessful referendum against same-sex marriage.[56] Parliament continued trying to undermine gender equality, including through the unsuccessful 2020 legislative proposal to ban the propagation of “gender ideology” in educational settings and the 2022 “anti-LGBT propaganda” bill, which sits in the Chamber of Deputies (the lower house of parliament) at time of writing.[57]
Crisis Pregnancy Centers (CPCs)
Both international and Romanian anti-rights groups, which often have religious affiliations, have established or supported organizations in Romania that target women and girls experiencing a “criza de sarcină” (“crisis of pregnancy”). Anti-abortion actors in Romania define a “crisis of pregnancy” as the moment a woman or girl considers abortion. Some understand the “crisis” to involve a personal difficulty, including with her partner, family, or community and/or financial or educational concerns.[58]
Romania’s “crisis pregnancy centers” (CPCs) often borrow the methodology and language of centers in the US, their country of origin. Like those of their US counterparts, the websites of Romania’s CPCs do not usually make it clear to visitors that they are anti-abortion. Instead, they display open ended phrases such as: “Are you pregnant, scared, and in need of help?” Or may also have explicitly misleading questions such as “Do you want to have an abortion? We are at your service!”[59] In addition, many CPCs in Romania are connected to and receive training, money, and other resources from anti-abortion organizations in the US.[60] CPCs often use misinformation, deception, and scare tactics—also imported from the US—to prevent or dissuade women and girls from terminating pregnancies.[61] For example, their advertising may imply that they offer abortions, or they may provide false or medically unsound information (for example, that having an abortion renders women unable to become pregnant again).[62]
However, in some areas of Romania where public health services remain scarce and access difficult due to financial, geographic, and structural constraints, there are no available or affordable sources of accurate information or support for pregnant women and girls.[63] Some county or municipal medical facilities or social service departments have even partnered with CPCs or promoted their services, giving them greater access to and credibility in communities.[64]
II. Availability and Accessibility of Abortion Services and Contraception
It’s a whole paradox. In Romania, it’s legal to have an abortion, but this right is actually restricted.
—Diana Oncioiu, journalist, Bucharest, December 5, 2022[65]
Diminishing availability and accessibility of access to abortions on request and contraceptives has a damaging impact on and violates the right to health of women and girls in Romania. Public health services for abortions on request are often unavailable or inaccessible for a variety of reasons, affecting everyone seeking an abortion, but especially harming certain demographics such as girls under 18, poor and rural women and girls, and Roma women and girls, who face additional access barriers. Most of the activists, journalists, and experts that Human Rights Watch interviewed said that religious conservatism contributed to perpetuating anti-abortion discourses and creating barriers for women and girls trying to access abortions on request in Romania.[66] Legal loopholes and the lack of clarity on key laws concerning sexual and reproductive health services have also impacted healthcare providers’ ability and/or willingness to provide timely access.
Inadequate Availability of Abortion Services at Public Healthcare Facilities
Twenty local activists, journalists, and experts interviewed by Human Rights Watch said access to abortions on request is decreasing, which they primarily attributed to the growing number of public hospitals and doctors that no longer provide abortions on request.[67] In addition to the aforementioned barriers posed by hospitals’ administrative decisions and conscientious objection (both of which have been influenced by religious conservatism), Human Rights Watch’s research found that practices related to or purporting to be related to Covid-19 restrictions, lack of space, lack of malpractice insurance coverage, and unclear legislation on abortions on request were key contributing factors to services being unavailable.
In their 2021 report, local NGOs FILIA Center and the Euroregional Center for Public Initiatives found that, between February and May 2021, only 59 of the 137 public hospitals that responded to their survey provided both abortion procedures and medication abortions on request.[68] According to the government’s Public Health Directorate, in 2021, 11 out of 41 counties recorded zero abortion procedures on request performed in public hospitals; 2 of those 11 counties also recorded zero abortion procedures on request performed in private clinics.[69] This data does not include statistics on medication abortions, which public and private hospitals and clinics do not track.[70]
Of the 16 ob-gyns Human Rights Watch interviewed in the cities of Brașov, Bucharest, Hunedoara, Iași, Timișoara, 14 said they did not provide abortion procedures on request in their public and/or private practices due to personal reasons or institutional restrictions. Of those 14, 10 did not give prescriptions for medication abortions.[71]
Hospitals’ Administrative Decisions
Some doctors do not perform abortions on request because of administrative decisions by public hospitals.[72] According to one journalistic investigation in 2019, 30 percent of 190 contacted hospitals refuse to grant abortions.[73] At least two public hospitals have official statements enshrining their administrative decisions not to provide abortions on request, but most made informal decisions (without accompanying paperwork) not to offer this service.[74]
Informal decisions can be longstanding. One medical resident whose hospital prohibits abortions told Human Rights Watch about its unwritten policy:
There is no written protocol to my knowledge, but this is the unwritten rule at this hospital for about 10 years. I found this out from the medical staff who had been at this hospital for 10 years or more, but no one could tell me the reasons why.[75]
Informal, unwritten decisions lead to a lack of transparency and uncertainty regarding the provision of abortions. One family planning doctor recalled how she learned her hospital stopped providing them:
Ten years ago, I received a patient. The patient found out she was pregnant during the examination, and so I called my colleagues who were in the relevant department to schedule an abortion. They told me that this service was no longer being performed.... I received the news verbally and did not receive any written notice.[76]
This lack of clarity, in turn, can make it much harder for women and girls who require abortion services to obtain them, especially if the person is nearing 14 weeks of pregnancy (the legal time limit for abortions on request). One journalist explained how this can happen:
You might hear in the city that this hospital does not perform abortions, but other than that, you don’t really know. You just go there and find out that this hospital does not do abortions. And maybe you’re in a hurry, and you don’t have enough time. There is a limited time when you can have an abortion.[77]
Religious Institutions Interference in Individual Healthcare Decisions
Human Rights Watch was able to speak with two priests in hospitals; one priest’s church was on the premises of the hospital. Dan Damaschin, a Romanian Orthodox priest whose church sits in the grounds of a public hospital in Iași, intercepted women and girls seeking abortions in order to dissuade them.[78] In an interview with a local newspaper associated with the Romanian Orthodox Church, Damaschin described how he and his helpers would attempt to detect which patients passing through the hospital courtyard might be on their way to seek abortion, and how they enlisted the help of a female volunteer to approach women and try to convince them to come to the church where Damaschin or his team would tell them about “what an abortion really means.”[79] According to a doctor working at the hospital, who wanted to remain anonymous, Damaschin’s efforts also contributed to the hospital’s informal administrative decision to stop providing abortions on request approximately 10 years ago.[80] `
Doctors’ Conscientious Objection
Romania does not have any legal provisions or mechanisms to regulate or monitor conscientious objection.[81] Unregulated conscientious objection in health care creates a lack of transparency about the availability of abortions on request in medical facilities and can lead to arbitrary and often damaging delay in or even prevention of access.[82]
