ROMANINA WOMEN AWAIT BETTER HEALTH CARE.

Byline: Jane Perlez The New York Times

Dorina Ciuplan, a 40-year-old mother of three teen-agers, recalled with a mixture of terror and emotion the nine self-induced abortions she endured during communist rule under Nicolae Ceausescu.

``I sometimes think I'm lucky to be alive,'' said Mrs. Ciuplan, her eyes watering as she described forcing miscarriages at home and then going to a hospital, where doctors and nurses tormented her with abusive words and rough treatment as they finished terminating the pregnancies rather than let her die.

For more than two decades, contraception and abortions were strictly forbidden by Ceausescu in an attempt to build his country into a colossus through population growth. His government was overthrown in 1989, and one of its legacies was orphanages filled with unwanted and neglected children.

Another legacy of those horrific years, for Romania's women, is abortion. Some 10,000 women are believed to have died from complications of illegal abortions, and many more were permanently maimed.

Abortions were legalized as soon as Ceausescu was toppled, and contraception is theoretically available through the state health system.

But overwhelmingly, Romania remains what Western doctors call an ``abortion culture,'' with an abortion rate that remains the highest in Europe. It also has by far the highest rate of pregnancy-related mortality, the strongest indication that Romania continues to lag far behind the rest of Europe and Russia in providing reproductive health services for women.

According to the United Nations Population Fund, Romania had 3.2 abortions for every live birth in 1990. By last year, the rate was 2.2 abortions per live birth. In 1995, the equivalent rate was 2.0 in Russia, 0.67 in the Czech Republic and Hungary and 0.2 in Germany.

The reasons why Romanian women turn to abortion center on the reluctance of the government to promote family-planning despite healthy doses of Western aid to help the country establish such services, Western and Romanian doctors say.

Dr. Iulian Mincu, who was minister of health until recently and who had been a personal physician to Ceausescu, publicly stated his opposition to family planning.

After a public outcry over poor conditions in the health system, Mincu was dismissed this summer by Ceausescu's successor, Ion Iliescu, in an attempt to clean up the government's image prior to parliamentary and presidential elections that Iliescu lost anyway.

President-elect Emil Constantinescu made it clear during his campaign that he would make improved health services a priority, and family planning advocates said they were optimistic that the new government would be more supportive of their efforts.

Without guidance from the government, many Romanian doctors have been more enthusiastic about the more lucrative work of performing abortions than about recommending family-planning measures, said Daniela Draghica, one of the administrators of 12 pilot family-planning clinics in Romania opened in 1995 and financed by the U.S. Agency for International Development.

The state pays for abortions, but as with almost all public health services women say they feel obliged to give the doctor a sizable extra payment, thus making abortions more financially rewarding.

A 28-year-old woman who would give only a first name, Adina, was at the gynecological clinic at Giulesti Hospital in Bucharest. She said she had had six abortions. An abortion costs 3,000 lei, a little less than $1, at public hospitals, where the vast majority of Romanians get their health care. But she said she had paid an additional $7 as a ``gift'' to the doctor.

On top of this, many doctors, repeating myths from the Ceausescu years, tell women exaggerated stories that oral contraceptives are deleterious to their health, Mrs. Draghica said.

``Women had these myths about contraception,'' Mrs. Draghica said. ``The doctors had told them that pills were bad because they made women fat and gave them heart disease. It's a battle to get their confidence.''

Some women are beginning to look for other alternatives. Maria Staicu, 41, who lives in the city of Sibiu and has two children, said the pain and debasement she endured in 1991 when she had a legal abortion left her determined not to go through it again.

``They did 20 women in a few minutes: `Ready, go; ready, go,' '' she said, describing the atmosphere in the state hospital. In the last five years of the Ceausescu regime, she had managed to buy Hungarian-made oral contraceptives on the black market, she said. After her abortion in 1991, she was fitted with an IUD. ``I would prefer anything else than an abortion,'' she said.