ROMA WOMEN’S REPRODUCTIVE HEALTH
AS A HUMAN RIGHTS ISSUE IN
Enikő Magyari-Vincze
Policy paper
January 2006
TABLE
OF CONTENTS
Abstract ……………………………………………………………………………… p. 3.
1. Understanding Roma women's reproductive health ……………………………. p. 5.
1.A. Problem definition. Roma women’s reproductive health as human right and socially determined phenomenon. The stakeholders.
1.B.
The
importance of the problem. The impact of (the lack of) reproductive
rights
on Roma women’s life.
1.C. Statement of purpose. Mainstreaming gender and ethnicity in public policies.
1.D. Methodology. Ethnographic research and policy investigation.
1.E. Paper overview. Analysis and recommendations.
2. Main research findings ………………………………………………………….. p.10.
2.A. Roma women's discrimination in the context of reproductive health care policies and services
2.B. Roma women's exclusion from the mainstream Roma policies and movement
2.C. Roma women's social exclusion on the base of their ethnicity, gender and social position
3. Reproductive health of Roma women as a policy matter ...……………………… p. 15.
3.A. The policy problem
3.B. The context of the policy problem
3.C. Policy recommendations
3.C.a. Principles guiding my policy recommendations
3.C.b. Expected results
3.C.c. Policy recommendations – general and specific
Bibliography ………………………………………………………………………... p. 22.
Endnotes ……………………………………………………………………………. p. 24.
ABSTRACT
My policy paper
addresses the
access of Roma women to reproductive health in
The
access of Roma women to reproductive health is shaped by structural
discrimination, cultural prejudices, school segregation and
abandonment,
poverty, disparities in income distribution and unemployment,
inadequate
housing and food, lack of clean water and sanitation, lack of official
documents and of medical insurance in many cases. As my ethnographic
fieldwork presented
in the separate research paper shows, these conditions are affecting
women in
particular ways as a result of which they are subject to triple
discrimination,
but also agents who are able to use creative strategies for dealing
with all of
their private and public burdens, among them reproduction. Most
importantly,
one may observe that Roma women are situated at the crossroads of
several
conflictual subject positions, prescribed for them by different
discourses and
institutions (example state policies, health care providers, their own
communities, Roma policies). Some of them, for example, would like to
enforce
them to make more, others to make fewer children. That is why they
might be
quite confused in their effort of identifying with one or another
position
while also following their own interests as autonomous human beings.
How do
they feel, think and act under these circumstances? These aspects of
the issue under
scrutiny are analysed in my research paper entitled "Social Exclusion
at
the Crossroads of Gender, Ethnicity and Class. A View through Roma
Women's
Reproductive Health".
At the same time the
issue of
reproductive health is an issue of human
rights,
central to general well-being and crucial for achieving equity and
social
justice, so any women should have access to it regardless of her
ethnicity, age
and socio-economic position. Reproductive rights of women include the
right to
have access to reproductive health care information and services, the
right to
sexual education and bodily integrity, the right to decide on the
number of
children and the time-spacing of births, and the right to decide on the
contraceptive method most appropriate for their medical and social
condition. As
my primary research proves there are many structural and cultural
factors
within the health care system that limit the opportunities of the de
facto
use of reproductive rights by Roma women. It is also observed that the
ethnic
blindness of reproductive health policy and the gender blindness of
Roma policy
fail to serve Roma women properly. This happens despite the fact that
there are
initiatives within the Romani movement in
The
stakeholders involved into the issue of reproductive health are the
Ministry of
Health and the National Agency for Roma of the Romanian Government,
non-governmental organizations working on the domain of sexual
education and
reproductive health (like the Society for Sexual and Contraceptive
Education,
and the Romanian Family Health Initiative), but also on the domain of
Roma
women’s rights (like the Association of Roma Women from Romania, the
Association for the Emancipation of Roma Women, and the Association of
Gypsy
Women for Our Children). But obviously this issue is also in the
interest of a
larger community of people dealing with Roma communities, among them
Roma
health mediators, Roma schools mediators, local Roma experts and other
(formal
or informal) community leaders.
The
recommendations of my policy paper refer to the need of mainstreaming
ethnicity
into the public health policy and of mainstreaming gender into Roma
policy in
order to overcome the effects of ethnic and gender
discrimination in
relation to reproductive rights and access to healthcare of Roma women. As such they seek to have a contribution to
the general
aim of mainstreaming gender and ethnicity in all public policies from
1.