Doctors and other people Human Rights Watch interviewed had conflicting opinions about whether doctors were legally obligated to perform abortions on request. Eight healthcare providers that Human Rights Watch interviewed said doctors had a right to refuse to provide abortions on request.[83] Mirela Buiciuc, Specialist in the Women and Mother Health Unit at the Ministry of Health, shared this view, telling Human Rights Watch that the “conscientious objection clause” in the Code of Medical Deontology allowed doctors to decline when asked to perform an abortion on request.[84] Melany Pasca, legal adviser to three members of parliament in the political party Reper, disagreed: “Technically, public hospitals should be providing abortions on request as it is a medical service.”[85] “The law is thin ice,” said one doctor, referring to such confusions surrounding abortion care provision. “I think the rules of abortion should be more specific.”[86]
According to a 2019 investigation by EUobserver, as well as several experts we interviewed, many doctors did not provide referrals to another healthcare provider after denying patients abortion care.[87] Of the doctors that Human Rights Watch interviewed who did not perform abortions on request, none considered it their duty to refer patients to other institutions or doctors. “If somebody wants to get an abortion, they will find a way,” replied a doctor when asked about the lack of legal obligation for referrals for women and girls who seek an abortion on request. “It’s a false problem. There are much more real issues.”[88] The two doctors who said they actively referred patients elsewhere did not believe it was a duty tied to any code or legislation.[89] One doctor described doing so as “an act of kindness.”[90]
Two public hospital managers said that their hospitals do not keep a record of which doctors refuse to provide abortions on request.[91]
Religious Conservatism’s Influence
Religion plays a notable role in doctors’ conscientious objections. According to 2020 research by the FILIA Center, a feminist NGO based in Bucharest 51 of the 137 hospitals that responded to its inquiry cited “religious reasons” as the main reason that doctors refused to perform abortions on request.[92]
Some of our interviews reflected this as well.[93] A doctor in Bucharest told Human Rights Watch that she thought abortion refusal among doctors was partly a “religious issue”; she used as an example the fact that the two colleagues who performed abortions on request at the public hospital where she worked were not Christians. She said she referred people seeking an abortion to those colleagues, as she does not provide them. This doctor also believed doctors pressured each other not to provide abortions.[94]
A doctor in Timișoara said she would convince her patients not to have abortions because she believes God decides the number of pregnancies and children. When one pregnant woman (who already had a son) was feeling sick and wanted an abortion, this doctor said she stopped her from going ahead by saying: “Kill the baby that’s already in your home. What’s the difference?”[95]
Covid-19 Restrictions Continuing Impact on Availability of Abortion Services
When the government declared a state of emergency because of the Covid-19 pandemic in March 2020, some public hospitals were designated “Covid hospitals.” They became responsible for Covid-19 patients and officially suspended a range of other services, including abortions on request.[96]
In April 2020, the Ministry of Health released a circular recommending that hospitals resume providing unrestricted access to abortion procedures and medication abortion in accordance with domestic law.[97] However, the process of reinstating abortions on request has been slow, in part because the circular “was apparently a subject to free interpretation by health institutions” many of which did not comply.[98] “The rights of women during the pandemic were undermined,” said one doctor.[99]
Dubious Excuses for Not Providing Abortion Services
“Covid hospitals” and other public hospitals have relied on Law No. 95/2006 on Healthcare Reform—which stipulates that a public hospital can stop performing a medical act if it has insufficient staff or administrative services necessary to carry out that act[100]—to legally justify not offering or reinstating abortions on request.
For example, the Elena Doamna Hospital of Obstetrics and Gynecology in Iași became a “Covid hospital” in March 2020, suspending abortions on request and most non-emergency services. As of 2024, all services except abortion procedures on request had been restored.[101] One doctor said the hospital explained its failure to restore abortion procedures on request claiming that it now had a “lack of space.”[102]
The Odobescu Municipal Hospital in Timișoara, which had suspended abortions on request since April 2020 due to Covid-19, also used lack of space to justify why they did not reinstate abortion procedures on request.[103]
Not all space-related assertions were related to the pandemic. Human Rights Watch found that one hospital, Dr. I. A. Sbarcea Hospital, had stopped offering abortion procedures on request in 2015 due to ongoing construction, which halved the number of functional operating rooms. Doctors at this hospital, as well as other public hospitals, said they could not perform abortion procedures on request without a separate operating room.[104] “This is the only way hospitals can [legally] restrict services,” explained a lecturer of medical law. “They can’t do it by telling doctors to perform or not perform something, but the physician cannot perform any treatments without the proper resources that are provided by the hospital.”[105]
“It’s not normal to have no place in a county, to have no county hospital that provides abortions. This is the Ministry of Health’s responsibility,” Radu Vlădăreanu, then vice president of the Romanian Society of Obstetrics and Gynecology, said. “During the pandemic, hospitals restricted unnecessary interventions, but abortions are an emergency because of their deadline.” He also said there is no medical reason for hospitals to require a separate operating room for abortion procedures on request.[106]
Lack of Malpractice Insurance Coverage
Concerns about a lack of malpractice insurance coverage for elective services, including for abortions on request, was cited as playing a role in limiting the number of physicians willing to provide such services, further restricting their availability.[107] In February 2022, responding to an inquiry by Senator Silvia Dinică on access to abortions on request during the Covid-19 pandemic, the then Secretary of State within the Ministry of Health pointed to a lack of malpractice insurance coverage for abortions on request as a factor contributing to the diminishing number of state hospitals providing the service.[108] According to FILIA Center, a lack of malpractice insurance coverage for abortions on request was a main reason some medics and public hospitals gave for not providing them.[109] For instance, a medical resident at a hospital in Brașov, told Human Rights Watch that having no malpractice insurance for abortions on request pushed doctors to practice “defensive medicine.” “It’s complicated legally. It’s probably easier to say we don’t do that here,” she explained, referring to the fact that the public hospital where she worked did not perform abortions on request.[110]
However, an activist from the Romanian Midwives Association informed Human Rights Watch that there are multiple insurance companies which give doctors coverage for malpractice related to abortions on request. As of February 2025, Human Rights Watch confirmed that at least one major insurance company, Omniasig, has a medical malpractice insurance policy that does not explicitly exclude coverage for abortion on request or elective services.[111]
Women’s rights experts who spoke to Human Rights Watch about malpractice insurance issues questioned the level of risk that existed from a threat of a malpractice lawsuit for a doctor providing abortions on request.[112] One doctor who provides the service agreed, saying, “I think it’s an excuse not to perform abortions on request.”[113] In January 2023, three members of the Romanian Parliament requested the Ministry of Health to provide information on the number of medical malpractice cases reported following abortion procedures in the previous five years. The Ministry of Health reported that among the 35 out of 42 Public Health Departments across Romania that submitted a response as of February 2023, none had reported any cases of malpractice cases related to abortion procedures.[114]
Lack of Awareness of Abortion Law, Medication Guidelines
Despite the existence of law and guidance on abortions on request, doctors are not always aware of them.
