Enikő Magyari-Vincze




1.      Research outline

The policy research proposal on Reproductive Health and Roma Women in Romania is integrated into the broader issue of Public Health and Roma, one of the priority domains of the 2005-2006 International Policy Fellowship program.

The access to reproductive health is defined and recognized by the international community and by the Romanian government as an important dimension of public health. Moreover, it talks about the process of the de jure and de facto democratic reform in our society (and eventually about the reproduction of the social and cultural mechanisms of exclusion and discrimination), but also about the localization of the global (including European) politics related to this domain. Further on it reflects the ways by which the local (reproductive) health policies are responding (or are failing to respond) to the interests and the particular conditions of the affected groups (in our case, Roma women).

In order to assure the democratic access to the public (health) services of all societal groups (regardless of their ethnicity, gender, economic condition, age, etc.), these policies need to be aware about the mechanisms by which social segregation and cultural divides are transforming the Roma communities into underserved ones. That is why, on the one hand, my research is going to focus on the analysis of the current Romanian legislation and policy on reproductive health, defined as part of the Third National Program coordinated by the Ministry of Health. On the other hand – by the means of an ethnographic research in a specific location from Romania –, the research will deal with the actual functioning of the reproductive health services across the local medical system from the perspective of the (under)served local Roma communities. Relying on the outcomes of the well-researched data, the project will identify the obstacles of the reproductive health services usage both from the point of view of the medical system and from the perspective of Roma women’s life conditions. The differences between the conceptions of Roma women and of doctors about the health situation of the former might have important policy implications that I would like to explore.

Ultimately my policy research aims to present feasible recommendations for action. Like recommendations related to the national legislation on reproductive health, in particular to the inclusion of the perspective of equal opportunities for women and men of different ethnicity into this legislation and into the related policies. But also suggestions for the improvement of the (reproductive health) services (theoretically) granted across the medical system and of the medical training on providing accessible reproductive health care services for the underserved Roma population. Related to the latter I am thinking about the ways by which this training could include an education in cultural differences. Ultimately, through all these I am following 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. At the same time my aim is to increase the gender awareness of Roma policies that should be conscious about the situation of Romani women and about all the factors, which discourage them from paying attention to their own (reproductive) health. My ethnographic research aims to identify their life conditions and cultural conceptions, but, on the base of this, also the ways through which they might be empowered to demand healthcare related information and services. Altogether my aim is to make policy recommendations that reduce the gaps between reproductive health policy and Roma policy, and are conscious about the need to build connections between gender and ethnic awareness in order to be able to respond to the particular situation of Romani women.    

Because the principle of participation should underpin all public policy-making process, I intend to design my policy recommendations with the active participation of those most affected. That is why I will contact some Roma women’s organizations from which to learn about their activities and views on Romani women’s reproductive health,  but also whom to consult while designing my policy recommendations (like the Association of Roma Women in Romania, the Association for the Emancipation of Roma Women, the Association of Roma Women for their Children, and the related department of Romani Criss). I intend to communicate my recommendations to the main actors of this field (like the Ministry of Health, County Health Directorates, local reproductive health care providers) through leading non-governmental organizations from Romania. In these terms I am having in my mind the Society of Contraceptive and Sexual Education (S.E.C.S.) from Cluj and Bucharest, and the Resource Centre for Roma Communities located in Cluj. S.E.C.S. is the main leading non-governmental organization in the field of reproductive health, currently involved in training medical providers (more than 3,000 family doctors until now), in technical assistance for local health authorities, advocacy and IEC activities. My current policy research actually continues our ongoing co-operation on their project for the Improvement of post-abortion care in Hunedoara county, Romania. As a scholar affiliated with Babes-Bolyai University from Cluj, Romania and with Foundation Desire from the same city in the past years I was having several contacts with the mentioned non-governmental organizations. The fact that formerly we were working together on different projects related to issues like women’s condition, gender relations and (ethnic, gender and sexual) discrimination in Romania guarantees the fulfillment of the goals of my recent policy research project.



2.      Research objectives

The main objective of my proposed policy research on Reproductive Health and Roma Women in Romania is twofold.

On the one hand it aims to provide:

·        a critical analysis of the current Romanian legislation on reproductive health, and

·        a critical analysis of the obstacles to reproductive health services usage.

The comprehensive assessment of the relevant factors that shape the state of affairs in this domain (both in terms of institutional practices, life conditions and personal experiences) is going to rely on empirical data. Empirical data will be collected on the related national legislation, on the reproductive health care provider actors across the medical system, and on the cultural conceptions and social practices of Romani women connected to reproductive health. 

            On the other hand this policy research aims to provide recommendations for:

·        the inclusion into the related national legislation and policy of the perspective of equal opportunities for women and men of different ethnicity (defined also as part of the strategy of gender mainstreaming recommended by the European Union to Romania as accession country);

·        the improvement of the reproductive health care services provided across the medical system in order to assure the full and real access of women to these services, regardless of their ethnicity and economic conditions (this includes the identification of strategies for strengthening the medical training on assuring accessible reproductive health care services for the underserved Roma population).



3.      Research methodology

Viewed in a broad framework, the access to reproductive health and the obstacles of the reproductive health services usage depend on many factors. This issue is related to many social and economic problems encountered by the Roma population in Romania, all of which shape health condition in general, and reproductive health in particular. Among them one should note 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 some cases.