UNDERSTANDING REPRODUCTIVE HEALTH
1.A. Problem definition
Roma women’s
reproductive
health as human right and socially determined phenomenon
This policy paper[1]
addresses
the access of Roma women to reproductive health in
I am subscribing to the definition according to which "reproductive health is a state of complete physical, mental and social well-being…in all matters relating to the reproductive system".[3] In terms of physical well-being its mostly used indicators are: fertility rate, infant mortality rate, and maternal mortality rate, the proportion of births attended by skilled health personnel, contraceptive prevalence, and occurrence of abortions, uterine cancer and breath cancer.[4] As health in general, reproductive health in particular is socially and culturally conditioned. In the case of Roma communities it is shaped by structural discrimination, cultural prejudices, school segregation and school abandonment, poverty, disparities in income distribution and unemployment, inadequate housing and food, lack of clean water and sanitation, lack of official documents and of medical insurance in many cases. In my ethnographic research I was focusing on the ways in which the use of contraceptives and abortion was shaped by Roma women’s life conditions, by the cultural conceptions dominant within the investigated communities and by the nature and functioning of the local health care system, but, on another level, also by the existing public health and Roma policies.
Most
importantly my policy study treats the issues of reproductive health as
part of
the problem of reproductive rights, and considers that reproductive
rights
include:
-
women’s
“right to have control over and decide freely and responsibly on
matters
related to their sexuality, including sexual and reproductive health,
free of
coercion, discrimination and violence",[5]
-
the
right to the highest standard of reproductive health,
-
the
right to have access to reproductive health care information and
services,
-
the
right to sexuality education and bodily integrity,
-
the
right to decide on the number of children and the time-spacing of
births,
-
women’s
right to decide on the contraceptive method most appropriate for her
medical
and social condition.
A whole
range of stakeholders are involved into the issue of Roma women’s
reproductive
health as human right. Among them governmental agencies (most
importantly the
Ministry of Health and the National Agency for Roma of the Romanian
Government)
and non-governmental organizations working on the domain of sexual
education
and reproductive health (like the Society for Sexual and Contraceptive
Education, and the Romanian Family Health Initiative), but also on the
domain
of Roma women’s rights (like the Association of Roma Women from
Romania, the
Association for the Emancipation of Roma Women, and the Association of
Gypsy
Women for Our Children). But obviously this issue is also in the
interest of a
larger community of people dealing with Roma communities, among them
Roma
health mediators, Roma schools mediators, local Roma experts and other
(formal
or informal) community leaders.
I
consider that Roma women's organizations are playing a huge role in
empowering
Roma women within their own communities, and – at their turn – the
mainstream
Roma organizations do have the responsibility to support them in this
endeavour. That is why my recommendations do refer to this aspect of
policymaking, to. Only the empowerment of women could turn them into
individuals able of taking decisions about their reproductive health
and of really
using their reproductive rights regardless of the requirements of
different (patriarchal
and/or racist) authoritarian discourses and institutions that put a
pressure on
them, for example wanting them or to make more, or to make fewer
children.
1.B.
The importance of the problem
The
impact of (the de facto lack of) reproductive rights on Roma women’s
life and
on Roma communities
Reproductive health is defined and recognized by the international community and by the Romanian government as an important dimension of public health. But the human rights discourse is hardly shaping the public talk and practices regarding reproductive health, and there is a reduced concern with the de facto access of Romani women to health care information and services.[6] That is why there is a need to raise public awareness about reproductive health as a reproductive right both within Roma policies and within public health policies, and about the necessity to consider the social determinants of Roma women’s health and access to health care.
Reproductive
rights are important because the presence or absence of these rights
has a huge
impact on how people live and die, on their physical security, bodily
integrity, health, education, mobility, social and economic status and
other
factors that relate to poverty. Reproductive health underpin the other
goals
relating to gender equality, maternal health, HIV and AIDS and poverty
alleviation, and are crucial to the achievement of the goals overall.[7]
Women
belonging to marginal groups (among them Romani communities) often lack
the
rights or opportunities to make choices around reproduction even if
1.C. Statement of intent
Mainstreaming
gender and
ethnicity in public policies. Ethnicizing reproductive health policy
and
gendering Roma policy
This
paper aims to have a research-based contribution to the development of
a
reproductive health policy and of a Roma policy, which consider
reproductive
health as a human right of women and treat it as a socially and
culturally
determined phenomenon. The ethnic awareness of reproductive health
policy and
the gender awareness of Roma policy should be based on the recognition
of the
fact that ethnic and gender differences are not naturally given, but
are
produced, maintained and turned into inequalities by several social and
cultural factors and mechanism.