According to a medical law lecturer, a potential explanation for the various misconceptions about abortion care legislation is:
The medical law is young and not necessarily very well known by physicians. Some studies show that physicians are not very well aware of all the legal requirements, which is why, in some situations, they are not complying with the law.[115]
The Romanian Society of Obstetrics and Gynecology’s guidelines recommend that doctors provide medication abortion within 12 weeks of amenorrhea.[116] However, some doctors Human Rights Watch interviewed believed that medication abortion could only be prescribed within 5 to 10 weeks of amenorrhea.[117] Since a few doctors that Human Rights Watch interviewed only provided medication abortion (and refused to perform surgical abortion procedures on request), doctors’ lack of understanding of the legal time limit for medication abortion further restricts the availability of abortion services for women’s and girls’.[118]
Barriers to Accessing Abortion Services
Women and girls in Romania face major barriers to accessing abortion care. These barriers include harmful laws, cost, lack of information, misinformation, lack of available services, and obstruction of access. These barriers affect all women, girls, and pregnant people, and they also have a disproportionate impact on some specific populations, including people living in poverty, people living in rural areas, and adolescents under age 18.
Economic Barriers to Accessing Abortion Services
Romania’s National Health Insurance House does not cover the cost of abortion on request, which must instead be paid for by the patient through out-of-pocket payments or private health insurance.[119]
At public hospitals, these services can cost about 150 Lei (about €30 or US$32) for the abortion procedure, and up to 1,500 Lei (about €300 or US$308) including the ultrasound and check-up procedures — the equivalent of about half a month to a month’s wages for someone working on the national minimum wage. In private hospitals, however, these services can cost between1,200 to 5,000 Lei (about €240 to €1,004 or US$247 to $1,030).[120] On the higher end, the cost for these services at private clinics equates to roughly Romania’s average net monthly income of 5,158 Lei (about €1,037 or US$1,127).[121]
The lack of available and accessible abortions on request at public hospitals, discussed in the previous section, often push women and girls to seek these services from private hospitals and clinics.[122] But many women and girls who are forced to seek out abortion services from private-sector providers are still unable to access them because of these cost, or must otherwise face significant financial hardship to do so. Around 32 percent of the population was at risk of poverty and social exclusion in 2023.[123] “Rich women will always have a solution for abortion,” a doctor pointed out. “The problem is with [poor] women, who cannot afford the procedure.”[124]
These cost-based barriers have much more pronounced impacts on the accessibility of abortion services for certain socially and economically marginalized communities in Romania that are more likely to experience poverty, including Roma, and rural women and girls. According to the World Bank, as of 2021, 46 percent of Romania’s population lived in rural areas, where there are higher levels of poverty and less healthcare infrastructure.[125] The Survey on Minorities and Discrimination in EU (2016) found that about 70 percent of Roma people in Romania live below the risk-of-poverty threshold.[126]
The lack of available healthcare services in rural communities creates additional cost-based barriers for rural women and girls, who may have little to no access to specialized care in their vicinity. They must instead travel at their own expense to access gynecological care or go without.[127]
Barriers for Adolescents Under 18
The law requires adolescents under the age of 16—not those between 16 and 18—to have parental or legal guardian consent for non-emergency sexual and reproductive health services.[128] However, several doctors and a medical resident Human Rights Watch interviewed believed that they could not legally provide obstetrics and gynecological services to a girl between the age of 16 and 18 without guardian consent.[129] Two experts said they believed doctors were sometimes simply reluctant to provide such services to girls under 18—perhaps because of stigma around adolescent sexuality.[130] This is another area of health legislation that healthcare providers are unaware of, misunderstand, or misinterpret, contributing to barriers to 16- and 17-year-old girls’ access to sexual and reproductive health services. A 2024 telephone survey of clinics and hospitals providing ob/gyn services by the Independent Midwives Association found that out of 66 public hospitals and clinics they identified as providing some form of abortion care, only 17 confirmed that they would provide services for girls ages 16 to 18 without a legal guardian present.[131] Laws that require parental consent can create a significant barrier for adolescents seeking sexual and reproductive health care, as they can delay or entirely prevent access to essential services, particularly for those who fear judgement, lack supportive family environments, or face potential harm from disclosing their needs to parents.[132]
Lack of Access to Contraceptives
From 1999 to 2007, an internationally funded, nationwide program expanded access to family planning, establishing 210 family planning clinics that offered free contraception and training to over 8,000 doctors and nurses in family planning.[133] Since losing its eligibility for international development aid after joining the EU in 2007, Romania’s state-run family planning clinics have decreased in number by nearly 50 percent and have eliminated key services. As of February 2025, all 138 Ministry of Health-operated family planning clinics offered family planning services, including free counseling on family planning and sexually transmitted infections (STI), but they no longer provided free contraceptives.[134] Also since 2013 until at least 2024, the Ministry of Health did not allocate funding for the acquisition and distribution of free contraceptives through any of its existing programs, such as the Women’s Health Subprogram and the National Health Strategy.[135]
Compounding the lack of free contraceptives from these facilities, the national health insurance does not cover contraceptives, creating a financial barrier for women and girls, especially for people with lower incomes.[136] Emergency contraceptive pills, for example, typically cost between 60 and 74 Lei (between about €12 and €15, or US$13 to US$16) — equating to roughly one-half of a day’s pay for someone working a minimum wage job.[137] For some, particularly those experiencing poverty, the lack of state-sponsored provision of free or subsidized contraception can contribute to unwanted pregnancies.
