Challenges in sexual and reproductive health of Roma people who live in settlements in Serbia.

The European Journal of Contraception and Reproductive Health Care, 2015; 20: 101–109

Eur J Contracept Reprod Health Care Downloaded from informahealthcare.com by Nyu Medical Center on 05/20/15 For personal use only.

Challenges in sexual and reproductive health of Roma people who live in settlements in Serbia Katarina Sedlecky∗ and Mirjana Ra šević† ∗Institute for Mother and Child Health Care of Serbia, Family Planning Centre, Belgrade, Serbia, and †Institute of Social Sciences, University of Belgrade, Belgrade, Serbia ............................................................................................................................................................................................................

ABSTRACT

Objective To investigate the differences in sexual and reproductive health (SRH) between Roma women of reproductive age who live in settlements and the general population of women of the same age in Serbia who do not live in settlements. Methods The Multiple Indicator Cluster Survey 4 (MICS4) was administered to Roma and Serbian women and the results were compared between the two groups. In order to get a qualitative perspective, a specifically designed, short open-ended questionnaire about Roma women was given to Roma Health Mediators (RHMs). Results Roma women have a higher total fertility rate and adolescent birth rate, and early marriage is much more common among them. Differences are less clear regarding antenatal care and assistance during delivery from skilled personnel. Roma women more frequently rely on traditional contraception, and are less likely to use modern contraceptives than the general female population. Problems in the socio-economic sphere, poor school enrolment and maintenance of traditional patterns in Roma people living in settlements contribute to the disparities observed. Conclusion Although data on the SRH of the general population of women in Serbia are far from being satisfactory, those for women who live in Roma settlements are much worse. Political actions aimed at the empowerment of Roma women in the spheres of education, employment and health promotion have been implemented with the hope that they might improve the SRH of this vulnerable population group.

K E Y WO R D S

Sexual and reproductive health; Roma women; Family planning health indicators; Contraceptive prevalence; Childbearing; Antenatal care

I N T RO D U C T I O N

The Roma population is, according to the most recent census in 2011, the third largest ethnic group in Serbia, excluding Kosovo and Metohia1. The total number of Serbian inhabitants was 7,186,862, including 5,988,150 ethnic Serbians, 253,899 Hungarians, and

147,604 Romanies. However, although the registered number of Roma inhabitants officially is as mentioned above, the actual number has been estimated to be between 450,000 and 500,0002. The discrepancy may well illustrate the extent of social deprivation and marginalisation of Romanies in Serbia, as a large number

Correspondence: K. Sedlecky, Mother and Child Health Care Institute of Serbia – Family Planning Centre, Radoja Dakica Street 8, Belgrade 11070, Serbia. Tel: ⫹ 381 3108 207. E-mail: [email protected]

© 2014 The European Society of Contraception and Reproductive Health DOI: 10.3109/13625187.2014.957825


Sexual and reproductive health of Serbian and Roma women

Sedlecky and Rašević

of them avoid disclosing their ethnicity because of the existing prejudices and discrimination3. Approximately half of the Roma population live in settlements which are distributed across the country4 and are mainly located on the outskirts of cities or in smaller industrial towns. Their living conditions vary considerably, but many live in slums without the basic conditions for normal life. Begging, malnutrition, high prevalence of chronic diseases, child exploitation, theft, and petty offences are some of the characteristics that are often attributed to the Roma, and that tend to prevent their inclusion in the Serbian society5. There are no official or reliable data on the health status of the Roma people in Serbia. However, surveys show that the mortality rate among them is significantly higher than in the population as a whole; Romanies have a life expectancy more than ten years shorter than that of the general population6. Also infant and maternal mortality rates are very high7. Roma children fall ill far more frequently (between three and ten times more often) than is common in the general population families3. There is little information about the sexual and reproductive health (SRH) of Roma people in general, and especially of that in women. Serbia is burdened with many problems in the field of SRH8,9. Low prevalence of modern contraceptives use, estimated high rates of induced abortion, absence of sexuality education in schools, high cervical cancer morbidity and mortality rates, poor control of sexually transmitted infections (STIs) are, among others, the most prominent issues10,11. Although the directions needed to face the challenges that hinder progress in the sphere of SRH have been identified12, specific actions have been partial and insufficient, so far. In spite of the aforementioned challenges affecting society as a whole, the particular vulnerability of Roma people who live in settlements has been recognised. Therefore, the Serbian Ministry of Health supported international and non-governmental (NGO) initiatives to establish the work of Roma Health Mediators (RHMs) who were tasked with familiarising the Roma population on how to access healthcare services and enjoy their right to health. This investigation focused on the sphere of the SHR of Roma people who live in settlements in Serbia. The first objective was to explore the differences in the SRH indicators between Roma women and the general female population of the country. The second objective was to highlight the factors that 102

might contribute to understanding the SRH of Roma women from the settlements.

