4.4-O5Discrimination against Romani women in maternity care in Europe - a mixed methods systematic review

Abstract

Background: International efforts to improve access to and quality of maternal and new-born care are often hindered by the failure to eradicate discrimination in both policy development and the provision of services (Partnership for Maternal, New-born and Child Health, 2015). EU Member States are required to ensure Romani women have access to quality healthcare in line with the principle of non-discrimination (European Commission, 2011; Pohjolainen, 2014). Aim: To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this. Method: Systematic mixed-methods review using a segregated approach. Eight databases were systematically searched using terms for “Roma” and “maternity care”. A broad search for grey literature also included the websites of relevant agencies. Standardised data extraction tables were utilised, quality was formally assessed, and a line of argument synthesis was developed and tested against the data from the grey literature. Results: Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria with data predominantly from Central and Eastern European regions. These revealed that many Romani women encounter barriers to accessing maternity care, and experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature. Conclusions: There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives