Breaking the Barriers – Romani Women and Access to Public
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European Monitoring Centre on Racism and Xenophobia Observatories Européen des Phénomènes Racistes et Xénophobes Europäische Stelle zur Beobachtung von Rassismus und Fremdenfeindlichkeit Breaking the Barriers – Romani Women and Access to Public Health Care European Monitoring Centre on Racism and Xenophobia Observatorie Européen des Phénomènes Racistes et Xénophobes Europäische Stelle zur Beobachtung von Rassismus und Fremdenfeindlichkeit Breaking the Barriers – Romani Women and Access to Public Health Care Europe Direct is a service to help you find answers to your questions about the European Union New freephone number: 00 800 6 7 8 9 10 11 This report has been prepared by an independent researcher on behalf of the project “Romani Women and Access to Public Health Care” undertaken jointly by the Office of the OSCE High Commissioner on National Minorities (http://www.osce.org/hcnm/), the Council of Europe’s Migration and Roma/Gypsies Division (http://www.coe.int/T/E/Social_Cohesion/Roma_Gypsies/), and the European Union’s European Monitoring Centre on Racism and Xenophobia (EUMC) (http://eumc.eu.int). The opinions expressed by the author do not necessarily reflect the opinion or position of the OSCE HCNM, Council of Europe or EUMC. A great deal of additional information on the European Union is available on the Internet. It can be accessed through the Europa server (http://europa.eu.int). Cataloguing data can be found at the end of this publication. Luxembourg: Office for Official Publications of the European Communities, 2003 ISBN 92-95008-14-6 © European Communities, 2003 Reproduction is authorised provided the source is acknowledged. Printed in Luxembourg PRINTED ON WHITE CHLORINE-FREE PAPER Breaking the barriers – Romani Women and Access to Public Health Care Table of Contents Foreword 1 Executive Summary 3 i. Introduction 3 ii. Overview 4 iii. Key findings 6 iv. Recommendations 8 PART I A. Introduction 13 1. Inadequate attention to Romani women and access to health care 13 2. Health status of Romani populations: an overview 14 B. Legal standards 20 1. Principles of non-discrimination and equality 20 2. Special measures 24 3. The right to the highest attainable standard of health 26 4. Participation of Romani women in improving access to health care 29 C. The importance of ethnic data collection to improving access to health care 34 PART II A. Discrimination against Roma in access to health care 39 1. Physicians’ refusal to treat Romani patients 39 2. Health care institutions’ refusal to assist Roma 42 3. Segregation of Roma in health care facilities 43 4. Inferior and degrading treatment of Roma 44 5. Discrimination in access to emergency care 45 B. Improving access to health care for Romani women 48 1. Access to preventive care and Romani women’s attitudes towards health 48 2. Access to reproductive and sexual health care 49 2 Breaking the barriers – Romani Women and Access to Public Health Care a. Access to maternal health care 50 b. Access to family planning 52 c. Access to sexual health care 55 3. Domestic violence and Romani women 68 4. Access to mental health care 62 5. Access to substance abuse treatment 64 PART III A. Access to documented legal status 66 1. Access to legal status 66 2. Access to identification documents 69 B. Access to social benefits and health 71 C. Access to education and health 76 D. Access to adequate housing and health 81 1. Inadequate living conditions 81 2. Residency requirements 84 3. Forced evictions 87 PART IV A. Health and government strategies to improve the situation of Roma 90 1. Components of government strategies essential to improving access to public services 90 a. Recognition of the role of discrimination in impeding access to health care 91 b. Public awareness campaigns to ensure implementation of special measures 92 c. Coordination and supervision of the overall integration programme, especially at the local level 94 d. Adequate anti-discrimination laws enforced by a specialized body 95 e. Measures to ensure the consideration of a broad range of Romani health interests 96 2. Components of government strategies essential to improving access to health care for Romani women 98 a. A holistic approach to women’s health with a gender perspective 98 3 Breaking the barriers – Romani Women and Access to Public Health Care b. Integration of women’s needs into mainstream health and related services through a multi-sectoral approach 100 B. Improving access to health care through greater familiarity with Romani culture 102 C. Improving access to health care through Romani health mediators 104 D. The potential of intergovernmental initiatives to improve access to health care for Romani women 107 PART V Recommendations 110 4 Breaking the barriers – Romani Women and Access to Public Health Care Foreword The situation of the Romani community in various parts of Europe has become a benchmark of our development in the field of fundamental rights