The main measures in the field of mother and child health are:

regionalization of the obstetrical and neonatal health care;

creating new levels of competency and supra-specialization that will met the present needs in medical services;

promoting breastfeeding by extending the rooming-in system in the maternity hospitals and increasing the number of Baby friendly hospitals;

improving emergency medical assistance by measures regarding local infrastructure for communications and transportation, increasing the efficiency of the emergency reaction, especially in rural areas, specific training of medical staff for obstetrical and pediatric emergencies, modernizing the neonatology intensive care departments, OBGYN and pediatrics by redesigning the functioning rooms and providing proper equipment.

In order to improve the quality of care for pregnant women and newborns, starting with the fall of 2003 a training programme for the profession of midwives has been established at university level. It will identify and monitor the pregnant women, will keep in touch with family practitioners for registering pregnant women and performing the prevention tests during pregnancy and after birth; it will also be involved in providing information regarding the pregnancy course and newborn care.

It was also considered the harmonization of the health and social protection policies, considering the socio-economic realities of Romania.

As a part of the decentralization and in view of strengthening the responsibility of the local autonomy, the Ministry of Health encourages the local initiatives regarding the improvement of the population health status by identification of special needs and adequate solutions.

Legislative measures

a) Starting 2001, the Framework contract regarding the conditions of providing medical assistance within the social health insurance system and its methodological regulations provides the medical assistance for free for all pregnant women, newborns and toddlers regardless their social status; it also gives supplementary points for family practitioners who register on their patient list children in need.

b) Government Decision 534 / 2002 for the approval of the Strategy regarding the rehabilitation and reorganization of the pre-hospital medical assistance in OBGYN and neonatology in Romania for 2002 – 2004

c) Order 458 / 2004 regarding improving access of pregnant women to medical investigations and specialty consultations

d) Order 12 / 2004 for adopting the Protocol regarding the methodology of pre-birth and after-birth consultation, the pregnant women book and the annex for the medical surveillance of the pregnancy and confinement.

e) Strategy regarding the promotion of breastfeeding (Order 809 / 2003)

f) The Program RoNeonat for the rehabilitation of the neonatology assistance

g) Order 660 / 2005 regarding the increase of the social services efficacy in maternity and pediatric hospitals

h) Emergency Ordinance 96 / 2003 regarding the protection of maternity at work place

An intervention of the National Health Program no. 3 for mother and child is “Prevention of iron deficiency anemia in pregnant women”. For the year 2005 this intervention was provided for 89,217 pregnant women that equaled 59.48% of the target population. Starting with 2001, the number of the beneficiaries had increased year by year: 38,447 pregnant women in 2001, 50,778 pregnant women in 2002; 59,087 pregnant women in 2003; 73,893 pregnant women in 2004.

27. The report indicates that a national strategy has been developed by the Ministry of Health in collaboration with national and international organizations to improve the use of new contraceptive methods. The Special Rapporteur on the right to everyone to the highest attainable standard of physical and mental health (E/CN.4/2005/51/Add.4), while acknowledging that this strategy was an important step toward the improvement of sexual and reproductive health, noted with concern that the abortion rate remained high, suggesting that some women may be approaching abortion as though it were a form of family planning. Kindly provide information about any barriers women face in accessing reproductive health services, in particular vulnerable or marginalized groups, such as rural women or Roma, how these barriers are addressed by this strategy, and its impact. Please also provide updated information on the use of contraceptive methods and abortion rates.

Another intervention implemented through the National Health Program 3 is “Increasing the accessibility to reproductive health services” with two main objectives in 2005:

strengthening the primary medical assistance for reproductive health services together with the specialty services;

promoting the modern contraceptive methods.

The objectives are to decrease the number of un-wanted pregnancies, decrease the child abandon, and increase the quality of pre- and postnatal care and reducing the maternal mortality from abortion by free distribution contraceptives to the vulnerable groups.

Resultsof the Family Planning Programme, 2000 -20042401,0802,5702,311240181.000147.60153.57018.05016.5001,0991,1561,1761,0580,9482000200120022003June 2004Number of Family Planning service purveyors inThe primary assistanceNumber of active beneficiaries of Family Planning servicesAbortion rate (at 1000 live newborns) Furthermore, the Family Planning Program was successful as the following figures show for (the columns represent the increasing number of family doctors providing family planning services; the number of beneficiaries has increased to 181,000; the rate of abortion has decreased to 0.948 per 1000 live births).

