"There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans

Teresa Janevic,Pooja Sripad,Vera Dimitrievska,Elizabeth Bradley

doi:10.1186/1475-9276-10-53

Teresa Janevic, Pooja Sripad + Show 2 more

Open Access

https://doi.org/10.1186/1475-9276-10-53

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Abstract

IntroductionRoma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism--personal, internalized, and institutional--affect access to maternal health care among Romani women.MethodsEight focus groups of Romani women aged 14-44 (n = 71), as well as in-depth semi-structured interviews with gynecologists (n = 8) and key informants from NGOs and state institutions (n = 11) were conducted on maternal health care seeking, experiences during care, and perceived health care discrimination. Transcripts were coded, and analyzed using a grounded theory approach. Themes were categorized into domains.ResultsTwenty-two emergent themes identified barriers that reflected how racism affects access to maternal health care. The domains into which the themes were classified were perceptions and interactions with health system, psychological factors, social environment and resources, lack of health system accountability, financial needs, and exclusion from education.ConclusionsThe experiences of Romani women demonstrate psychosocial and structural pathways by which racism and discrimination affect access to prenatal and maternity care. Interventions to address maternal health inequalities should target barriers within all three levels of racism.

Highlights

Roma, the largest minority group in Europe, face widespread racism and health disadvantage
Roma, the largest minority group in Eastern Europe, historically have faced widespread racism and discrimination, a position that in many ways has worsened during the post-Communist transition [1]
In Serbia and Macedonia, many Roma face the additional burden of being internally displaced persons (IDPs) or refugees since large numbers, estimated at 80, 000, of Roma fleeing the war in Kosovo

Summary

Introduction

The largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism–personal, internalized, and institutional–affect access to maternal health care among Romani women. The largest minority group in Eastern Europe, historically have faced widespread racism and discrimination, a position that in many ways has worsened during the post-Communist transition [1]. Existing data regarding access to maternal health care among Romani women in Serbia and Macedonia, limited, shows large disparities compared to non-Roma. We lack data to examine if similar disparities exist in maternal morbidity and mortality, the infant mortality rate among Roma in Serbia was estimated to be 25 per 1000, approximately three times the national average [5]

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