The lack of access to scientifically accurate information about contraceptives in Romania contributes to stigma and myths that adversely impact the ability of women and girls to make informed choices about avoiding pregnancy. Two community medical assistants who serve communes in Iași county said that lack of information contributed to the stigma surrounding contraception and made it harder for them to distribute free condoms that had been given to them by an NGO.[138] “This is a taboo subject and people do not open their hearts easily,” one community medical assistant explained.[139] Healthcare experts at the Public Health Directorate of Iași raised concerns about misinformation online, saying it included false claims that contraception use causes infertility and weight gain, and that spreads fear about contraceptives.[140]
Lack of Support from the Ministry of Health for Sexual and Reproductive Health Rights
The Ministry for Health remained passive in the face of activists’ concerns about the declining access to abortions on request and other sexual and reproductive health issues. As reported by Newsweek Romania, in 2020 the spokesperson of the Ministry of Health said: “Abortion on demand is at the discretion of the doctor whether or not he accepts such a practice. It is not an obligation.... And the Ministry, I told you before … encourages birth.”[141] In response, 12 NGOs sent an open letter to the then-Minister of Health on September 29, 2020, decrying what they perceived to be an undermining of women’s bodily autonomy and calling for the spokesperson’s dismissal.[142] Anti-rights organizations retaliated by sending an open letter of their own to that same minister on October 2, 2020, stating: “Given the unprecedented demographic crisis Romania is going through, we can only welcome and encourage the fact that the ministry is promoting pro-natal policies.”[143] As of 2024, the government had not responded to the 12 NGOs’ letter.
In May 2023, a Ministry of Health representative told Human Rights Watch that increasing access to abortions on request was a priority for the ministry, as evidenced by its National Health Strategy for 2023-2030.[144] The same representative and another both said there was a working group actively strategizing around topics such as family planning and access to abortion on request.[145] The Ministry of Health specified that decreasing inequities in access to health services and improving the availability and accessibility of timely and cost-effective health services and technology are objectives in the National Health Strategy.[146] Yet, according to activists interviewed by Human Rights Watch, the ministry had been unresponsive to their advice and inefficient in ensuring sexual and reproductive health rights, including access to abortion.[147] However four activists confirmed to Human Rights Watch that the working group was revived to discuss and finalize the 2023-2030 sexual and reproductive health rights strategy, including an action plan and budget. In order to be implemented, these proposals require approval from the newly elected government and the allocation of necessary funds.[148]
Protocol Between the Romanian Orthodox Church and the Ministry of Health
The Ministry of Health has signed protocols with the Romanian Orthodox Church to collaborate in the field of health care, despite the church’s anti-abortion activities, including on the grounds of public hospitals.
In October 2022, the Ministry of Health signed a new 10-year-long protocol with the Romanian Orthodox Church, replacing older protocols signed in 1995 and 2008.[149] The new protocol regulates the church’s activities in “health units subordinated to the Ministry of Health” and collaboration between the two institutions.[150] The protocol focuses on the delivery of “medical services for the benefit of individuals, families and communities in situations of difficulty.” It does not explicitly discuss sexual and reproductive health, including abortion, or women and girls’ needs.
The protocol assimilates the hospital priest into a category referred to as “specialized staff,” that also includes psychologists, and ensures the Ministry of Health pays them.[151] It also facilitates conversations between the church and the ministry in order to “debate and define priorities in the field of medical assistance integrated with religious assistance.”[152]
III. The Role of Crisis Pregnancy Centers in Limiting Access to Reproductive Health Care
They put a lot of pressure on me to keep the pregnancy although I told them I don’t want to, that I can’t. Everything was disguised as ‘We will help you to get what you need.’
—Irina Mateescu, activist and midwife, Romanian Midwives Association, January 18, 2023[153]
Access to abortion has also been complicated by the emergence of so called crisis pregnancy centers (CPCs), which are a manifestation of the anti-rights movement.[154] CPCs promote anti-abortion rhetoric and misinformation and target women and girls in difficult life situations, making misleading offers of support and information and sometimes promising resources such as temporary housing and money in exchange for keeping a pregnancy, which may or may not be fulfilled.[155] Many CPCs in Romania are affiliated with religious organizations and conduct anti-abortion activities alongside the provision of other charitable social assistance, sometimes in collaboration with public institutions.[156]
Human Rights Watch found that many of the practices of these actors often undermine the right of women and girls to seek and receive information vital for their reproductive health, an essential element of the human right to health. Romania’s failure to protect undue interference with women and girls’ access to information about the availability of abortion services through the adequate regulation of these actors, and explicit collaboration with them in certain instances, described below, can and has led to violations of the right to health.
Impact on Access to Abortion
As the availability of abortion services and other reproductive health care has decreased in public healthcare facilities and private healthcare services remain prohibitively expensive, many women and girls have increasingly sought help from CPCs.[157] However, one activist noted, “even when they tackle legitimate social issues, they do it in a biased way.”[158] According to her, CPCs such as the ones associated with Pro Vita lured young girls with promises of support, but do not make clear that such support lasts no longer than one or two years after they gave birth. Some of these girls ended up in her NGO. This activist spoke about the consequences of not being able to choose:
The girls say, ‘I love my baby so much, but….’ Their life spirals down when they have babies in a context where there is no support. Most leave school.[159]
Human Rights Watch found that CPCs’ practices have significantly hindered access to abortion services at public healthcare facilities. While this is the overt goal of these private institutions, Romania’s failure to ensure the availability, accessibility, and quality of abortion services at public facilities, which is exacerbated by the failure to regulate these private entities to prevent their interference with women and girls’ access to abortion services leads to violations of the human right to the highest attainable standard of health as well as the principle of equality and non-discrimination.
As CPCs and their anti-abortion rhetoric increasingly penetrate the public healthcare system and impact access to legal abortion, those working on sexual and reproductive health rights expressed growing concern about the future of Romania’s abortion landscape.
