Prepared by
Rodica Comendant, MD, PhD
Director, Reproductive Health Training Center (RHTC), Chișinău, Moldova
Senior SRHR Expert, WHO Consultant on Safe Abortion and Family Planning
Regional Coordinator, Regional Reproductive Health and Rights Coalition (RRHRC)
Oksana Ceban, MD, Director Reproductive Health and Family Planning Center, Tiraspol, Transnistria
Catalina Comendant
Project Manager, Reproductive Health Training Center (RHTC), Chișinău, Moldova
Regional Co-coordinator, Regional Reproductive Health and Rights Coalition (RRHRC)
Transnistria is a narrow strip of territory located along the eastern bank of the Nistru (Dniester) River, bordering Ukraine. The region has an estimated population of approximately 350,000–380,000 people and includes the main urban centres of Tiraspol (administrative centre), Bender, and Rîbnița.
Source: https://pl.wikipedia.org/wiki/Plik:Moldova-CIA_WFB_Map.png
Although internationally recognized as part of the Republic of Moldova, Transnistria has operated under de facto separate governance structures since the early 1990s following the post-Soviet conflict. This contested status shapes nearly every aspect of social policy, including sexual and reproductive health and rights (SRHR). Limited international oversight, restricted engagement with external systems, and reduced access to funding mechanisms create structural challenges for the development, monitoring, and accountability of SRHR services. At the same time, local providers and civil society actors have managed to build meaningful progress through sustained collaboration with international partners and long-term technical support from the Reproductive Health Training Center in Chisinau.
Within this context, SRHR service provision has gradually evolved toward more evidence-based and rights-oriented care. One of the most significant developments has been the establishment of a coordinated network of five model centres providing medical abortion, post-abortion family planning, and telemedicine-supported services. The Reproductive Health and Family Planning Center (RHFPC) in Tiraspol plays a central coordination and mentoring role, helping maintain continuity and quality of care across the region.
Access to healthcare remains shaped by economic realities. Women in Transnistria face lower average income levels compared to the rest of Moldova, and many reproductive health services are not covered through insurance schemes that exist on the right bank of the Nistru River. These factors increase out-of-pocket costs and can delay care-seeking. Economic constraints may lead to the postponement of medical consultations, reinforcing inequalities in access and highlighting the importance of decentralised and telemedicine-supported pathways.
Telemedicine medical abortion (TMA) has emerged as an important response to geographic and financial barriers, allowing women from smaller towns and rural areas to access safe services without travelling long distances. The model has proven both feasible and acceptable, with providers increasingly relying on structured counselling, follow-up calls, and digital registration systems to ensure continuity and safety.
The telemedicine pathway follows a clearly defined clinical algorithm aligned with WHO recommendations. It includes eligibility screening (confirmation of gestational age and exclusion of contraindications), comprehensive counselling, documented informed consent, remote supervision of the medication process (mifepristone plus misoprostol), and structured follow-up at defined intervals. Where clinically indicated, referral pathways to inpatient facilities are clearly established. This structured model contributes to both safety and standardisation of care.
During 2025, a total of 329 telemedicine medical abortions were provided across the five model centres, demonstrating not only sustained demand but also the consolidation of provider capacity. Medical abortion services are systematically linked with post-abortion family planning counselling, allowing women to receive modern contraceptive methods immediately after care. Particular emphasis has been placed on expanding access to long-acting reversible contraceptives (LARCs), including intrauterine devices and subdermal implants. Immediate post-abortion initiation of contraception contributes to reducing the risk of repeat unintended pregnancies and aligns with WHO recommendations on post-abortion family planning as a key preventive strategy.
Provider mentorship has played a critical role in maintaining service quality. Experienced clinicians support colleagues in smaller centres through real-time consultation and hands-on supervision. This mentorship model not only strengthens individual competencies but also reduces clinical variability, harmonises service provision across facilities, and contributes to long-term system stability.
At the policy level, important progress has recently been achieved toward institutionalizing evidence-based SRHR care. The revised Family Planning protocols were officially approved in January 2026. Now, both the updated Family Planning standards and the 2024 Safe Abortion protocols, which include (TMA) telemedicine medical abortion as service delivery, are aligned with WHO recommendations. The approval of these protocols enhances legal clarity and professional security for healthcare providers, reduces ambiguity in clinical decision-making, and supports uniform application of standards across institutions. By adapting WHO guidance to local organisational realities, the updated documents contribute to both normative stability and sustainability of services beyond project-based initiatives.