METHODS

To ascertain the differences between the two groups, the Serbian population generally and the Roma population living in settlements, two surveys, one quantitative and one qualitative, were undertaken. Throughout the paper, whenever we mention ‘Roma women’ we are only referring to those living in settlement camps, and not to all Roma women. Conversely, when we write ‘general Serbian population of women’ we are alluding to Serbian women who are not residing in encampments. The first survey evaluated SRH indicators obtained from the Multiple Indicator Cluster Survey 4 (MICS4) for Roma women of reproductive age in comparison to the general population of women of the same age in Serbia. The second explored the SRH of the Roma population; the questionnaire used by the RHMs is included in the Appendix. In 2010, MICS4 was administered in Serbia by the United Nations Children’s Fund (UNICEF) and the National Statistical Office on two population samples: 5385 women representative of the whole Serbian female population and 2118 Roma women13. The SRH data were gathered from female respondents 15 to 49 years of age. The survey included topics such as fertility, contraception, antenatal care, assistance during delivery, early marriage and marital union, giving birth before 15 and before 18 years of age, domestic violence, HIV/AIDS knowledge, sexual behaviour, literacy and education. The data were analysed and compared between investigated groups by means of descriptive statistics. The second questionnaire was designed specifically for the Roma Health Mediators (RHMs) with six open-ended questions addressing their opinions concerning childbearing, birth control and utilisation of health care of Roma women, and their perceptions of the sexual and reproductive behaviour of young Roma people. Roma health mediation was initiated by the Serbian Ministry of Health in 2008. Currently, this programme provides work for 75 women from Roma settlements who run health education services and assist the Roma population in fulfilling their rights to obtain health and social care14. Employed by local

The European Journal of Contraception and Reproductive Health Care



self-governments, RHMs are working in close collaboration with professionals from the primary health care centres. Additionally, RHMs conduct frequent field visits to Roma settlements. Between 1 January 2009 and 30 November 2013, RHMs recorded 137,276 Romanies, including 45,304 adult Roma women15. Although RHMs are not healthcare workers, they have been specifically trained to provide guidance regarding various health-related topics, including SRH. We designed the questionnaire so as to allow a qualitative analysis of the answers of RHMs and thus to gain a better insight into the SRH of Roma women. The questionnaire was sent to the RHMs’ coordinator who distributed it by e-mail. She chose 70 RHMs and omitted five who were recently employed and not considered to have sufficient experience. All RHMs filled out the questionnaire and returned it to the coordinator; the response rate was 100%. The authors worked together, initially reviewed the answers, and listed key subjects. For the majority of questions RHMs usually gave more than one explanation. Then items were grouped in larger categories. The numbers were used to interpret RHMs’ observations that were not based on numbers. We analysed data according to the frequency of classified statements. Some RHMs’ answers were assessed by authors as very good illustrations of qualitative analysis and therefore presented in extenso. RHMs’ answers in the Serbian language were translated into English by a native English speaker who lives in Serbia.The authors concurred that meaning was not changed. This investigation was approved by the Ethical Committee of the Institute of Mother and Child Health Care of Serbia.

R E S U LT S

Quantitative analysis of sexual and reproductive (SRH) indicators According to information obtained from MICS 4, the data on reproductive health indicators of Roma women differ from those of women in the general population in Serbia as shown by the following indicators: married before the age of 15 (17 vs. 1%) or before the age of 18 (54 vs. 8%); having had a live birth before the age of 15 (4 vs. 0.5%) or before the age of 18 (31 vs. 3%); adolescent birth rate (159 vs. 24); total fertility rate (2.7 vs. 1.7).