Spread of Misinformation about “Post-Abortion Trauma”
CPCs commonly propagate misinformation about something they call “post-abortion trauma,” a term coined by CPC activists in the US.[160] Scientific studies have found claims of the existence of “post-abortion trauma” to be unfounded.[161]
Two anti-abortion activists described to Human Rights Watch their beliefs regarding “post-abortion trauma”. Alexandra Nadane, the Executive Director of ROUA Center, a CPC network in Romania, situated CPCs’ anti-abortion stance in relation to “post-abortion trauma”:
Our attitude is that, in all situations, to have a baby is better than to have an abortion.... If the teens and the women had an abortion, the trauma, it’s very difficult and there are consequences over time.[162]
Dan Damaschin, who also runs the anti-abortion organization Voice of Life (Glasul Vieții), told Human Rights Watch that he considered “the trauma of giving birth much less significant than the trauma of getting an abortion.” In keeping with his belief, he counseled two adolescent girls who had become pregnant after rape, whom he said had agreed to continue their pregnancies after his interventions.[163]
Nina’s Encounter with a CPC, Inability to Obtain an Abortion, and Challenges after Her Son’s BirthWhen Nina became pregnant at 19 in 2019, she wanted an abortion. Her family doctor told her that his hospital did not provide abortions on request, so she should search online for a provider. When she Googled “abortion,” the first result was “avort.ro.” Not knowing it was a CPC, Nina called the organization. “They told me things that sounded sci-fi,” she recalled. “That doctors don’t use anesthesia, that the fetus would be handed to me all sliced up.” The woman with whom Nina spoke said that the state and church would help her if she kept the baby. But Nina still wanted an abortion, so the woman scheduled two appointments for her at the Giulesti Maternity Hospital in Bucharest. The doctor did not show up for either appointment. By then, Nina was already 12 weeks pregnant. Nina tried calling the woman again, but she never answered. “I felt betrayed,” Nina said. “I felt like my life was not my own, in a way. It felt like somebody else was making decisions for me.” She was unable to access abortion care before the 14-week limit. After her son was born in 2020, Nina had to postpone her university education, quit her job, and leave the capital due to financial difficulties. She recounted how her inability to have an abortion still affects her today:
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Government Support
Some public institutions, including General Directorates for Social Assistance and Child Protection and public maternity hospitals, have formally or informally collaborated with CPCs, providing them with significant access to public healthcare facilities and women and girls seeking abortion services.[165] The Ministry of Labor and Social Protection provides accreditation as a social service provider to at least one major CPC in Romania called the Pulse Center (Centrul PULS).[166] On its website, Pulse Center warns that abortion causes “a series of long-lasting and often irreversible physical, mental and emotional consequences” for women and girls, and offers “post-abortion syndrome” counselling.[167]
In addition to the government’s partnership with the Romanian Orthodox Church within health facilities, the government has also endorsed the church’s role as a major provider of social services. In April 2023, the Ministry of Labor and Social Protection signed a protocol with the Romanian Orthodox Church, formalizing their collaboration in the provision of social assistance, including the development of a network of social services provided by the church.[168]
This collaboration can direct state support toward anti-abortion initiatives conducted by the church through its associated organizations, which carry out such activities and social services. Examples include Pro Vita Department in Iași, which also conducts food drives and provides educational scholarships—and pressures women and girls not to seek abortion. Another example is the Romanian Christian-Orthodox Students Association (Asociația Studenților Creștin-Ortodocși Români, ASCOR), whose members volunteer at annual anti-abortion marches and support the work of CPCs while also delivering forms of social assistance.[169]
The Pulse Center (Centrul Puls), a CPC in Oradea, has had contracts with public social service and educational institutions to conduct abstinence-only sex education across the counties of Bihor, Botoșani, Cluj, and Iași.[170] In Iași county, Dan Damaschin’s CPC carried out a significant amount of social service work in the absence of sufficient state-provided social services.[171] It also offered a free hotline billed as providing counseling and material support to pregnant women and girls who called, which dispensed medical misinformation about abortion.[172] In August 2023, the Iași City Hall was an official partner and organizer for Damaschin’s “International Festival of Family, Life and Good Deeds,” which promoted his CPC’s work.[173] Pro Vita Department also organized a “Family Festival” in September 2023 in partnership with the Iași City Hall and fundraised for the construction of its anti-abortion Saint Emilia Maternal Center.[174]
Romanian Orthodox Church’s Support
Since at least 1990, the Romanian Orthodox Church has supported CPCs.[175] In 2020, Patriarch Daniel donated €6,000 for the inauguration of a Bucharest-based CPC that was established by a woman who had been honored in 2019 by Heartbeat International with an award for her anti-abortion work in Romania.[176] During the Sixth National Conference of Support Centers for Pregnant Women in September 2022, the Patriarch’s welcome speech said that the church “needs to become systematic and professionalized” to establish more CPCs.[177]
Several Romanian Orthodox-affiliated CPCs across Romania utilize the name “Pro Vita,”[178] which activists tend to associate with the country’s overarching anti-rights movement.
Pro Vita organizations connected to the church have worked to oppose abortion, as well as contraception, sex education, and LGBT rights.[179] For instance, the Federation of Orthodox Pro Vita Organizations published a press release in 2022 denouncing abortion in all circumstances, stating:
Even if abortion is legal today in Romania, this does not make it any less serious or moral…. The Orthodox Church has always condemned abortion…. Pro-abortion activists, soldiers of the culture of death, invoke all sorts of pretexts and borderline situations to create exceptions by which they claim to morally justify the killing of the unborn in the womb.[180]
The press release also included misinformation on contraception and called for the integration of “moral education” and compulsory pre-abortion counseling.[181] Human Rights Watch contacted PRO VITA Bucharest Association, a major anti-abortion organization and member of the Federation of Orthodox Pro Vita Organizations, in April 2023. This organization has been at the forefront of anti-abortion activities in Bucharest, including by offering CPC services and advocacy for anti-abortion laws and policies through the Romanian and European courts.[182] The organization’s founder, Bogdan Stanciu, declined to speak with us.
While visiting the Elena Doamna Hospital of Obstetrics and Gynecology in Iași, Human Rights Watch saw advertisements posted in the reception area for Pro Vita Department, an anti-abortion organization that is part of the Romanian Orthodox Church’s Archdiocese of Iași. Pro Vita Department conducts “crisis of pregnancy” activities, including the operation of a phone line for pregnant women and girls seeking information about abortion.[183] Human Rights Watch contacted the presiding priest, but he declined to speak with us. However, we spoke with doctors and a security guard at the hospital who confirmed that a woman from Pro Vita Department frequently entered the hospital to provide anti-abortion counseling services.[184]
US-Based Actors’ Support
Several activists, journalists, and experts interviewed by Human Rights Watch said religious actors in the United States, particularly Protestants, advance anti-abortion discourses and activities in Romania, including through CPCs.[185]
One activist told Human Rights Watch about how American missionaries spread anti-abortion ideology in Romania:
In Brașov, there are a lot of American missionaries. Some are doing a good job of providing services to people who need them, but some spread these [anti-abortion] messages in addition to offering the social services. It’s a very good way to infiltrate and brainwash.[186]
Establishment and Support of Crisis Pregnancy Centers
Christian affiliated US-based anti-abortion organizations have established and/or supported CPCs in Romania through funding, training, advocacy, and networking opportunities.[187] PRO VITA Bucharest Association, a major anti-abortion organization in Romania, credits US anti-abortion activists with developing so-called pre- and post-abortion counseling in Bucharest hospitals in the early years of Romania’s anti-abortion movement in the 1990s.[188]
At time of writing, US-based anti-abortion organizations continue to support anti-abortion counseling through CPCs in Romania. For instance, priest Ioan Chișărău’s organization, Gift of Life (Darul Vieții), is affiliated with and funded by the American Catholic anti-abortion organization Human Life International. Chișărău told Human Rights Watch that he worked in tandem with Protestant churches, such as Baptist and Pentecostal ones, which he said are the Christian denominations most supportive of the anti-abortion movement in Romania.[189] In September 2022, Heartbeat International, an American interdenominational Christian anti-abortion organization, held a “pregnancy help” conference in Bucharest where anti-abortion activists and operators of CPCs in Romania gathered to train and network.[190]
IV. Lack of Access to Comprehensive Sexuality Education
Reproductive health and rights is something everyone needs but lack information on. This subject is taboo.
