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Title: Training exercise : WorldWID Fellows Training Program
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Title: Training exercise : WorldWID Fellows Training Program
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Language: English
Creator: WorldWID Fellows Training Program
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Table of Contents
    Learning objective
        Page 1
        Page 2
    Background information for planning
        Page 3
    Women's reproductive health in Romania: A brief summary
        Page 4
        Page 5
    WorldWid fellow fo USAID/Romania
        Page 6
        Page 7
        Page 8
Full Text




WorldWID Fellows Training Program
January 19 February 3, 1998
Training Exercise: Planning a Participatory Workshop

Learning Objective:
Demonstrate knowledge of gender and development issues, gender
analysis and participatory methods by designing a gender sensitive
workshop based on a specific situation.

Setting:
A WorldWID Fellow currently placed in the USAID/Romania Mission is
focusing on communication strategies in order to increase the use of
modern contraceptive methods to avoid unwanted pregnancies, and thus
decrease the use of abortions to avoid unwanted births. This work is
part of the UAID/Romania mission's Strategic Objective to increase use
of modern contraceptives methods, with an emphasis on private sector
delivery systems. Reproductive health care has become an important
strategic objective for USAID/Bucharest because of years of inattention
to the needs of women and the prohibition on family planning services.
Despite the illegality of contraception and abortion under the Ceaucesan
government that was overthrown in 1989, Romanian women did
anything possible to have only two children, many losing their lives or
their health in the process. After five years of efforts by the new
government, the Ministry of Health's family planning program is
beginning to provide services around the country and to provide family
planning training to about 400 general practitioners and obstetricians
and gynecologists.

Romanian NGO-sponsored family planning clinics provide services to
approximately 35,000 women, through a network of 12 clinics, seven of
which are USAID-supported. In addition, the first contraceptive
marketing and distribution project site visit occurred in November 1995.
A Young Adult Reproductive Health Survey to measure progress in
contraceptive prevalence was completed by the Center for Disease
Control (CDC) early this year.

A consortium of NGO's is currently implementing the programs directed
toward reaching the USAID Strategic Objective. In a recent planning
meeting which included USAID, their implementing partners, and a
WorldWID Fellow and the WorldWID program director (who was visiting
the fellow at the time of the meeting), it became clear that there was a
basic a lack of inclusion of the perspectives of people that will be affected
by the communication strategies being implemented. In general, the
implementing NGOs have provided training focused on strategies for
mass communication (such as TV and radio spots) and understanding
specific health and reproductive rights issues. One person participating








in the planning meeting posed a question that no one was able to
answer: "How do the women at the grassroots level perceive their
needs? "

As a result of the meeting, it was agreed that the WorldWID Fellow would
put together a workshop as a first step toward helping address this
communication gap. The workshop would train Romanian healthcare
and communication professionals, both women and men working with
the related programs, in participatory methods and how to listen to
people, particularly women, at the grassroots level.

Task:
Using the background information provided, plan a gender sensitive 3-
day workshop for professionals involved in the Human Reproductive
Rights campaign in Romania. This focus of the workshop is to train the
professionals in the use of participatory methods in order to enable them
to get at felt needs and understand barriers of participation of their
community members.








Background Information for Planning


Training Team: WorldWID Fellow, WorldWID Director, others?

Where: Romania. Working Class Apartment Block or in SECs clinic.

Participants: Up to 12 professionals involved in implementing the
Human Reproductive Rights Campaign in Romania. Includes SECs and
individuals from other project groups in other locations.

Client group the participants work with : A diverse and representative
group of up to 40 community members from the Working Class
Apartment Block.

General Context:
Distrust of government
Deference to medical professionals
Distrust of medical care
Over reference for abortions by doctors and medical staff
Conservatism about women's rights to anything
Taboos, etc.

