UPR 4th Cycle: Advancing Sexual and Reproductive Health and Rights (SRHR) in Moldova

Relevant 3^rd Cycle Recommendations: 127.147; 127.148; broad 127.157

 Context

While the Republic of Moldova has established a legal SRHR framework, universal access is still an issue. Adolescent pregnancy rates in the Republic of Moldova remain three times higher than the European average, approximately 6 out of every 100 babies in Moldova are born to adolescent mothers, and between 2015 and 2020 there has been an increase in HIV among young people.

The issue persists because of several institutional barriers. Although family planning services are de jure covered by the National Health Insurance Company (CNAM), free contraceptives are currently distributed only to 12 categories of “vulnerable groups.” This creates a tiered health system where access depends on vulnerability status and on external donor support rather than being guaranteed as a universal right. As a result, contraceptives remain underutilized as many people in Moldova cannot afford or access modern contraceptives. Abortion services are generally provided on a fee-for-service basis and are not covered by CNAM, also creating financial barriers for many women and adolescents. Furthermore, recent regulatory changes (Order No. 45/2025) have introduced restrictions on access to medical abortion via telemedicine, leaving it available only in crises. And, finally, the fragmentation and quality of Comprehensive Sex Education (CSE) programs fall behind international standards. The recommendations of the 3^rd UPR cycle have therefore been only partially implemented.

Recommendations:

• Amend laws to explicitly include modern contraception and safe abortion, including medical abortion, within the package financed by the National Health Insurance Company (CNAM).
• Establish permanent public funding for contraceptives and medical abortion supplies to end reliance on external donors and reposition the government’s primary accountability toward its citizens. Modern contraceptives should be included in the National Essential Medicines List and made available to all individuals who lack sufficient financial resources.
• Legally mandate that CNAM finances these services through the Unified Programme to ensure they are treated as basic health entitlements.
• Transition from restricted coverage to cost-free access for the entire reproductive-age population, removing all financial barriers to essential care. Safe abortion services, which are currently provided on a fee-for-service basis, should also be covered by CNAM and offered free of charge.
• Ensure that medical abortion via telemedicine is available to all eligible women, in line with WHO recommendations, rather than being restricted to crisis and exceptional situations. Particular attention should be given to women living in rural areas and adolescents, who face disproportionate barriers to accessing in-person services.
• Improve the systematic collection and publication of disaggregated data (by age, disability, and geography) regarding SRHR service uptake to identify and address remaining inequalities.
• Institutionalise mandatory, evidence-based CSE across all educational levels to fulfil the state’s direct obligation to its youth, independent of fluctuating donor support.
• Defined mandatory training standards for educators to ensure the delivery of high-quality SRHR education is a core competency of the national education system.
• Eliminate administrative hurdles that prevent accredited health professionals and CSOs from conducting specialised SRHR activities in schools.
• Expand non-formal SRHR programs to reach out-of-school youth and marginalised groups, ensuring no citizen is left behind by gaps in institutional coverage.