—Loredana Apachiței, Head of the regional branch of the Standing Committee on Sexual and Reproductive Health and Rights including HIV and AIDS (SCORA), Timișoara, April 28, 2023[191]
Preventing unintended pregnancies can be difficult due to barriers in access not only to contraceptives, but also to scientifically accurate sexual and reproductive health information. Several activists and doctors we interviewed said sexuality education was crucial for preventing unplanned and adolescent pregnancies.[192] One activist stressed that “Access to contraception must happen with sex education. One without the other won’t work.”[193]
Activists advocating for CSE and sexual and reproductive health rights in Romania told Human Rights Watch that the Ministry of Education has not properly implemented the curriculum; according to the most recent data available at time of writing, its enrollment rate was 12 percent in 2011-2012 and below 6 percent in 2014-2017.[194] In 2021, the Ministry of Health reported a 7% enrollment rate.[195]
In its 2020 review of Romania, the UN Working Group on Discrimination Against Women and Girls noted that a global anti-rights backlash was impeding the introduction of sexuality education in Romania.[196] Romania’s actions to broadly erode sexual and reproductive health rights, including retrogression in guaranteeing access to sexuality education, undermines the sexual and reproductive health rights of women and girls across the country.
As discussed above in the background section, in April 2020, parliament amended the law on the protection and promotion of children’s rights to require schools and specialized governmental institutions to specifically cover “sexual education” “at least once a semester” in schools.[197] But in June 2022, parliament removed the “once a semester” requirement and made the subject optional again, and now only available to students in grades 8 and higher, with written consent from the parents or legal representatives of students under 18. The amendment also replaced the term “sexual education” with “health education,” under pressure from the Romanian Orthodox Church.[198] According to a deputy inspector chief, school inspectors are not obligated to ask or collect feedback about health education because it is an optional course.[199]
Inadequate Training for Health Education Teachers
Health education teachers, who are usually teachers of biology or other relevant subjects, are not adequately trained in all the subjects that the curriculum covers, including on gender equality.[200] Consequently, some ask external experts, such as doctors and nurses or NGO staff, to cover certain subjects.[201] Such external organizations have included Youth for Youth and SCORA, which are both organizations that work to bring scientifically accurate and accessible education on sexual and reproductive health to the classrooms.[202]
Efforts to Undermine Gender Equality in Schools
Gender equality is a key value and component of CSE, and the two are mutually reinforcing.[203] However, educators lacked guidance on how to integrate gender equality into their teaching, including any state-provided gender equality manual for teachers.[204] In its absence, activists created and introduced one in 2022.[205] In response, anti-rights actors wrote an open letter to the Ministry of Education criticizing the manual prepared by activists as an “attempt to indoctrinate students early with gender ideology,” including by discussing gender stereotypes and gender roles.[206] One of the manual’s creators described how anti-abortion activists sabotaged workshops that were introducing the manual to educators, mocking its contents and harassing activists:
In the second part of the event, one of the men [who seemed intent on sabotage] left the room. I felt relief. But the man came back claiming he had a ‘gender revelation’ last night. He was wearing a dress and impersonating a trans person and acting ridiculous. He came over to me and tried to kiss me.[207]
Misinformation about Sexual and Reproductive Health
The intentional removal, by political actors, of key topics and discussions that matter to young people from the school curriculum and educational spaces, leaves an enormous gap in student’s lives, which is often not filled through legitimate and science-based means. Such gaps expose children and young people to misinformation and disinformation about their sexual and reproductive health and undermine broader efforts to protect children and young people from sexual and gender-based violence.
A 19-year-old high school student in Iași told Human Rights Watch: “We were misinformed about many things,” referring to the health lessons she received. She recalled how, due to her lack of knowledge about consent and sexual violence, she did not realize that a nonconsensual sexual experience she had had constituted sexual assault until she talked to a friend with more knowledge of sexuality education.[208] A 20-year-old university student in Iași said his high school teachers ignored students who asked questions about sex.[209]
Adolescents who cannot access sexual and reproductive health education in schools are reluctant to seek information directly from healthcare providers due to the dearth of youth friendly services for sexual and reproductive health.[210] Instead, they often turn to the internet. One 17-year-old activist in Bucharest used TikTok to learn. “There’s so much about my body and how it works that I found out through TikTok,” she said. “I had to learn sex ed through TikTok, and that’s very telling about the situation in Romania.”[211]
Although that activist’s search was educational, some activists we interviewed were concerned about how adolescents could navigate the abundance of sources on the internet to find accurate and helpful information without the foundations to identify accurate and scientifically-accurate information.[212] Some children and young people rely on online pornography to find answers, without guidance from trained professionals on the dangers of normalizing harmful pornography. A volunteer coordinator and advocate for young people's sexual health at local NGO Youth for Youth (Tineri pentru Tineri) said: “I had friends who were interested in the topic of sexual and reproductive health and searched online for answers...They only found porn and could not find much information.”[213]
Impact on Adolescent Pregnancy and Birth Rates
According to Eurostat data from 2022, Romania had the highest adolescent birth rate for girls ages 10 to 14, and the second highest adolescent birth rate for girls ages 15 to 19, of all EU member states.[214]
In Romania, the lack of access to sexual and reproductive health information, including CSE, coupled with barriers to accessing contraceptives, contributes to adolescent pregnancy rates by depriving adolescents of their right to seek, receive, and impart information that can help them make informed choices about their health.[215]
While there is no available data on the social and economic effects of pregnancy on adolescent girls and young women in Romania, global studies have shown that adolescent pregnancy can detrimentally impact educational attainment, wages, and girls and women’s mental health, among other things.[216]
V. Romania’s Human Rights Obligations
Obstacles to access to safe abortion, contraception, and sexual and reproductive health information in Romania violate the government’s human rights obligations under European and international law. In particular, they violate the rights to life, health, non-discrimination, privacy and respect for family life, and freedom from cruel, inhumane and degrading treatment.[217] Where abortions (at any stage of pregnancy) are criminalized, the arrest and imprisonment of individuals on abortion-related charges also violate the right to liberty and security of person.[218]
These rights are enshrined in various international human rights treaties—including the International Covenant on Civil and Political Rights (ICCPR),the International Covenant on Economic, Social and Cultural Rights (ICESCR), the Convention Against Torture (CAT), the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), and the Convention on the Rights of the Child (CRC)—and regional treaties, including the Council of Europe’s European Convention on Human Rights and the European Social Charter as well as the Charter of Fundamental Rights of the European Union.