My
policy recommendations refer to the need of mainstreaming ethnicity
into the public
health policy and of mainstreaming gender within the Roma policy in
order to
overcome the effects of ethnic and gender discrimination in relation to
reproductive
rights and access to healthcare of Roma women.
They
seek having a contribution to the general aim of mainstreaming gender
and
ethnicity in all public policies from
One of
the conclusions of my policy paper is that the problem of women’s
reproductive
rights is a highly sensitive issue within Roma communities, within the
Roma
movement, but also within the public health care services providers.
That is
why my recommendations are also referring to the need:
-
of
empowering women within Roma communities and within the Roma movement
in order
to turn the public talk about women’s body, sexuality and related
rights into a
legitimate issue;
-
of
liberating Roma women from the authority of pro-natalist concerns in
order to
be free for feeling entitled and acting accordingly in decisions
concerning
reproduction;
-
of excluding
the risk of the emergence and functioning of a racist fertility
control, which
claims that it provides Roma women with reproduction control methods
while actually
is working with the aim of “preventing Roma over-population”.
1.D. Methodology
This policy paper is based on the recognition of the fact that (reproductive) health is determined socially, economically and culturally, and the problems related to it are also talking about the lack of reproductive rights, or, at least, about the lack of opportunities to make use of these rights. That is why the framework of my analysis is shaped by a social, cultural and critical approach. Otherwise the analysis is based on a primary empirical research done in the summer of 2004 (in cooperation with the Society for Sexual and Contraceptive Education from Cluj), and between June and December 2006 (with the support of the International Policy Fellowship Program).
As
health in general, the state of reproductive health is shaped by the
social and
economic conditions of Roma women’s life, but also by the cultural
conceptions/prejudices
about Roma women existing within their own groups and within the
community of
health care providers. I managed to reveal these aspects of the problem
by the
means of an ethnographic research done within local Roma groups and the
local
community of health care providers (family doctors, gynecologists, and
medical
assistants) in the city of
1.E. Paper overview
The
analysis part of my policy paper is presented separately in my research
paper
entitled "Social Exclusion at the Crossroads of Gender,
Ethnicity
and Class. A View Through Roma Women's Reproductive Health". Its main findings are presented in Chapter 2
of this
paper. Basically it refers to the causes, manifestations and effects of
Roma
women’s lack of opportunities of de facto using their
reproductive
rights. It identifies the obstacles of the reproductive health
services
usage both from the perspective of Roma women’s life conditions and
from the
point of view of the health care system. Additionally it
shows that the Romanian reproductive health policies and the
existing Roma
policies are failing to respond to the interests and particular
conditions of
Roma women, and willingly or not transform them into an underserved and
triple
discriminated group. It observes that, unfortunately, the few
initiatives for militating
for Roma women’s rights do not have yet the authority to impose a
change in the
way of thinking about and acting around this issue and to increase its
legitimacy and prestige within the mainstream Roma policies.
The
recommendation part of this policy paper presented in Chapter 2
formulates
suggestions for non-governmental organizations and governmental
agencies. These
are related to the needed changes that might improve Roma women’s real
access
to reproductive rights and reproductive health care information and
services. Eventually
they suggest the general necessity of mainstreaming ethnicity and
gender in the
Romanian public policies.
2.
MAIN RESEARCH
FINDINGS
My analysis of
reproductive
health was focused on the prevalence of abortion and use of
contraceptives
neglecting its other aspects. I am aware of the fact that it is
dangerous to
reduce reproductive health to these issues, because this –
willingly-or-not –
might favor the assimilation of the former with fertility control that
I would
like to avoid. Especially because during my fieldwork I encountered
both on the
side of Roma organizations and on the side of health care providers
this
tendency due to which one claimed pro-natalist, and the other racist
fertility
control aims forgetting about the main issue that is supposed to be
served by
reproductive health policies, i.e. about women's health. Still, under
the
conditions of post-socialist
2.A. Roma women's
discrimination in the context of reproductive health care policies and
services
The abolition of the
Ceausist
anti-abortion law (a law that conferred, among others, the specificity
of
The Strategy of the Romanian Ministry of Health on the domain of reproduction and sexuality was launched only in 2002, as a result of which courses on family planning for family doctors and the distribution of free contraceptives started (but very timidly!). Ultimately, in 2004 the Law regarding reproductive health and the medically assisted human reproduction was elaborated, which defines the issue of reproductive health and health of sexuality as a priority of the public health system, and discusses about these issues in terms of rights. Leaving aside the fact that its discourse is mostly couple (family) than women-centered, one should also expect that – as it was in the case of each gender-equality-related law – for quite a time a gap is going to be there between the legal provision and its actual implementation.
