Confronting racism in family planning: a critical ethnography of Roma health mediation

Posted by Maria Codina on February 25, 2019 at 12:46 pm

Roma health mediators are part of a government funded, community-led health intervention. One of the programme’s central aims is to improve access to reproductive care for Roma women, often said to be one of the most disadvantaged population groups in Europe. This paper is a critical analysis of mediation in Romania, focusing on how social determinants shape access to family planning and how mediators are employed to address inequalities. It is based on ethnographic observations of mediators at work, as well as in-depth interviews with community members, health professionals, and mediators. Health professionals tended to see Roma families as wanting and having an unreasonably large number of children and tried to curtail this through the promotion of contraception. This contrasted with the perspective of community members, who appeared not to choose having many children but who instead struggled to access contraception for financial reasons. Roma health mediators generally seemed aware of multiple and intersecting pressures that women were facing, but ultimately tended to frame family planning as a matter of choice, culture, and knowledge. I set these perspectives against the background of anti-Roma racism and eugenic sentiments, reflected in popular discourses about Roma reproduction. I explore how an intervention that nominally aims to promote the emancipation of Roma communities, in fact entrenches some of the racially fused assumptions that are connected to inequalities of access to reproductive health care in the first place. The discussion has implications for Roma reproductive health interventions across Europe, and for participatory interventions more globally.


Dr Florian, a specialist of obstetrics and gynaecology working in a large municipal hospital, drew me a pie chart with which he tried to demonstrate that the Roma population would soon overtake the Romanian population in terms of its size. He told me that he was concerned about an increased birth rate among the Roma population and how this would affect the demographic fabric of Romanian society. “I think in fifty years from now they will become the majority here in Romania.” – “And how do you imagine that society to be?” I asked him. “A jungle” he laughed, “a jungle!” He elaborated: “if there are three, four or five million, they can’t be integrated. They start shifting the integration, we as the majority, we will have to start integrating with them.” Dr Florian’s language was objectifying. The way he spoke was reminiscent of how someone might talk about a threatening epidemic. He said their number was “growing fast”, that “a critical point” had been reached. He bluntly portrayed the Roma population as a problem for Romanian society; undesirably deviant and Other. His proposed solution was to stop paying families child allowance after their third child, and to further promote free contraception. This narrative of fear, the open anxiety of a shifting demographic pattern is widespread in Romania, and has been well documented and analysed. The public health-focused literature on Roma further consolidates a picture of unequal access to contraception between Roma and non-Roma women, and emphasises gender-based discrimination from within communities, as well as geographic, educational, and financial barriers. Both in the popular, and racially tinged discourse of a “demographic shift”, and in the public health literature, reproduction of Roma women is seen as a “problem”. The Roma health mediation programme is one of the only interventions that have been developed to tackle discrimination and health inequalities faced by Roma women. It is a state-financed community-led health intervention that employs women of Romani origin to act as a link between Roma communities, health professionals and local authorities. One of its main aims is to address unequal access to contraception. Although the programme has gained much recognition in the field of Roma rights, it has not been the subject of critical in-depth analysis.


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