Rural Women

28. Please provide updated information of the situation of rural women and indicate the measures carried out by the Government to improve their access to health, education, employment and their participation in decision-making processes at all levels

ANES proposed through the National Strategy for Equal Opportunities between women and men for the period of 2006-2009 measures to facilitate access for women in risk of being socially excluded, as rural women, to health assistance services, initial or continuous training to help them manage to find and keep a job. The Strategy contains objectives regarding:

Strengthening equal access of women and men in the labor market;

Conciliating family and working life;

Stimulating balanced participation of women and men in decision making process;

Fighting stereotypes and sexist roles in educational system;

Promoting the development of care facilities in the community for children and elderly persons in need;

Promoting measures which allow a flexible working time.

Marriage and family relations

29. In its last concluding comments, the Committee expressed concern at the different ages of marriage established in the Family Code for boys (18 years) and girls (16 years, and exceptionally 15). A similar concern was expressed by the Committee on the Rights of the Child in its last concluding observations. Have any steps been taken by the Government to raise the: minimum age of marriage for girls to 18.

According to Article 4 of the Family Code a man is allowed to marry only if he has reached the age of eighteen, and a woman only if she has reached the age of sixteen. However, for serious reasons, the marriage of a woman who has reached the age of fifteen may be approved. The draft Civil Code that is currently under parliamentary debate provides that, both for women and men a marriage may be approved, for serious reasons, if she / he have reached the age of 16.

The draft regulation is presented below:

“Article 204 - (1) Marriage may be concluded provided that the two spouses have reached the age of 18.

(2) Minors over the age of 17 may marry only with the consent of their parents or, where appropriate, of their guardian. Should either of the parents be deceased or unable to express volition, the other parent’s consent shall suffice.

(3) In the event that there are no parents and no guardian to provide their consent, such shall be required from the person or the authority that has been habilitated to exercise parental rights.

(4) However, for serious reasons, minors who have reached the age of 16 may be married based on a medical endorsement, provided that, in addition to the consent in paragraph (2), they have also the approval of the president of the county council or, where appropriate, that of the general mayor of the City of Bucharest, in the jurisdiction of which the minor domiciles.”

Optional Protocol

30. Please describe measures in place to publicize the Optional Protocol and encourage its use.

By means of the adoption of the National Strategy for Equal Opportunities between women and men and of the General Actions Plan for the implementation of the Strategy, it is compulsory to undertake specific measures and actions to promote the integration of all international provisions regarding gender equality, as well as measures to publicize and promote all the legal framework to support women and respect human dignity and human rights.

Annex 1. PREVALENCE OF TOBACCO CONSUMPTION AND BURDEN OF DISEASE RELATED TO TOBACCO

RECENT DATA ON THE PREVALENCE OF SMOKING AMONG ADULTS

(suggestion: look for Living Standard Measurement Survey /LSMS/– World Bank)

