A Right to Equal Healthcare- The Case of Romani Women in Macedonia

Teresa Janevic, a 2010-11 Individual Advanced Research Opportunities (IARO) fellow, writes about her experience researching prenatal and maternity care among women in Serbia and Macedonia. The following is part of a series of blog pieces from our US scholars, who are conducting research in the field.

An hour and a half scenic drive through the mountains from Skopje, Macedonia, is situated beautiful Prilep, a town of about 65,000 people. I travelled there to interview Nesime Salioska, the founder of the NGO ‘Roma SOS.’ Nesime was welcoming and excited to show me around town, and I was eager to learn her perspectives on my research based on her experiences as a Romani woman fighting for the right to health and social protection for the Romani community in Prilep.

In Macedonia, gynecologists are part of the primary health care system, which was privatized in 2006. As a result, many areas face shortages of gynecologists, in particular in Romani neighborhoods. Nesime told me that the first barrier to Romani women accessing gynecological care was the lack of gynecologists in the city overall. Next, there are financial barriers. She explained, “If you give the doctor some unofficial money, then you will be treated much better, and if you don’t give any unofficial money then you won’t be treated as well.”

Although according to the law women should receive a pelvic exam and Pap test free of charge, I was told that doctors often do not practice that. Further, many Romani women do not have health insurance, since they often lack the personal identity documents necessary to obtain it. When Romani women do go to see the gynecologist, they face the additional barrier of the attitude providers have toward Romani women. For example, they may not take the time to explain a health condition to a Romani woman. “So many Romani women are leaving the health institutions without any knowledge about their health condition, without any awareness about the consequences and the issues.”

The NGO Roma SOS tries to break these barriers by working on many ‘fronts’ simultaneously: health education workshops, assistance obtaining documents, scheduling women for exams. In one example of a woman whom Roma SOS helped obtain health insurance, Nesime stressed the importance of their work: “this Romani woman was without any assistance, without any education, without any support, without knowing where to go, which means if we did not exist as a NGO and provide assistance, she would simply not have health insurance.”

The bright spot is that often the attitudes of the doctors changed after working with Roma SOS to conduct health education workshops for women. I also heard from gynecologists I spoke with that interacting with the community outside of the office helped foster understanding.

Nesime supports the current development of health mediator program which is (slowly) underway in Macedonia, which links the Romani community with health institutions. However, she stresses that it is important that these mediators are not the only way for the Romani community to access health institutions. Her vision and that of Roma SOS “is to create opportunities for the Romani community to become equal citizens with equal rights and opportunities in society”.

More information about Romani women’s civil society organizations in Macedonia can be found at www.RomaWomenInfo.com. To learn more about Teresa Janevic's research in Macedonia during her IARO fellowship, read her research brief here.