The Right to Health
As a party to the International Covenant on Economic, Social and Cultural Rights (ICESCR) Romania has legal obligations to respect, protect, and fulfil all economic, social, and cultural rights, including the right to the highest attainable standard of physical and mental health. The Committee on Economic, Social and Cultural Rights (CESCR), which provides authoritative interpretations of the obligations of states parties enshrined in the ICESCR, explained in its general comment no. 14 that governments’ right-to-health obligations include the duty to ensure the availability, accessibility, acceptability and quality of health facilities, goods and services. This includes the duty to ensure that access to these healthcare resources is accessible without discrimination, especially for the most marginalized sections of the population, and without cost-based barriers. This also requires that states parties ensure “the right to seek, receive and impart information and ideas concerning health issues.”
In its general comment no. 22 on the right to sexual and reproductive health, the CESCR noted the right to sexual and reproductive health is “indivisible from and interdependent with other human rights” and “essential to the realization of the full range of [women’s] human rights.”[219] The CESCR has also specified that sexual and reproductive health care and information should be characterized by non-discrimination; physical, financial, and information accessibility; and a lack of barriers.[220]
Safe Abortion
Both the CESCR and the Committee on the Elimination of Discrimination against Women (CEDAW Committee), which oversees compliance with CEDAW, found that denying women and girls access to safe abortion, including abortion on request, can violate their rights, including their rights to life, health, and non-discrimination.[221] In some cases, barriers to abortion access may even amount to cruel, inhumane and degrading treatment.[222]
The UN Human Rights Committee (HRC), which monitors compliance with the ICCPR, has clarified that states parties should not regulate abortion in a manner that pushes women and girls to resort to unsafe abortions.[223]
The European Convention on Human Rights (ECHR) guarantees, among others, the rights to life, prohibition of torture and inhuman or degrading treatment or punishment, liberty and security, and respect for private and family life.[224] While neither the right to health nor the right of access to abortion are explicitly enumerated in the ECHR, the European Court of Human Rights has on many occasions found that fundamental rights including the right to privacy and family, and the right to be protected from inhuman and degrading treatment, have been violated where women or girls have been unable to access abortion effectively.[225] The Court has repeatedly found that when abortion is allowed in some situations, the legal framework governing that right to abortion must ensure effective access and failure to ensure access in practice will lead to a violation of the right to private life and may lead to violations of the prohibition on inhuman and degrading treatment and to an effective remedy.[226]
The Charter of Fundamental Rights of the European Union enshrines the rights to “benefit from medical treatment under the conditions established by national laws and practices” and to integrity of the person.[227] Currently the Charter does not explicitly address access to abortion in EU countries where abortion is not legally available, but in April 2024 the European Parliament adopted a resolution calling for inclusion of the right to abortion in the Charter on Fundamental Rights.[228]
Conscientious Objection
The HRC has directed states parties to remove barriers to legal abortion, including those caused by healthcare providers’ exercise of conscientious objection.[229] The CESCR has likewise stated that conscientious objection “must not be a barrier to accessing services” and that there should be an adequate number of available and accessible healthcare providers who provide abortion services at all times, in both public and private healthcare facilities.[230]
In its general comment no. 24 on state obligations in the context of business activities, the CESCR stated that “private health-care providers should be prohibited from denying access to affordable and adequate services, treatments or information,” but “where health practitioners are allowed to invoke conscientious objection to refuse to provide certain sexual and reproductive health services, including abortion, they should refer the women or girls seeking such services to another practitioner within reasonable geographical reach who is willing to provide such services.”[231]
In its 2017 concluding observations on Romania, the CEDAW Committee expressed concern about the refusal of doctors and hospitals to perform abortions. The CEDAW Committee called on Romania to legally prohibit institutions from invoking conscientious objection and to guarantee mandatory referrals when doctors conscientiously object.[232] During its Universal Periodic Review (UPR) in 2023, Romania also received and accepted recommendations to strengthen its protection of the right to safe abortion and ensure that conscientious objection does not deny access to legal abortion.[233]
The European Court of Human Rights has, on multiple occasions, addressed states’ obligations to ensure that healthcare providers’ conscientious objections do not impede access to legal reproductive health care. In R.R. v. Poland, where doctors refused to provide a woman timely access to pre-natal diagnostic services and abortion care, and P. and S. v. Poland, where doctors invoking conscientious objection failed to comply with the obligation to refer patients to other physicians, thereby causing difficulties for a teenage rape survivor to access legal abortion, the court found violations of article 8 (right to respect for private and family life) of the ECHR.[234]
In its 2021 conclusion on Romania, the European Committee of Social Rights, which oversees compliance with the Council of Europe’s European Social Charter, said that states parties with statutory provisions for abortion (like Romania) must “organise their health service system” to ensure that conscientious objections do not impede access to abortion services.[235]
Parental or Legal Guardian Consent for Adolescents Under 16
The UN special rapporteur on the right to health and the Committee on the Rights of the Child (CRC Committee), which monitors compliance with the CRC, have both noted that the requirement of third-party consent hinders access to legal abortion.[236] The CRC Committee specifically urged states to ensure adolescents’ views are always heard and respected in abortion-related decisions.”[237]
Non-discrimination
The Working Group on the issue of discrimination against women in law and in practice (now the Working Group on discrimination against women and girls) has noted that where abortion is restricted or otherwise unavailable, “women with limited resources have little choice but to resort to unsafe providers and practices.”[238] After its 2020 visit to Romania, the group commented on the barriers faced by rural women and girls those living in poverty and discriminations against Roma women and girls, in access to health care. It encouraged the government to financially support and include civil society working to address such problems in decision making.[239]