Although there are no clear differences regarding unmet need for contraception, it is apparent that Roma women still rely on traditional contraceptive practices to a greater extent than women from the general population (Table 1). To be precise, traditional methods (first and foremost, coitus interruptus) were used by 58% of Roma women of reproductive age (15 to 49 years), compared to 39% of Serbian subjects of the same age group, while modern methods were utilised by 6% and 22%, respectively. Similar usage rates are noted in the age group 20 to 24 years. Undeniably, modern contraceptive prevalence rates are extremely low in both study groups. The data for combined oral contraceptives (COCs) and intrauterine devices (IUDs), each considered separately, are less than 5% among Serbian women and below 1% for Roma women. Differences are also observed with regard to antenatal care. Six percent of Roma women and 1% of those in the Serbian community gave birth with no antenatal care, whereas only 72% Roma women made four or more visits during pregnancy compared to 94% of women from the general population in Serbia. Interestingly, there are no differences in the figures relating to assistance during delivery, as almost all births in Serbia, including those from Roma settlements in the two years preceding the MICS survey, occurred with skilled personnel in attendance. However, the percentage of caesarean sections was much higher among women from the general population (25%) than among Roma women (14%). Roma women in Serbia, unlike those in the general population, tend to marry at an early age (17% before the age of 15 and 54% before 18 years of age vs. 1% and 8%, respectively). Discrepancies were also observed in the sexual behaviour of women aged 15 to 24 years, as the percentage of never-married who had never had sex was 83% for Roma women and 48% for Serbian citizens, and percentages for women who had sex with a non-married, non-cohabitating partner in the last 12 months were 9% and 41%, respectively (Table 2).Additionally, disparities between Roma women and the general population in Serbia are illustrated by the data on elementary literacy (77 vs. 99%), primary school completion rate (35 vs. 92%), HIV/AIDS knowledge (13 vs. 53%), transition to secondary school (68 vs. 98%), and approval of physical abuse of women by husbands/partners (20 vs. 3%).


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Table 1 The family planning health indicators of women in Serbia.


Indicator Fertility Total fertility rate (15–49 years of age) Adolescent birth rate (15–19 years of age) Have had a live birth before 15 (15–19 years of age) Have had a live birth before 18 (20–24 years of age) Contraception (15–49 years of age) Not using any method Using any modern method Using any traditional method Contraception (20–24 years of age) Not using any method Using any modern method Using any traditional method Modern contraception type (15–49 years of age) Intrauterine device (IUD) Combined oral contraception (COC) Male condom Emergency contraception (EC) Unmeet need for contraception (15–49 years of age) Met need for contraception Unmet need Demand for contraception satisfied

Women from the general population in Serbia

Women living in Roma settlements

1.7 23.9 0.5% 3%

2.7 158.5 4% 31%

39% 22% 39%

37% 6% 58%

39% 22% 40%

41% 6% 54%

3% 4% 14% 0%

1% 1% 3% 0%

61% 7% 90%

64% 10% 86%

Source: Statistical Office of the Republic of Serbia. Republic of Serbia Multiple Indicator Cluster Survey 2011, final report. Belgrade, Republic of Serbia: Statistical Office of the Republic of Serbia 201113.

Qualitative analysis of sexual and reproductive health of Roma people According to the opinion data from the RHMs, Roma women tend to have more children than women from the general population in Serbia due to several reasons. One of the most important is the specific, traditional socio-cultural milieu in which Roma women live, which asserts that giving birth, especially to sons, is the most important women’s role (Table 3). As for the grounds for having many children, RHMs frequently cited poor knowledge of modern contraception, combined with a lack of money for the termination of unplanned pregnancy. One third of RHMs mentioned child allowance and parental cash benefit as important reasons for the high parity of Roma women. To be precise, in public sector health facilities the cost of an induced abortion in Serbia varies between €50 and €150; child allowance per month is from €20 to €30 for the first four children up to the age of 18; and parental cash benefit at birth amounts to €300 for the 104

first-, €1,200 for the second-, €2,200 for the third-, and €2,900 for the fourth child.There are no financial benefits from the fifth child onwards16,17. As one of the RHMs expressed: ‘Roma women will continue to give birth to children as long as it is required by the husband and, in some cases, by the mother in law’. The main reason for early marriage in the Roma population, according to the RHMs’ opinions, is compliance with the customs and cultural norms. That is, a girl is supposed to leave school and marry at the onset of menarche. Premarital virginity is still a crucial issue, and dating is forbidden for single adolescents of both sexes. Consequently, a girl is pressurised to enter marriage when she falls in love for the first time. Following tradition, a large number of parents arrange the marriage of their children, and a girl is considered an ‘old maid’ if she has not been married by the age of 20. “Apart from tradition, the important reason why Roma girls flee into marriage before they turn




Table 2 Indicators of sexual and reproductive health of women in Serbia.


