Research
"There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans
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* Corresponding author: Teresa Janevic janevite@umdnj.edu
1 Department of Epidemiology, UMDNJ School of Public Health, 683 Hoes Lane West, PO Box 9, Room 209, Piscataway, NJ 08854, USA
2 Department of International Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA
3 Director, Global Health Initiative, New Haven, CT 06520, USA
4 Population Research Center, University of Groningen, The Netherlands
International Journal for Equity in Health 2011, 10:53 doi:10.1186/1475-9276-10-53
Published: 17 November 2011Abstract
Introduction
Roma, 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.
Methods
Eight 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.
Results
Twenty-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.
Conclusions
The 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.