and social justice. As this report demonstrates, the situation of Romani women in relation to health care is poor and emphasizes how much needs to be done. Numerous other reports in a whole host of fields from employment to education also highlight the plight of members of the Romani community. Advances in social protection, health, housing availability, educational attainment and similar indicators of development will remain tarnished if they are not to the benefit of all members of society. The right of all individuals to equality before the law and to the protection from discrimination is a bedrock of democratic societies. Inequality, discrimination, exclusion on the basis of a person’s racial or ethnic origin or social status is wrong not only in legal terms, but also in moral and social terms, including with implications for economic development. It is to all our benefit when all members of society can participate freely and equally and realize their full potential as individual human beings, members of communities and as citizens. The impetus for this study arose from the suggestion of the Director of the Office of the OSCE High Commissioner on National Minorities to build upon the findings from the High Commissioner’s April 2000 Report on the Situation of Roma and Sinti in the OSCE Area which identified a number of issues from a public interest perspective and offered a range of recommendations aimed largely to remove the obstacles to full enjoyment of equal treatment. Health stood out for the lack of information available, and for the apparent interplay between gender and racism. This study builds on that initial OSCE report by drawing attention to the overall situation of Romani women and their healthcare concerns. The project on Romani Women and Access to Public Health Care, of which this report forms a central part, was the first collaborative effort between the OSCE’s Office of the High Commissioner on National Minorities, the Council of Europe’s Migration and Roma/Gypsy Division and the European Union’s European Monitoring Centre on Racism and Xenophobia − an example of successful cooperation at the regional level between inter-governmental organizations pooling their expertise and resources. This joint undertaking drew upon the common concern for Roma in relation to which different areas of expertise and experience − ranging from human rights analysis to knowledge about health and education strategies to experience of combating racism and xenophobia − was useful in addressing Romani women’s health concerns. It is the conviction of the three organizations that policy-making based on comprehensive information, reliable data and international standards, informed by the views and desires of those directly affected, can make a substantial difference to people’s lives. Indeed, effective implementation of such policies can close the gaps in opportunity among various groups and contribute to the construction of cohesive communities where all members have a stake and can contribute. If discrimination is to be eliminated, it requires action by all of us. Certainly, governments hold the principal responsibility and have the central role in tackling these issues through adoption and implementation of policy and law, and by directing State institutions in action. But without the active engagement of civil society, and the vital support of the Romani Women themselves, 1 Breaking the barriers – Romani Women and Access to Public Health Care even the best policy and law will risk failure. As such, this report outlines a set of recommendations ranging from legislative action, capacity building of Roma and health authority structures, health education and public awareness-raising. In the course of this study, two independent experts were engaged to conduct country visits and individual interviews: Ms. Anna Pomykala, assisted by Ms. Mariana Buceanu. We would like to thank all those who were involved in this project, including Ms Pomykala also for having drafted this report and all those who were involved in the interviews, editing, consultation process and otherwise contributed their support leading to the full realization of the project. We would especially like to thank the Romani women themselves for their involvement and contributions to this project, in particular at the NGO Meeting on Romani Women and Access to Health Care held in Vienna on 28-29 November 2002, hosted by the EUMC. In addition, we are grateful to the Government of the United Kingdom and to the EUMC for having made substantial financial contributions to this project, along with The Themis Foundation which provided a small but important grant to Ms. Pomykala at the very beginning of this project which enabled her to attend two international conferences where vital contacts were established. We intend this report to assist policy and law makers to better understand the complex and interrelated nature of the healthcare issues and to assist them to improve the design and implementation of policies on Romani women and health.