The downsizing of the gynecology section at the state hospital of the city where I did my fieldwork and its under-developed infrastructure illustrated the mechanisms of devaluing women's concerns, in particular reproductive health. Even if theoretically the society and the state recognize the role of women in biological reproduction, they do not invest much money into and do not confer much symbolic prestige to this domain of health care.
At the local level health care providers looked to be more than willing to administer to Roma women for free the contraceptives that are at their disposal (mostly injectables, whose secondary effects are only very vaguely known). Under these conditions women had "chosen" to use the contraceptives that were for free because they did not afford buying others (which might be more proper for their health) and they better took something/anything that was available for free (despite its negative consequences) than making more children under their given material conditions.
The ethnic-blind reproduction policies maintain Roma women's underserved status, because do not consider the differences between the socio-economic condition of Roma and non-Roma women and do not care about the lack of equal opportunities in de facto using the formally assured reproductive rights. This means, among others, that – also due to this – Roma women continue to be disposed "to choose" abortion as a method for the control of reproduction, and if they decide to use modern contraceptives they are obliged "to choose" the ones that are available for free and not the ones, which might be indicated according to their medical condition. Still, one may say that reproduction policies are in the best case ethnic-blind, for it might happen that they might be "ethnically aware", although not in a positive but in a negative sense. More precisely, reproduction policies might not be like that in themselves, but they might be used for racist purposes, following the aim to control the unwanted Roma "overpopulation".
2.B. Roma women's
exclusion
from the mainstream Roma policies and movement
The discourses that characterize Roma policies and views about Roma women reveal the fact that they are driven in the best case by a gender-blindness, which refuses to recognize the importance of Roma women's issues, and, in the worth case, by pro-natalist concerns, which, at their turn, reproduce the subordinated position of Roma women from which it is very difficult to act as autonomous subjects trying to de facto use their reproductive rights. One may try to understand that in the case of a vulnerable community which, on the top, aims to construct its identity on the base of culturally valued traditions, pro-natalist concerns may have their functions in this attempt. They might be used as an instrument of defense in the front of the racist prejudices and practices directed against the community. This is why the issue of reproduction control is sensitive in the case of Roma groups (but in fact it is sensitive in the case of any social group during times when it wants to prove its strength through demographic indicators).
International organizations are having a potential empowering ability towards local women’s organizing that started to have important initiatives in the 2000s. However, it should be mentioned that there is a gap between the discourse and practices of international organizations, and those of the local ones, so the latter are still having huge difficulties in implementing these ideas within their national movements, and also within the communities where they work. The lack of financial resources, the lack of primary researches (whose first results, nevertheless, are starting to be seen) on which policy-making from below should be based, the reduced number of projects dealing with women-related issues, the resistance of central Roma organizations towards deconstructing traditions that subordinate women, the lack of cooperation between Roma and non-Roma women’s organizations, and many other factors are responsible for the marginalization of Roma women’s organizations. At its turn, at the level of NGOs, this phenomenon is reproducing women’s discrimination on the base of their sex and ethnicity within their community and the broader society.
2.C. Roma women's
social exclusion
on the base of their ethnicity, gender and social position
In the case of Roma men and women the processes of social exclusion are not only functioning through class differentiation and social stratification, but also due to their culturally devalued ethnicity marked by a darker skin color on the base of which they are discriminated and excluded from vital resources (like education and employment) that are crucial for living in dignity and providing a self-respect needed for making future plans.
The ethnicization/racialization of the negatively valued social phenomenon (like poverty, criminality, lying, stealing, dirtiness, laziness, abortion on request, too-many-birth and so on and so forth) and the internalization by Roma of the practices, which are blaming the victim and are naturalizing/legitimizing acts of discrimination against them are having a contribution to the discrimination of Roma men and women.