Modern contraceptive use among Romanian women ages 15-44 who were
in a union was below 15 percent in a 1993 reproductive health survey,
compared to 40% in the Czech Republic. A 1996 young adult survey
showed a rise in use of modern methods: among young women ages 15-
24, modern method use between 1993 and 1996 rose from 8 to 18%;
almost all the increase was the result of condom use, with prevalence
rising from 4 to 13%. These figures are all still extremely low, however,
compared to the rest of Europe, even Eastern Europe. Abortion rates
remain among the highest in Europe. Moreover, ironically, high levels of
infertility are linked to the high rate of abortion, especially repeat and
self-induced abortions. High levels of child abandonment also reflect the
despair women experience at not being able to plan their pregnancies.

(sources: personal communication from Elizabeth Duverlie email)









Women's Reproductive Health in Romania: A Brief Summary*

" It's better to abort than to abandon. Abortion is safe, legal, stigma-free,
socially acceptable. Abortion is convenient, low-cost, hassle-free, easily
available."

These are three of the women's views on abortion from USAID- funded
focus group research in 1995, conducted by UNICEF. Most women 20
and over do not see anything wrong with abortion as a regular means of
controlling births. The good news is that attitudes are changing among
women under 20: they seem more open to contraception as an
alternative to abortion.

Interestingly, the men in the focus groups took the high moral ground.
They labeled abortion immoral and even criminal, but a necessary evil:
"unsafe but necessary when there is no choice." USAID's work in
reproductive health revolves around attempts to provide that choice.

Modern contraceptive use among women ages 15-44 who were in union
was below 15 percent in a 1993 reproductive health survey, compared to
40 % in the Czech Republic. A 1996 young adult survey showed a rise in
use of modern methods: among young women ages 15-24, modern
method use between 1993 and 1996 rose from 8 to 18%; almost all the
increase was the result of condom use, with prevalence rising from 4 to
13%. These figures are all still very low, however, compared to the rest of
Europe, even Eastern Europe.

"Unmet need" for family planning is a major concern in Romania.
According to the 1993 survey, 43% of women (nearly 1.5 million) were
using traditional methods and thus had a
need for more effective contraception. About 11% of women in union, or
some 400,000, were not using contraception but wanted to space or limit
childbearing. Thus, around two
million women have reproductive needs that could be met by access to
contraception and better services. In the absence of high and more
effective use of modern contraceptive
methods, Romanian women achieve their desired family size primarily
through abortion.

As a result, abortion rates in Romania are among the highest in Europe.
Maternal mortality is by far the highest in Europe (even though it has
dropped dramatically since 1989), as is the number of abortions per live
births. High levels of infertility are believed to be linked to the high rate
of abortion, especially repeat and self-induced abortions.








Most OB/GYNs are not trained in modern family planning methods, most
general practitioners are not ALLOWED to provide them, and, after over
20 years of negative propaganda many doctors remain unconvinced that
contraception is safe. Contraceptive supplies are not easily or
consistently available. Prices are often beyond the means of the average
woman, especially in rural areas! Contraceptives are often more
expensive than even repeat abortions. Moreover, OB/Gyns derive a
major proportion of their income from abortions.

Finally, Romania does not have an explicit national reproductive health
policy, nor does the Romanian government or the Ministry of Health view
improving family planning/reproductive health as a priority.

1. Romania Reproductive Health Survey (RRHS), conducted by the
Institute for Mother and Child Care, Ministry of Health, and the Centers
for Disease Control, Atlanta

*excerpted from a draft memo by Elizabeth Duverlie, WorldWID Fellow,
USAID/Romania, as a brief for the visiting Ambassador)




'97 04:05PM G/1ID 703 816 0266 F




WORLDWIDE FELLOW FOR
USAID/ROMANIA


TSAID/Romani~ S~agtrateI jOjectiye 3,:

Increased Use of Modern Contraceptive Methods,
With Emphasis on Private Sector Delivery Systems


UsAIDiRama~as. Sratgic .Q.sS^ivet2.1:

Increased, Better-Inforiped Citizens' Participation
in Political and Economic Decision-Making
Through Pluralistic Mechanisms

RCKGROUND

Often called a "Latin Island in a Slavic Sea," Romania has
been distinguished from other countries in Central Europe, due to
its unique history; its Communisa dictator who resisted the
reform deemed inevitable in other countries in the region, its
staunch pro-natalist policy; and its strategic geo-political
location.