Indicator Early marriage or marital union (20–49 years of age) Married before age 15 Married before age 18 Attitudes towards domestic violence (15–49 years of age) Believe that the husband/partner is justified in beating his wife/partner for any reason HIV/AIDS knowledge (15–49 years of age) Comprehensive knowledge Sexual behaviour (15–24 years of age) Never-married/never had sex Had sex with a non-married, non-cohabiting partner in the last 12 months Literacy (15–24 years of age) Ability to read a short simple statement Education Primary school completion rate Transition rate to secondary school

Women from the general population in Serbia

Women living in Roma settlements

1% 8%

17% 54%

3%

20%

53%

13%

48% 41%

83% 9%

99%

77%

92% 98%

35% 68%

Source: Statistical Office of the Republic of Serbia. Republic of Serbia Multiple Indicator Cluster Survey 2011, final report. Belgrade, Republic of Serbia: Statistical Office of the Republic of Serbia 201113.

18 is seeing it as a chance for a better life. That is, although their parents get them out of school and prepare them for the duties of married women such as cooking and cleaning, they forbid them to go out with their friends and date with boys, because they are obliged to be virgins on the wedding night.” (Laura, RHM). RHMs have identified four main barriers to modern contraceptive use among Roma women. These are (i) the negative attitude of a husband towards modern

family planning; (ii) financial constraints to buy contraceptives; (iii) the lack of information concerning effective pregnancy prevention; and (iv) fear that contraception is harmful to health (Table 4). Contraception is not free in Serbia. Certain COCs are subsidised by the state, and copper intrauterine device (Cu-IUD) costs may be refunded by social centres for persons who are financially supported by the state. Embarrassment to talk about contraception with a husband and/ or a gynaecologist was mentioned by 16 respondents (22%). According to the RHM’s opinion, religious

Table 3 Opinion of Roma Health Mediators (RHMs) about the reasons for higher parity of Roma women in Serbia. Reasons why Roma women deliver more children than the average woman in Serbia Tradition Partner/family pressure Preference for sons Roma women do not recognise the benefits of using modern contraceptives for family planning Lack of money for termination of pregnancy Financial support for families with children ∗RHMs

Number (and percentage) of statements given by 70 RHMs∗ 43 21 16 34

(61%) (30%) (23%) (49%)

46 (66%) 23 (33%)

were free to cite more than one reason.


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Table 4 Opinion of Roma Health Mediators (RHMs) about the barriers to reliable contraception use confronting Roma women in Serbia. Number of statements given by 70 RHMs*


Barriers to reliable contraception use Lack of relevant information Fear that contraception would be harmful to health Religious beliefs Husband is against contraceptive use Embarrassed to speak about contraception with their husband Ashamed to speak about contraception with a gynaecologist Financial constraints

23 21 6 28 8 8 25

(33%) (30%) (9%) (40%) (11%) (11%) (36%)

*RHMs were free to cite more than one reason.

beliefs are less important reasons why Roma women do not use reliable contraception. “Roma women do not use IUDs because they would have to go to a gynaecologist for the insertion procedure and follow-ups; they do not use the pill because it has to be taken every day and it causes weight gain. The men refuse to use the condom for some of the following reasons: Oh, that’s rubbish! I never used it! My father did not use it either and there is nothing wrong with him! Some husbands forbid their wives to use contraception, calling them bad names and insulting them if they mention protection.” (Lena, RHM). Equity of Roma women in utilisation of health care was one of the questions asked to RHMs. Ten of them (14%) noted that Roma women are exposed to discrimination because of their belonging to that ethnic minority. Although Roma women can receive medical help in emergency situations, 26 RHMs (37%) listed several explanations for inequity in the access to primary health care in comparison to the general population in Serbia. The most important ones are a lack of health insurance and poverty; consequently, the women have no money for travel expenses, diagnostic and therapeutic procedures, and medications. On the other hand, 34 RHMs (49%) declared that Roma women are treated in the same way as other women when accessing primary health care institutions. “Legally, Roma women have the same treatment as all other women. However, in practice they are faced with many difficulties. Most of them have the problem of obtaining personal documents and a health-insurance card. Many Roma people 106