Country	Males %	Females %	Age group	Sample size/ is it national or not?	Year of surveys	Definition of smoking	Source of information	Other comments
Romania	35.2	17.9	14-24	1209/ national	2003	daily	Center for Health Policies and Services – "Knowledge, attitudes and practices about tobacco use in Romania"; UE financed project, published in 2004	Total: 27.2
Romania	6.8	7.9	14-24	1209/ national	2003	occasional	idem	Total: 7.3
Romania	42	25.8	14-24	1209/ national	2003	active smokers (daily + occasional)	idem	Total: 34.5
Romania	50.6	29.8	14-24	1209/ national	2003	Ever smokers*	idem	Total: 40.6
Romania	48.3	23.3	25-34	1209/ national	2003	daily	idem	Total: 35.9
Romania	6.0	2.7	25-34	1209/ national	2003	occasional	idem	Total: 4.0
Romania	54.3	26.0	25-34	1209/ national	2003	active smokers (daily + occasional)	idem	Total:39.9
Romania	68.0	38.0	25-34	1209/ national	2003	Ever smokers	idem	Total:53.0
Romania	43	22.1	35-44	1209/ national	2003	daily	idem	Total: 32.4
Romania	6.5	8	35-44	1209/ national	2003	occasional	idem	Total: 6.8
Romania	49.5	30.1	35-44	1209/ national	2003	active smokers (daily + occasional)	idem	Total: 39.3
Romania	72.6	38.4	35-44	1209/ national	2003	Ever smokers	idem	Total: 55
Romania	35.4	16.4	45-60	1209/ national	2003	daily	idem	Total: 25.1
Romania	7.4	2.6	45-60	1209/ national	2003	occasional	idem	Total: 4.9
Romania	42.9	19	45-60	1209/ national	2003	active smokers (daily + occasional)	idem	Total: 29.9
Romania	68.6	25.5	45-60	1209/ national	2003	Ever smokers	idem	Total: 45.8
Romania	40	19.5	Total (14-60)	1209/ national	2003	daily	idem	Total: 29.7
Romania	6.7	4.9	Total (14-60)	1209/ national	2003	occasional	idem	Total: 5.6
Romania	46.7	24.5	Total (14-60)	1209/ national	2003	active smokers (daily + occasional)	idem	Total: 35.3
Romania	64.2	32.0	Total (14-60)	1209/ national	2003	Ever smokers	idem	Total: 47.9
Romania	61.8**	15-24	3500/ national	2004	Ever smokers	National Antidrug Agency – "Prevalence of drugs use in Romania" – financed through Global Fund (WB); published in 2005
Romania	33.3	15-24	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	32.9	15-24	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	70.5	25-34	3500/ national	2004	Ever smokers	idem
Romania	46.0	25-34	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	46.0	25-34	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	65.0	35-44	3500/ national	2004	Ever smokers	idem
Romania	40.0	35-44	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	40.0	35-44	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	62.7	45-54	3500/ national	2004	Ever smokers	idem
Romania	39.3	45-54	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	38.7	45-54	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	44.2	55-64	3500/ national	2004	Ever smokers	idem
Romania	20.3	55-64	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	19.7	55-64	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	62.1	Total (15-64)	3500/ national	2004	Ever smokers	idem
Romania	36.8	Total (15-64)	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	36.5	Total (15-64)	3500/ national	2004	Active smokers (smoked in the last month)	idem
Romania	75.4	48.7	Total (15-64)	3500/ national	2004	Ever smokers	idem
	48	25.5	Total (15-64)	3500/ national	2004	Recent smokers (smoked in the last year)	idem
Romania	48.7	25.3	Total (15-64)	3500/ national	2004	Active smokers (smoked in the last month)

*Ever smokers = active smokers + persons who smoked more than 100 cigarettes in their life but didn’t smoke in the month before the survey.

** The prevalence rates by sex and age were calculated separately.

* please describe briefly the sampling strategy (e. g. is it a probability sample survey, where data collected in households...)

RECENT DATA ON the PREVALENCE OF SMOKING IN YOUTH

(suggestion: look for ESPAD 2003, HBSC, Global Youth Tobacco Survey)

Country	Males %	Females %	Age group	Sample size	Year of surveys	Definition of smoking	Source of information	Other comments
Romania	65.1	49.1	13-15	4118	2004	Ever smokers	GYTS Romania
	27.1	19.7	Idem	Idem	Idem	Current smokers	Idem
Romania	70.8	58.5	14-18	4371	2003	Ever smokers	ESPAD Romania

* please describe briefly the sampling strategy and methodology

3. OTHER DETERMINANTES OF SMOKING

A) URBAN SETTING/RURAL AREA

Country	Romania
Total number of residents	Census 2002	21680974	Number of urban residents	Census 2002	11435080	Number of rural residents	Census 2002	10245894
	2000*	22435205		2000	12244598		2000	10190607
	2001*	22408393		2001	12243748		2001	10164645
	2002*	21794793		2002	11608735		2002	10186058
	2003*	21733556		2003	11600157		2003	10133399
	2004*	21673328		2004	11895598		2004	9777730
Center for Health Policies and Services – "Knowledge, attitudes and practices about tobacco use in Romania"; UE financed project, published in 2004
Prevalence of smoking (total)	Ever smokers: 47.9 Active smokers: 35.3 Daily smokers:29.7	Prevalence of smoking (urban)	Ever smokers: 51% Active smokers: 37.9%	Prevalence of smoking (rural)	Ever smokers: 44.1% Active smokers: 32.0%
National Antidrug Agency – "Prevalence of drugs use in Romania" – financed through Global Fund (WB); published in 2005
Prevalence of smoking (total)	Ever smokers: 62.1% Active smokers (last month): 36.5	Prevalence of smoking - urban >50001 households	Ever smokers: 68.5% Active smokers (last month): 40,6 %	Prevalence of smoking (rural)	Ever smokers: 53.9% Active smokers: 31.4%
		Prevalence of smoking – urban 10001-50000 households	Ever smokers: 67.5% Active smokers (last month): 40.1%