A lower-middle income country of about 23 million people,
Romania experienced a slow and stumbling start following the fall
of its dictatorship in 1989. From 1989 through 1993, output fell
by 32 percent with industrial output down 54 percent; u.ne.mploy-
ment rose to 10 percent of the labor force, while real wages fell
by about 30 percent. However, a major fiscal adjustment of 1993
turned around the macro-stabilization process, and upward trends
have continued to date. Economic indicators, finally' beginning
to be positive, continue to be supportive of required transition
changes to a market-oriented democracy. Although inflation is
about 30 percent, it is much lower than earlier rates. GDP grew
by 6.9 percent in 1995, though Romania's per capital GDP of $1,352
in 1995 remains among the lowest in Central Europe. The govern-
ment has shown a strong commitment to the stabilization effort,
which is supported by the International Monetary Fund (IMPF) the
World Bank, the IBRD, and the ESRD.

Some problems currently do exist in the area of foreign
exchange and balance of payments, meaning that the currency will
continue to depreciate and pressures on inflation will persist;
such problems will no doubt restrict key imports and could have
an impact on efforts to build up the private sector through








F 2 "


imported inputs and equipment necessary to modernize the indus-
trial sector. Additionally, there is some concern that the
economic gains in recent years are fragile, being based more on
increased consumer demand, rather than on capital investment or
exports.

The government has also been working on structural reforms
supportive of the transition to a market-oriented economy. A
land reform program resulted in so percent of agricultural land
being privatized. The housing stock was also privatized. The
majority of state-owned companies were transformed into commer-
cial entities and progress has been made since mid-1993 in the
liberalization of prices, including elimination of most price
controls on industrial and agricultural products, energy and
agricultural products, energy produces and consumer goods.

Romania is considered to be a politically stable country.
Elections in 1992 were considered to be fair and open. As a
consequence of the above listed factors, the enabling environment
for the transition of Romania to a market-oriented economy
continues to be positive, with the caveat chat the problems
facing Romania remain among the most challenging in the region.

In the political realm, Romania is working out its particular
form of democracy. There are unresolved issues regarding'presi-
dential terms; the relationship between the executive, legisla-
tive, and judicial branches; the correct balance of power and
authority between the between central and regional government;
the ideal balance between public and private; and other basic
issues of establishing market-oriented democracy.

In the social sector, the time is not yet ripe for the privat-
ization of social services, such as health. The central govern-
ment has staunchly held on to the necessity to control this
sector, Indeed, even the health reform calls for only one,
government-owned insurance fund. The consensus of individuals
working in Romania is that reform in the social sector will come
about by building up a network of non-government organizations
which will provide parallel services and become catalysts for
higher-level system change through training of government staff
and actively advocating laws and regulations in support of more
privatized services.

Although Romania has made and continues to make progress in
its transition to a market-oriented democracy, it continues to
lag behind other countries in Central Europe. This is partly
because problems which the political and economic legacies of the
Ceausescu era left behind are more severe than most other coun-
tries in the region. International dcnor and. diplomatic pressure




'97 04:06FPI G.'"HID 703 816 0266 P.







and Romania's desire to join the European Union have been impor-
tant elements in the change process. The Government of Romania
has begun to put into place many of the required laws and regula-
tions for macroeconomic stabilization and now is beginning to lay
the necessary foundation for structural changes. Key changes o
date have included the ratification of a new Constitution, the
establishment of a multi-party electoral system, the holding of
two elections deemed open and fair, the accelerated mass privat-
ization law, the bankruptcy law, the environmental law, the
health reform and all their permutations to restructure and
re-texture society toward transition goals.




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