complain about the way they are treated by health workers, mainly complaining about impoliteness and not receiving enough information about what interests them. Often, there is also a language barrier. They are excluded because of the cost of the medicines; they are hindered by having to wait for a check-up and by not knowing their way around health institutions.” (Dragana, RHM). Asked about the causes for the much higher utilisation of health care services for antenatal care and delivery, in comparison to contraceptive counselling and cervical cancer screening among Roma women, RHMs stated that the latter use health care services only if they have specific needs or problems. Antenatal care and delivery are very important to Roma people, as it means caring for the unborn child. Additionally, according to the health care policy in Serbia pregnant women have free access to any kind of health services which they need, even without a health card. “Pregnant women have a right to free services, checkups without health-insurance cards and do not have to wait in queues. As regards preventive check-ups, unlike those concerning pregnancy, the women do not have their husband’s support or anybody else’s, they do not have time for themselves as they are burdened by the everyday needs of their family and home, or they do not have money to pay for bus fare to the healthcare centre. Shyness still prevails among the older generation.” (Silvija, RHM). Regarding the question as to who provides induced abortion for Roma women, all except five RHMs stated gynaecologists do, at official health care facilities.




Three RHMs thought that Roma women do not terminate pregnancies, one RHM had no information, and the remaining RHM acknowledged that some Roma women had undergone a criminal abortion. Changes in the sphere of partnership, family life, parenthood, and the sexual and reproductive behaviour of young Roma people in comparison to their parents’ generation were apparent to 60 RHMs (86%). They reported that the marriage of young Roma people is more frequently based on emotions; they do not want to live in multi-generational families; they perceive that education of their children results in a better life. About half of the RHMs who observed changes in the behaviour of young Romanies (n ⫽ 27, 45%), mentioned their intention to use efficacious contraceptives in order to achieve the desired number of children. Small changes were noted for young Roma people who live in two-generation instead of multi-generational families as cited by six RHMs (9%), while four RHMs (6%) thought that there were no differences between younger and older generations. “Many young people do not live differently from their parents, because they are brought up that way, whether they are male or female. They enter into marriage arranged by their parents who they listen to by tradition. Unfortunately, this can hardly be changed. I must mention, however, that there is an increasing number of young people who have been getting into premarital relationships, planning a family and are interested in using contraception. Still, in the first years of marriage they do not use contraception, while after that, when they mature a little bit more, they tend to use some form of contraception.” (Lena, RHM).

DISCUSSION

Findings and interpretation This study demonstrates marked differences in SRH behaviours between Roma and other Serbian women. The variance is considerable in total fertility rate, early marriage, and adolescent birth rate.There are two areas of sexual and reproductive behaviour, antenatal care coverage and birth control, with less apparent disparities between the two groups. Acceptable rates of antenatal care and assistance during delivery by skilled personnel have been achieved for all women in Serbia.


On the other hand, birth control indices are dissatisfying with a high percentage of women from both groups ‘not using any method of contraception’. The question is: why are the percentages of women from both groups so low for ‘unmet need’? This might be explained by (i) a common lack of awareness within Serbian society of the benefits of preventing unplanned pregnancies; (ii) the social acceptance of induced abortion as a birth control method; and (iii) a reluctance to use modern contraceptives because of misconceptions and fears that it would imperil women’s health and quality of life9,12. Some differences exist in the type of contraception used by the groups investigated. Roma women are inclined to use traditional forms of contraception and are less likely to rely on condom-, COC- or IUD use in comparison to women from the general population. Furthermore, there are only slight differences in birth control usage between generations, as both younger Roma and Serbian women tend to behave like those who are older. This generational consistency might be due to the lack of education and awareness of SRH and modern contraceptives. Two factors may help to explain the sexual and reproductive behaviours of Roma women brought to light by the MICS4. One of those is the lasting influence of the traditional enculturation and the other, the unique position of Roma within the Serbian society. The influence of traditional values was an important theme in the results of MICS4 and in the responses to the questionnaires given to the RHMs. Data on the sexual behaviour of women aged 15 to 24 years, the barriers to reliable contraception use, and the attitudes towards domestic violence all illustrate the subordinate role of women within the Roma community. That is to say, a Roma girl must be a virgin and fertile or she has no chance of marriage, and therefore, no standing within the Roma community. As motherhood is central to the life of Roma women they do utilise health care services for antenatal care and delivery. Early marriage and high parity of Roma women are combined with low educational aspirations. Therefore, Roma women usually only get poorly paid physical work. However, RHMs noted some influence of modernisation in the behaviour of young Roma people, which might be pertinent for their SRH. Romanies suffer within Serbian society from prejudices, and may well be subjected to those biases from healthcare workers and other government employees.