What is happening with Romani women living under the conditions of severe poverty in terms of reproductive health looks to be a vicious circle from which one may not easily escape. On the base of their material conditions they do not want to have many children. But men are not really preoccupied with not letting their wives pregnant (they do not accept to use condoms) and women – if they rely on their partners – do need to make abortions in the case of any unwanted pregnancy. Not being married officially and hardly having their own home (sometimes on the one hand men and on the other hand women with their children stay separately in their parent's houses) women cannot rely on their "husband's" help in raising children. Nevertheless, women do know about contraceptives, but their information are not necessarily medically based and – due to the existing taboos – they hardly talk about this openly nor even among each other, not to talk about in the presence of strangers. In terms of modern contraceptives they "choose" what is available for free and not what is necessarily proper for their medical condition.
Romani women expressed a powerful desire towards taking their destiny in their hands (or acting as agency), nevertheless having very limited choices for doing this. On the base of what they considered to be a right decision under the given material conditions and within the social relations in the context of which they were living they felt (and were) morally entitled to decide, for example, on the number of children, on making abortion or using contraceptives. Their desire might have been to act as powerful individuals and they did make moral claims on the base of which they took their decisions regarding reproduction, but this decision-making was strongly limited by structural factors, social expectations and cultural conceptions witch they could not control. In this way their choice was not totally theirs among others due to the fact that they were excluded on the base of their gender, ethnicity and class from the resources that could ensure their reproductive health. But also because it was always important for them to be accepted and respected individuals within their group and their autonomy was limited by very strict community expectations regarding womanness and motherhood.
My research proved showed that Romani women were situated at the crossroads of several contradictory subject positions. These were prescribed for them by different discourses and institutions (like state policies, Roma policies, their own communities, health care providers), so they might have been quite confused in their effort of identifying with one or another position while also following their own interests and desires as autonomous human beings. How did they feel, think and act under these circumstances? My research paper discussed this aspect of women's reproductive health in the context of their lived experiences (as revealed by the interviews) observing their paradoxical situation created due to the fact that they belonged to different communities, and, as such, were subordinated to different regulations.
As Romanian citizens, since December 1989, formally they were entitled to make use of their reproductive rights, but – as culturally devalued and socially excluded Roma individuals –, they were subjected to racial discrimination which makes them unable to really use their reproductive rights (transforming them into underserved categories, or even exposing them to racist fertility control). On the other hand, Roma women were viewed by the mainstream Roma movement (that expressed and legitimated patriarchal community values) as life-givers and caretakers who were obliged to carry the burden of the biological and cultural reproduction of Roma communities. This position prescribed to them might also has became an obstacle (at this time constructed from within) of their de facto access to reproductive health as far as it culturally imposes to them to marry and give birth at an early age, and give birth to as many children as they could in order to ensure the survival of the community.
The issue of Roma
women's status
is a newcomer one on the agenda of the Romani movement from
I
consider that Roma women's organizations might play a huge role in
empowering
Roma women within their own communities, and – at their turn – the
mainstream
Roma organizations should have the responsibility to support them in
this
endeavor. That is why my recommendations presented in the separate
policy paper
do refer to this aspect of policymaking, to. Only the empowerment of
women
could turn them into individuals able of taking decisions about their
reproductive health and of really using their reproductive rights
regardless of
the requirements of different (patriarchal and/or racist) authoritarian
discourses and institutions that put a pressure on them for example
wanting
them or to make more, or to make fewer children.
While my research paper uses a descriptive discourse and tries to interpret data in the context of the anthropological and feminist literature on reproduction, the policy paper uses a language of human rights because this:
3.
REPRODUCTIVE HEALTH OF ROMA WOMEN AS A POLICY MATTER
3.A. The policy
problem
My initial project defined the policy problem as the lack of real access of Romani women to reproductive health, asking how a gender conscious Roma policy and an ethnic aware reproductive policy might serve it better. But now, in the light of my fieldwork experiences I would like to emphasize another aspect of this issue. Since last year, when I visited the same settlement, the access of Roma women to free contraceptives increased, the injectable became the most wide-spread fertility control method that is “suggested” and administered to Roma women by family doctors.
I am observing here the risk of turning the women-centered reproduction policy (which aims to assure that women, including Roma women, are really using their reproductive rights as a right to control their own life and body, including the right to decide on the contraceptive method that is the most proper for their health and lifestyle) into an instrument of structural (and hidden) racism by which one may “prevent” the Roma “over-population”.