My research aims to grasp the inter-relatedness of these phenomena. That is why it has to be shaped by a multidisciplinary approach and to be fulfilled by the means of different empirical research methods. It has to be mentioned that – through the means of a qualitative investigation – I am going to focus only on some dimensions of reproductive health, first of all on family planning, abortion and pre- and post-natal care. But – mainly through figures – I am also planning to give an overview on the illnesses of the reproductive organs (like genital cancer) and on maternal mortality.  

The investigation of the national legislation on reproductive health consists of the analysis of the terms by which the issue is defined, of the principles that guide the underlying conception, of the recognized and neglected aspects of the problem, and of the type of the discourse that shapes and controls the whole approach. But it also has to highlight its processual and political character, viewed in the context of the post-socialist Romania, where – after more than three decades of severe pro-natalist communist politics – the right to abortion and contraception usage was achieved as a victory at the very end of 1989. 

The analysis of the medical system through which reproductive health services are offered (its structural barriers and hidden racism) consists of a qualitative case study done in Hunedoara county, Romania, in particular in the city of Orastie and neighboring villages. The collection of data through semi-structured individual and group interviews with doctors and medical assistants (gynecologists, family doctors, and their assistants, respectively the community medical assistants) basically is finished. However, I am planning to return there in order to make more interviews, and eventually to critically analyze the gathered empirical material.  This analysis will highlight the institutional obstacles of the usage of the reproductive health services by Roma women, including the mechanisms of co-operation, or contrary those of competition generated in a system, which – under the impact of the undergoing reform – transforms health care into a domain of market economy. Beside the interviews, the analysis will rely on statistical data about abortion, about contraceptives distributed for free, about the doctors involved into the practice of family planning, about natality, about the illnesses of the reproductive organs and about maternal mortality. The latter are going to be collected not only for the region, but as well as for the whole country.  

In order to identify the life conditions of Roma women, their cultural conceptions about and social practices related to their bodies, gender relations, childcare, abortion, contraception and medical system I will make an ethnographic study at the location mentioned above. Again, I have already collected several interviews there, but planning to return and make more in order to have a look on the diversity of women’s experiences rooted also in the diverse conditions of the different Roma communities from this area. Generally speaking, they are living or in segregated communities or in blocks of fats without water, sanitation and electricity in the cities of Orastie and Geoagiu, or on the precarious margins of the neighboring villages. But there are differences among them as far as the maintenance of the Roma traditions are considered (out of which some are discriminatory against women), or as far as religious beliefs, or access to political participation, or other factors are taken into consideration. The majority of Romani people from that region do not speak the Romani language (they are called “băieşi”). In order to facilitate my access to the “corturari”, whom do speak Romani, I am planning to cooperate with students knowing their language. Briefly put the analysis of these interviews aims to identify the obstacles of reproductive health services usage rooted in the life conditions, cultural conceptions and social practices of Roma women. The consultation of the background ethnographic literature and of relevant reports and studies is also among my aims. These emphasize that Romani women forego attention to personal wellbeing and tend to regard health services as generally inapplicable or unavailable to them. At the same time, in the context of unequal gender relations Roma women feel little power to choose when, with whom and with what form of protection, if any, to have sex. The custom of early marriage and of childbearing at a young age, but also the tradition of abortion linked to the fear of using contraception, or maybe generally of doctors and medical institutions put further barriers to Roma women’s health care.  

            The case study done within the mentioned particular location through the means of a qualitative inquiry it is not supposed to be representative as a sociological survey would be. But it should be noticed that in that territory one may encounter diverse Roma communities both in the urban and rural area, and out of the large number of interviews (approximately 100) one may be able to identify and describe in details different patterns of attitudes, conceptions, practices. This makes me to affirm that this concrete case study might have a broader relevance that transcends the geographical boundaries of the region. It has the potential of being used as a source out of which some important recommendations might be made regarding Roma women’s reproductive health in Romania.  



4.      Procedures for fulfilling the project

The support of the International Policy Fellowship program (both in terms of financial assistance and of the provided contacts across the professional policy networks and opportunities) would facilitate the fulfillment of the goals of the planned empirical research, of the critical analysis and of defining feasible recommendations.

In the perspective of a possible cooperation I was already contacting the Cluj regional office of the Society for Contraceptive and Sexual Education, and I am also planning to contact the other mentioned civic organizations. In the very near future they will provide the needed letters of references, which should state that – on the base of our collaboration – the communication of the recommendations to the main actors of the reproductive health policies and services, and also their implementation might become possible.



5. The utilization of the research results 

Even if my research will be able to grasp the interrelatedness of many phenomena (as discussed above), the policy recommendations related to reproductive health services could become really efficient if they would be integrated into a whole range of policies concerning the general improvement of Roma’s condition. However, there are some factors that function as obstacles in the full access to the reproductive health services and which might be changed if one intervenes into the related national legislation and in the ways in which the medical system is functioning in the terms of providing reproductive health services. The recommendations are going to be based on the expected research results related exactly to these factors.  

These recommendations are going to be communicated and implemented through the already suggested local non-governmental organizations acting on the improvement of women’s reproductive health in Romania. My objective in these terms is to transmit the recommendations of this research to the main actors involved into the development and implementation of policies on this domain, like the Ministry of Health, County Health Directorates and reproductive health care providers. It is to be emphasized that I am also going to exploit the existent mechanisms for communicating directly with the former, those through which they use to consult with non-governmental organizations and professionals on their policy-making decisions.