*Source: National Institute of Statistics

EDUCATION

Country	Romania, 2002 (census)
Total number of residents	21680974	Less then primary school residents: (without any school)	1083935	Primary educated residents	3898996	Secondary educated residents	12490872	High educated residents	1371108
Center for Health Policies and Services – "Knowledge, attitudes and practices about tobacco use in Romania"; UE financed project, published in 2004
Prevalence of smoking (total)	Ever smokers: 47.9 Active smokers: 35.3 Daily smokers:29.7	Prevalence of smoking (less then primary school)	No data	Prevalence of smoking (primary education.)	Ever smokers: 39.8% Active smokers: 31.4%	Prevalence of smoking (sec. education)	Ever smokers: 52% Active smokers: 38%	Prevalence of smoking (high education)	Ever smokers: 57.6% Active smokers: 37.9%
National Antidrug Agency – "Prevalence of drugs use in Romania" – financed through Global Fund (WB); published in 2005
Prevalence of smoking (total)	Ever smokers: 62.1% Active smokers (last month): 36.5	Prevalence of smoking (less then primary school)	No data	Prevalence of smoking (primary education)	Ever smokers: 33.3% Active smokers: 33.3%	Prevalence of smoking (completed sec. education)	Ever smokers: 65.8% Active smokers: 38.6	Prevalence of smoking (high education)	Ever smokers: 76% Active smokers: 47%

EXPOSURE TO ENVIROMENTAL TOBACCO SMOKE

Country

Men % total

Women % total

Children % total

Year of surveys

Source of information

Other comments

The only data about exposure to ETS are the following:

Country	„In the last week, at your workplace, how many days did other persons smoke in the same space with you? “	Active Smokers	Non smokers	Total	Source
Romania	Never	26.7	57.5	46.7	Center for Health Policies and Services – "Knowledge, attitudes and practices about tobacco use in Romania"; UE financed project, published in 2004
	Few days	15.5	16.9	16.4	Idem
	Almost daily	19.3	11.2	14	Idem
	Daily	38.5	14.3	22.9	Idem
Romania	„In the last week, at your home, how many days did other persons smoke in the same room with you? “
	Never	28.5	61.7	50.0	idem
	Few days	26.4	18.7	21.4	Idem
	Almost daily	10.1	5.8	7.3	Idem
	Daily	34.9	13.7	21.2	Idem
	„How many smokers are in your home? “
	None	0	61.4	40.4	Idem
	One smoker	42.6	27.9	32.4	Idem
	Two smokers	40.7	8.2	19.6	Idem
	More than 3 smokers	16.5	2.5	7.5
	„Who smokes in your home? “				GYTS Romania
	Father	66.1	57.1		Idem
	Mother	45.4	24.9		Idem
	Siblings	45.4	18.8		Idem
	Other people	85.9	73.1		Idem

D) PLACE OF EXPOSURE TO ENVIROMENTAL TOBACCO SMOKE

„Where do you smoke? “

	MEN	WOMEN	TOTAL adults	Source of data	Children 13-15	Source
Home (%)	91.4	92.7	91.9	Center for Health Policies and Services – "Knowledge, attitudes and practices about tobacco use in Romania"; UE financed project, published in 2004	95.1 (current smokers) 84.6 (never smokers)	GYTS Romania
Work place (%)	64.2	56.4	61.5	Idem
Public places (%)	77.7	52.4	68.9	idem	92.3 (current smokers) 78.3 (never smokers)	idem
On street	62.2	9.2	43.8	idem

4. CONSUMPTION PER CAPITA

Country

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

According to the Ministry of Agriculture, the cigarettes consumption is constant over years at about 35000 – 40000 tones.

A consumption of 35000 billion cigarettes is confirmed for 2004 by a newspaper (probably, the source is tobacco industry).