In my research proposal I was emphasizing that the policy recommendations to be made are going to have a contribution to the development of a (reproductive) health policy aware of ethnic differences and inequalities as produced by the social and cultural system, and able to overcome the effects of discrimination in relation to access to healthcare for Roma. Now I would like to add to this that this policy would need to function in a way that excludes the risk of becoming a mechanism, which reproduces racism by practicing and hiding it under the surface of a “humanitarian aid” (claiming that it provides Roma women with reproduction control methods while actually is concerned with “preventing Roma over-population”).
3.B. The context
of the
problem
The context of the real access of Roma women to reproductive health understood as reproductive right is composed by several social, economic and cultural factors, among them the following:
- The general life conditions of Roma communities (including a whole set of social and economic problems, starting from the lack of proper housing, through the non-access to education, to unemployment), under the conditions of which the concern for Roma women’s reproductive health is defined as a luxury and non-important issue even by women themselves and under which circumstances even Roma women are internalizing the “explanation” according to which population growth is the casual determinant of poverty.
- The mistreatment of Roma communities as a cultural group by the majority population, using “culture” and “cultural difference” to legitimate discrimination and negative prejudices against Roma (women) as if these would be the “natural” consequences and not the structural causes of Roma’s life circumstances.
- The gender regimes dominant within Roma communities, including power relations between women and men, and cultural conceptions about Roma women’s role in family and larger community, about women’s body, sexuality, childbearing, abortion, contraception and so on and so forth.
- The ethnic-blind reproductive health policy (including the National Strategy of Reproductive Health and Sexuality adopted by the Ministry of Health in 2004 as the strategy in the field of public health) and the actual functioning of the medical healthcare system which turns Roma women into an underserved social category, and/or, moreover, exposes them to the risk of being treated as instruments for a racist “Roma fertility control”.
- The actual functioning of the gender-blind Governmental strategy for the improvement of the situation of Roma from Romania (adopted in 2001), which, generally speaking has many insufficiencies (like not assuring the presence of a Roma expert in the local administration), and which, in particular, neglects Roma women’s needs and interests reproducing their status of minority within a minority group. The pro-natalist concerns of Roma communities and their leaders, which prevent considering women's reproductive health and rights as a priority.
- The malfunctions of the communication and cooperation between central and local Roma organizations and experts, as a result of which local people might not be supported properly in their efforts to get information and resources for their activities on the behalf of their immediate communities.
- The marginalization of Roma women’s activists within the larger movement for Roma rights, the lack of authority and prestige of women’s issues, including women’s reproductive rights within the mainstream Roma policies.
3.C. Policy
recommendations
3.C.a. Principles
guiding my
policy recommendations
- Women’s right to reproductive health (as part of reproductive rights) is a human right, so every woman must be able to use this right regardless of her ethnicity, age, social position and sexual orientation.
- The application of the principle of equality between women of different ethnicity in terms of access to reproductive health is not enough in order to counter-balance the structural discrimination to which Roma women are exposed, so there is a need of affirmative action measures that could really assure equal opportunities and equal outcomes in this domain (too).
- The medical services provided must be based on the respect of human dignity and individual choice of those seeking for (reproductive) healthcare regardless of their ethnicity, and – as far as Roma women are concerned – healthcare providers must avoid racist practices that subsume contraception to the aim of “preventing Roma over-population”.
- The well-being of Roma communities is part of the welfare of the larger community within which they live, so it is not only the responsibility of the former to “integrate”, but also the duty of the later to change its discriminatory attitudes towards Roma.
- The principle of equity and participation should guide the involvement of Roma women (and not only activist Roma women) on decision-making at different sites (including family, doctor-patient relation, different central and local governmental institutions, Roma organizations, and so on and so forth).
- Even if concerned with the prevalence of abortion and use of modern contraceptives, the policy that would improve Roma women's reproductive health should not be reduced to these issues and should not be confused with fertility control or family planning, because, if it would be so, it could easily be expropriated by other interests than women's health (like pro-natalist concerns on the side of the Roma or racist fertility control on the side of the majority).
3.C.b. Expected
changes
- The improvement of the (reproductive) healthcare policy and system in order to respond to the needs of the underserved Roma women (including the anti-racist cultural education of healthcare providers and of other authorities whose jobs are linked to Roma communities, ex. of those working at the Public Service for Social Work of the local government).
- The treatment of the issue of access of Roma women to reproductive health as an integral and important part of the conditions under which Roma communities are living and on which strategies of improvement should be applied,
- The avoidance of explaining poverty through population growth but instead – while respecting Roma women’s reproductive rights – identifying the social and cultural factors (including racism), which exclude Roma communities from elementary resources necessary for a decent life.