The European Committee of Social Rights, has also noted that “in assessing whether the right to protection of health can be effectively exercised, the Committee pays particular attention to the situation of disadvantaged and vulnerable groups...” Noting that regional norms require “member states to take as their main criterion for judging the success of health system reforms effective access to health care for all, without discrimination, as a basic human right” the committee explicitly focuses on “disparities between urban and rural areas”.[240]
Contraception
The CESCR has interpreted states parties’ right to health obligations to include the adoption of measures to improve “access to family planning … and access to information, as well as to resources necessary to act on that information.”[241] According to the UN special rapporteur on the right to health, family planning, which includes the use of contraceptives, empowers women to make autonomous, informed choices about their health while also reducing unsafe abortion and maternal mortality rates.[242]
Given its importance, both the HRC and the CEDAW Committee have urged Romania to ensure access to contraceptives, as well as information about them, for all women and girls.[243] In its 2018 review, the HRC recommended that Romania intensify efforts to prevent high numbers of early pregnancies and unsafe abortions by disseminating information and enhancing access to modern contraceptive supplies.[244] More recently, during its UPR in 2023, Romania also received and supported recommendations to develop its family planning services and increase access to free contraceptive supplies for adolescents and women.[245]
Comprehensive Sexuality Education
All children and adolescents have a right to information about sexual and reproductive health, including in accessible and easy-to-understand formats, as guaranteed under international law. The right to information includes a positive responsibility to provide complete and accurate information necessary for the protection and promotion of rights, including the right to health.[246]
According to the CESCR, the right to health includes access to education and information on sexual and reproductive health.[247] The UN Committee on Economic, Social and Cultural Rights notes the interdependence of the realization of the right to sexual and reproductive health with the right to education and the right to non-discrimination and equality between men and women, which, when combined, entail a “right to education on sexuality and reproduction.”[248] In order to fulfill this right, the CESCR has urged states to adopt measures ensuring that “all educational institutions incorporate unbiased, scientifically accurate, evidence-based, age-appropriate and comprehensive sexuality education into their required curricula.”[249] The CESCR also called for states to remove all barriers to women’s access to comprehensive sexual and reproductive health education.[250]
The Committee on the Rights of the Child has recommended that states adopt:
Age-appropriate, comprehensive and inclusive sexual and reproductive health education, based on scientific evidence and human rights standards and developed with adolescents, should be part of the mandatory school curriculum and reach out-of-school adolescents. Attention should be given to gender equality, sexual diversity, sexual and reproductive health rights, responsible parenthood and sexual behaviour and violence prevention, as well as to preventing early pregnancy and sexually transmitted infections.[251]
The HRC and the CEDAW Committee have called on Romania to implement mandatory and age-appropriate education on sexual and reproductive health rights. The HRC urged Romania to use such education to help prevent high rates of early pregnancies and unsafe abortions, and the CEDAW Committee recommended it cover modern contraception and risks of unsafe abortion.[252]
The Group of Experts on Action against Violence against Women and Domestic Violence, which monitors compliance with the Council of Europe Convention on Preventing and Combating Violence against Women and Domestic Violence treaty (Istanbul Convention), encouraged Romanian authorities to “step up their efforts to promote” a range of principles in formal education curriculums, including gender equality, non-stereotyped gender roles, and the right to personal integrity.[253]
Acknowledgements
This report was researched and written by Song Ah Lee during her Finberg Fellowship in the Women's Rights Division at Human Rights Watch. It was edited by: a former senior researcher on women’s rights; a senior editor; and Heather Barr, women’s rights associate director. It was reviewed by: Tom Porteus, deputy program director; Lydia Gall, senior researcher on Europe and Central Asia; Kriti Sharma, disability rights associate director; Elin Martinez, senior researcher on children’s rights; Margaret Wurth, senior researcher on children’s rights; Matt McConnell, researcher on health rights; and Kyle Knight, LGBT rights associate director. Legal review was by Aisling Reidy, senior legal advisor.
Design and production assistance were provided by Susanné Bergsten, officer in the Women’s Rights Division; Travis Carr, digital officer; Fitzroy Hepkins, senior administrative manager; and Jose Martinez, administrative officer.
The report was also reviewed by the following experts in Romania: Adina Manea of Youth for Youth, Andrada Cilibiu of FILIA Center, Daniela Draghici of Sexul vs Barza, and Irina Mateescu of Romanian Midwives Association. We are very grateful for their kind assistance and generous sharing of their expertise.
We sincerely appreciate the support of journalists Vald-Marko Tollea and Venera Dimulescu, who facilitated and interpreted numerous interviews albeit the sensitive issues our research covered.
Human Rights Watch would like to thank the incredible Romanian and Romania-based organizations, activists, and experts on sexual and reproductive health, women's rights, Roma rights, and LGBT rights for their support and guidance in conducting the research for this report. The organizations and associations whose experts we reached out to include: Sexul vs Barza, Girl Up Romania, Euroregional Center for Public Initiatives (ECPI), FILIA Center, Contraception and Sexual Education Society (SECS), Youth for Youth, MozaiQ, Plural Association, Romanian Midwives Association, ACCEPT Association, SPICC Association and its WISE Project, Resource Center for Urban Regeneration, NGO Federation of Social Services (FOSS), Rise Project, Sanitary Pads for All, Romanian Women’s Lobby, Sănătate pentru Mame și Sugari (SAMAS), The Association to Promote Roma Women’s Rights (E-Romnja), Resource Center for Roma Communities Foundation (RCRC), Association for Freedom and Equal Opportunities (A.L.E.G), Center for Action for Equality and Human Rights (ACTEDO), and the World Health Organization (WHO). We would also like to thank journalists from Să Fie Lumină, Libertatea, By Line Times, openDemocracy and The Guardian, who shared their personal investigations and experiences with us.
We would like to recognize and thank the numerous healthcare professionals and medical students who took the time to speak with us and give us valuable information and direction. We would also like to thank the religious officials who responded to our requests for interviews and gave us their insights.
Human Rights Watch would like to extend the deepest gratitude to the brave women who, despite difficult circumstances and through the pain of reliving memories, shared their stories with us.
Human Rights Watch acknowledges the cooperation, provision of data, and input from government officials and experts in the Ministry of Health, Ministry of Education, the National Agency for Equal Opportunities between Women and Men, the Public Health Directorate of Iași, a number of local government offices, and the political party REPER.
