Sexual and reproductive health in Romania and Moldova: contexts, actors, challenges.
PhD thesis, University of Glasgow.
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Over the past two decades sexuality and reproduction have proved potent and contested subjects. After the unexpected collapse of the state socialist systems, societies facing uncertainty and dislocation have turned both to the allure of ‘the west’ and to pre-socialist traditional values of family and gender. Along with this, aspirations of moving closer to Europe sits alongside a resurgent nationalist sentiment throughout the region, and it is sexuality and reproduction which has become a particularly contested battleground, as the female reproductive body has become a metaphor for the vitality and viability of the nation-state. Discourses of demographic crisis, calls to produce more (indigenous) children to increase the population and ensure the stability and viability of the state, and proscription of so-called ‘deviant’ (defined as non-heterosexual/non-reproductive) sexualities have all gained in currency as the nations of the region try to establish themselves as sustainable entities following the years of state-sponsored paternalism. At the same time, western nations and donor agencies offer support to redevelop and redesign out-of-date systems and bureaucracies and the opportunity to modernise and enjoy the benefits of capitalism and liberal democracy. A particular focus on developing civil society along with the reform of state institutions widens the social marketplace still further.
It is against this backdrop that policy makers and service providers attempt to develop and provide health services. Public health is a useful barometer of what is happening in society, as it reflects the effects of wider socio-economic and political trends. Within this, the study of sexual and reproductive health is crucial as it also has the ability to illuminate the differential effects of societal change on different groups within society, such as women or those from minorities. It also powerfully illustrates the contestations going on in wider society around meanings of the moral and healthy, as sexuality and reproduction are issues pertinent to the continued reproduction of states and other ‘communities of power’.
This thesis is a study of the experiences and perceptions of service providers in the field of sexual and reproductive health in Romania and the Republic of Moldova. Through interviews with service providers in both state and civil society sectors as well as regional and national authorities and international donor agencies, and an extensive media review of the portrayal of sexuality, reproduction and sexual and reproductive health, opportunities and barriers to providing accessible and responsive services within the contested arena of two postsocialist countries with much in common historically and culturally but following very different paths in the contemporary period are explored. The continuing importance of sexual and reproductive health as a category of study which can illuminate wider macro-level debates on national identity and vitality, as well as the importance of discursive battles over control of meanings, are amply illustrated in the thesis. In particular the relation between health and morality is extensively explored, and the relevance of an area studies approach to this wider topic is demonstrated. The thesis finds that it is vital to consider sexual and reproductive health services within their wider sociocultural context and that transnationally-funded initiatives do not take full account of the multiplicity of meanings and values underpinning the reactions of target populations to their services; indeed services are often framed as representing an unwelcome invasion of ‘alien’ morality. Ultimately providers and funders need to take the moral understandings of their target populations very seriously if they are to overcome the considerable opposition to their services.
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