- The empowerment of Roma women as a result of which they might be enabled to claim their (reproductive) rights within their own communities and within their broader social environment (among others, empowering their self-organizing capacities, increasing their participation on decision-making at different levels, and eventually mainstreaming their activities within the larger Roma movement).
- The elimination of practices of "convincing" Roma women to have more or fewer children as they desire according to their material conditions, social relations and emotional ties.
3.C.c. Policy recommendations
My policy
recommendations might
be subsumed under a larger heading, which refers to the need of mainstreaming
ethnicity and gender into the Romanian public policies. This idea
reflects
the recognition of the fact that Roma women’s issues (among them their
reproductive health understood as reproductive right) are an integral
part – on
the one hand – of the broader problems faced by Roma communities and –
on the
other hand – of the larger issues faced by women from
Roma women’s issues should be treated as such because otherwise their solutions would be only partial and not efficient enough. That is why there is a need for mainstreaming ethnicity or ethnicizing public policies, which means the necessity to analyze each public policy (including reproductive health policy) from the point of view of its impact on different ethnic groups living under different social conditions. On the other hand, there is a need for mainstreaming gender, meaning that public policies (among them Roma policies) should be gendered, or, differently put, should be assessed from the perspective of their impact on both women and men.
Subsumed to these broader aims, I am formulating the following policy recommendations related to Roma women’s reproductive health understood as a human right.
GENERAL RECOMMENDATIONS (for governmental agencies, for non-governmental organizations working on the domain of Roma rights and reproduction/sexual education/contraception, for donors)
- The reproductive health policy should be aware of ethnic differences and of the inequalities between women of different ethnicity, in particular of the social and cultural factors that turn Roma women into underserved categories. This links the issue of reproductive health of Roma women to rights regarding proper housing (including satisfactory sanitation infrastructure), education and employment, and to the right of living in dignity, of not being exposed to different forms of cultural devaluation and social exclusion.
- The reproductive health policy should include mechanisms of self-control in order to eliminate those factors that expose Roma women to the risk of becoming the subject of racist manipulations, and in order to avoid the transformation of the free distribution of contraceptives among Roma women into an instrument of institutionalized “Roma fertility control” governed by the “fear of Roma over-population”. A clear and explicit distinction should be made at each time between fertility control and reproductive rights.
- The policies responding to the health needs of Roma should be mainstreamed into national health strategies and services, which, at their turn should be gender sensitive.
- The policies responding to the needs of Roma women should be mainstreamed into the national strategies of promoting Roma rights and women’s rights, including reproductive rights. These rights should be also respected by Roma organizations and women's perspective should be introduced into the discussions concerned with demographic issues.
- A balance between policies of mainstreaming and targeting should be assured in order to guarantee equal opportunities for Roma (women). For this there is a need to integrate the special measures intended to reach equal access to health care (and reproductive rights) of the underserved categories into the policies, which generally aim to ensure equal access to well-being on each domain of life.
- The position of Roma mediators, including health mediators (who should be sensitive towards the particular needs of Roma women, too) needs to be strengthened within the institutions of local authorities (including medical institutions), in order to not being used only as sources of information about the community, but to act as empowered individuals able of taking decisions and controlling the available human and financial resources needed for the community development projects.
- More primary research (both quantitative and qualitative) should be done on Roma (women) with the involvement of Roma (women), in order to produce more data on which effective policy-making should be bases. The advantages and risks of the disaggregated statistics by ethnicity, sex, rural/urban should be considered from this point of view, too.
SPECIAL RECOMMENDATIONS FOR GOVERNMENTAL
AGENCIES
For the Committee
of
Anti-Discrimination and Committee for Equal Opportunities:
o should enforce the application of the Law of Equal Opportunities and of the Law of Anti-Discrimination in the domain of health care and in particular in the domain of reproductive rights;
o should give attention to the field of health care for Roma in their monitoring and recommendations;
o should consider how discrimination works at the crossroads of ethnicity and gender, in particular how Roma women, for example, are prevented from their access to a (reproductive) health care of a good quality and how they might become victims of racist fertility control;
o implementation of complaint mechanisms and provision of legal assistance to those in economic need should be assured.