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Although current Serbian law on compulsory primary education requires that all children complete nine years of school, this is not carried out in practice18. Also ineffective is a measure to encourage Roma people to continue their education, which offers children and adolescents from that community privileges when applying for secondary schools and universities. Furthermore, pronatalistic measures in Serbia contribute to the maintenance of the Roma’s traditional pattern of behaviour. Due to such policies, health care during pregnancy and delivery, and infertility treatment, are free of charge, whereas this does not apply to other aspects of SRH.

their SRH; the Serbian government should therefore do more to enforce the existing law on compulsory primary education. Empowering Roma women by positive discrimination in getting a job, with the introduction of new measures that would guarantee them a certain proportion of workplaces, may also be useful. Promoting birth control in all its aspects, including information, counselling and availability of a full range of affordable modern contraceptives, brought into line with antenatal care, will help Roma women to recognise the benefits of planning the family. All these measures would contribute to alleviating prejudices towards Roma people.

Strengths and weaknesses of the study

Unanswered questions

The strength of this study is its combining quantitative and qualitative research methods. The data used for the quantitative investigation are representative for both the whole population of Serbia and women from Roma settlements. To gain a better insight into the sexual and reproductive behaviours of Roma women, RHMs who work with women in all Roma settlements in Serbia were questioned for the qualitative part of this survey. The study highlights inequalities affecting the SRH of one of the largest marginalised and disadvantaged population subgroups. A limitation of this investigation is the lack of relevant data of the same nature for comparative analysis of the SRH state of Roma people in Serbia in the past, as well as across other countries where RHMs are working in this field. A weakness of the qualitative part of the study might be the fact that responses obtained from RHMs were not anonymous. That is, the questionnaires were sent and collected via the RHM’s coordinator, who communicates with RHMs via the only means available: e-mails. In spite of this flaw in the design, having in mind the content of the questionnaire, we believe the answers are unbiased as RHMs had no reason not to express their opinion on the issues raised. If we conduct similar research again we would ask RHMs to reply directly to us and would ensure that this was done anonymously.

Investigators must interview young Roma people, of both genders in order to learn more about their life, education, partner relationships, sexuality, views on parenthood and pregnancy, STI prevention, and expectations from both state and civil society in Serbia.

CONCLUSION

The SRH of Roma women who live in settlements in Serbia is poor. Indicators concerning their SRH are considerably worse than for the general population of women in Serbia. Factors contributing to these disparities are the traditional socio-cultural milieu and the specific position of Romanies within Serbian society. Education, empowerment of Roma women and promotion of modern FP might lead to the improvement of SRH in this vulnerable population group.

AC K N OW L E D G E M E N T S

The authors are very grateful to Dr Sarah Randall for reviewing the paper before submission. This investigation was part of Project no. 47006 financed by the Ministry of Education, Science and Technological Development of the Republic of Serbia.

Relevance of the findings The study highlights several implications for policymakers. RHMs considered education of Roma women to be a crucial factor for the improvement of 108

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.





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APPENDIX

Questionnaire for Roma Health Mediators on reproductive health of Roma women who live in Serbia (1) Why do Roma women give birth to more children than the average woman in Serbia? (2) What are the most important reasons for early marriage, commonly before 18 years of age, among Roma people? (3) What are the obstacles that prevent Roma women from using reliable contraception (intrauterine device, contraceptive pill, condom). (4) Are Roma women equally treated regarding the utilisation of health care services as women of other ethnic origin in Serbia?

(5) How do you explain the fact that Roma use healthcare facilities during pregnancy and childbirth whereas preventive healthcare check-ups – the early detection of cervical and breast cancer, counselling on family planning – are accessed to a much lesser extent? (6) Do you possibly know how and where Roma women undergo induced abortion? (7) To what extent do young Roma people behave differently regarding parenthood, family life, partner relationship, sexual behaviour and prevention of unwanted pregnancy, in comparison to their parents?


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