In a broader regional context where SRHR policies are increasingly contested or subject to political debate, the approval of updated protocols aligned with international standards can be seen as a particularly important and positive development. It demonstrates that even within complex political environments, progress toward evidence-based, rights-oriented reproductive healthcare remains possible through sustained professional collaboration, technical expertise, and long-term commitment to quality of care.
Beyond clinical services, access to accurate information remains a major challenge. Community-based educational activities show that many women still have limited knowledge about modern contraception, telemedicine pathways, and safe abortion care. Trainings facilitated by healthcare professionals, both from Moldova and Transnistria, and NGOs from both banks of the river Nistru have created spaces for open dialogue, allowing participants to ask questions and discuss topics often considered taboo. These sessions also highlighted how reproductive health decisions are shaped by broader social realities, including family dynamics, stigma, and gender-based violence. At the same time, learning and knowledge exchange has not been limited to local activities. Participation of providers from Transnistria in the 3rd Regional Conference on self-care in reproductive health (Chișinău, 2025) created an important opportunity to both share their own implementation experience and learn from colleagues across the Eastern Europe and Central Asia region. Through presentations, discussions, and peer exchange, providers were exposed to regional lessons on telemedicine medical abortion, protocol alignment with WHO recommendations, and strategies for expanding access to rights-based care. This regional dialogue strengthened professional confidence, reinforced evidence-based approaches, and contributed to ongoing learning by allowing local teams to compare their experience with broader regional developments and innovations.
Sexuality education as a formal, structured system remains difficult to assess based on available information. While community sessions provide valuable SRHR knowledge, there is insufficient evidence to evaluate the extent or quality of comprehensive sexuality education within schools or institutional settings. This suggests that many women continue to rely on informal or ad hoc sources of information rather than systematic educational frameworks.
When considering vulnerable groups, the available documentation provides only partial insight. Participants in community trainings, particularly mothers, raised questions about how adolescent girls can safely access reproductive health services, indicating both concern and a need for clearer youth-friendly pathways. However, the current evidence base does not allow for a detailed assessment of adolescents’ access or barriers. Similarly, the available materials do not provide sufficient information to analyse the experiences of LGBTQI+ persons in relation to SRHR services. At this stage, the team does not consider itself sufficiently versed in these areas to provide a reliable or comprehensive analysis.
Economic vulnerability and geographic isolation remain more clearly documented factors affecting access. Women living outside major urban centres benefit significantly from decentralised services and telemedicine options, which reduce travel burdens and increase privacy. Nonetheless, awareness of available services remains uneven, indicating that information gaps persist even where services technically exist.
Data availability represents an ongoing challenge. Publicly accessible, systematised and disaggregated SRHR data remain limited. Information on abortion methods distribution, contraceptive prevalence, adolescent pregnancy rates, and maternal morbidity is fragmented and not consistently available in the public domain. While these sources provide valuable insight, they do not necessarily reflect the entire health system, making broader analysis difficult. Much of the current understanding relies on project reporting and NGO-supported initiatives, which, while valuable, do not fully capture system-wide performance.
Overall, the SRHR landscape in Transnistria reflects broader regional dynamics seen across Central and Eastern Europe: shrinking civic space, cautious institutional environments, and ongoing tension between rights-based approaches and conservative or demographic narratives. Yet within these constraints, local providers have demonstrated a strong commitment to maintaining evidence-based, WHO-aligned reproductive health services. The development of telemedicine medical abortion pathways, the integration of modern family planning, and continued regional collaboration illustrate how progress can still occur through professional solidarity and cross-border support networks.
An important contextual element is that, in many areas of healthcare, professional practices and policy thinking in Transnistria are strongly influenced by medical and academic spaces connected to the Russian Federation, where many providers have professional ties, participate in conferences, or maintain family and professional networks. Against this background, it is particularly notable that, through long-term collaboration, trust-building, and consistent technical support from CIDSR/RHTC and regional partners, local professionals have chosen to implement WHO-aligned approaches in sexual and reproductive health despite different policy directions seen in other medical sectors.
This progress has also taken place in a context marked by reduced engagement of major international actors, including the gradual withdrawal or scaling down of some UN-led projects in the region, and continuing political tensions between the authorities on the two banks of the Nistru River. In this environment, medical and social cooperation projects have played an important bridge-building role, helping maintain dialogue, professional exchange, and shared standards of care. Such collaboration demonstrates how health-focused partnerships can create neutral spaces for trust, learning, and cooperation, ultimately improving access to quality, rights-based services for women and communities.