For the National
Agency for
Roma of the Romanian Government:
o a bigger attention should be paid to permanent contact and communication with Roma NGOs at local levels, in order to assure effectively that they really have access to information, services and funds needed for different community development project;
o a stronger support should be given to Roma women’s organizations and initiatives as a prove of de facto recognizing the role of women in the community and within the Roma movement;
o the participation of Roma women in the decision-making processes regarding Roma women’s rights (including the right to reproductive health) should be increased, and generally speaking the needs of Roma women should be included into the mainstream Roma policies;
o the recognition of Roma women’s reproductive rights within the strategies regarding Roma rights and the revisiting of pro-natalist concerns from the perspective of women who are morally entitled to choose on the number of children they desire to have under the conditions they live.
For the Ministry
of Health and
public health care providers:
o a culturally sensitive and anti-racist curriculum should be introduced into the education of physicians, including knowledge about taboos within Roma communities regarding women’s body and sexuality;
o a bigger emphasis should be put on the permanent education of health care providers in the domain of contraceptives;
o material and symbolic support should be given to physicians involved in family planning counseling;
o mechanisms that would enforce the cooperation within the community of health care providers (between family doctors, gynecologists, medical assistants, health mediators) should be implemented;
o a stronger commitment of physicians towards patient’s rights should be assured, in particular towards the rights of vulnerable and underserved groups, including Roma and, of course, Roma women, for example related to their right to choose the contraceptive method most appropriate for their medical condition;
o efforts should be done to train medical professionals belonging to Roma communities, an objective that links the issue of reproductive health of Roma women to the issue of access to education at all levels (including medical high schools and universities);
o besides the ethnic perspective, the gender perspective should be also introduced into the development and implementation of national health strategies.
SPECIAL
RECOMMENDATIONS FOR
NON-GOVERNMENTAL ORGANIZATIONS
Cooperation between Roma and non-Roma women’s organizations, local Roma experts and mediators, and NGOs working on sexual/contraceptive education should be strengthened. Together they should coordinate at local levels several programs, aiming to break the barriers between Roma women and health care providers, while considering the particular social and cultural background of the communities within which they work. Their aim should be the empowerment of Roma women, both as caregivers and as patients. They could provide, for example:
- health and sexual education for both women and men within Roma communities in a way that respects women's morel entitlements and rights to decide on reproduction-related issues;
- information on patient’s rights and reproductive rights;
- culturally sensitive education of health care providers and authorities.
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ENDNOTES
[1] As a policy study this paper wants to inform the policy-making process by carrying out primary research into a specific policy issue. As such it is issue-driven, it refers to the primary research data presented in a separate research paper, it formulates general recommendations and information on policy issues, and it targets mostly other policy specialists from non-governmental organizations and governmental agencies.
[2] Among others, the report Breaking the
Barriers –
Report on Romani women and access to public health care (2003)
shows that
Roma have lower life expectancies, higher infant mortality, a high rate
of
sickness, and low rates of vaccination. In
[3] The agreement on this definition was
achieved at the International Conference on
Population and
Development (ICPD) held in
[4]
Addressing the population and reproductive
health
issues and trends in Central and Eastern Europe and Central Asia, UNFPA
emphasizes the following, but without offering ethically disaggregated
data:
the rapid rise in rates of HIV/AIDS and sexually transmitted infections
— the
rate of increase during 2002 was among the fastest ever experienced
anywhere —
especially among young people, and in the eastern parts of the region;
inadequate access to quality services for counseling, diagnosis and
treatment
of STIs is increasingly recognized as a constraint on the whole region;
the
need to address the reproductive health needs of young people, ensuring
access
to information and services to help them adopt healthy behaviors; the
continuing incidence of recourse to abortion; the large discrepancy
between the
life expectancy of males and females in numerous countries; negative
population
growth rates in many countries; the ageing of the population throughout
the
region; the rise in trafficking of women and girls; high maternal
mortality
rates. See in Country Profiles for Population and Reproductive
Health
(2003).
[5] See Paragraph
96 of the
[6] The National Strategy of Reproductive Health
and
Sexuality developed in 2004 (as mentioned in Chapter 3.A. of this
paper)
introduces the perspective of rights into the discussion about
reproductive
health. But this remains only a theoretical approach, which is far away
of what
is happening in reality, and even more far away from treating Roma
women’s
status. Not only because the mechanisms of monitoring the
implementation of
rights are not functioning, but also because people (as patients) still
have to
learn about claiming their rights on this domain, too.
[7] See in Eldis
Health Key
Issues, Guide on Sexual and reproductive health and rights at www.eldis.org/health