title: "There's no kind of respect here" A qualitative study of racism and access to maternal health care among Romani women in the Balkans.
abstract: BACKGROUND
  Roma, the largest minority group in Europe, face widespread racism and health disadvantage. Using qualitative data from Serbia and Macedonia, our objective was to develop a conceptual framework showing how three levels of racism--personal, internalized, and institutional--affect access to maternal health care among Romani women.
  
  
  METHODS
  Eight focus groups of Romani women aged 14-44 (n = 71), as well as in-depth semi-structured interviews with gynecologists (n = 8) and key informants from NGOs and state institutions (n = 11) were conducted on maternal health care seeking, experiences during care, and perceived health care discrimination. Transcripts were coded, and analyzed using a grounded theory approach. Themes were categorized into domains.
  
  
  RESULTS
  Twenty-two emergent themes identified barriers that reflected how racism affects access to maternal health care. The domains into which the themes were classified were perceptions and interactions with health system, psychological factors, social environment and resources, lack of health system accountability, financial needs, and exclusion from education.
  
  
  CONCLUSIONS
  The experiences of Romani women demonstrate psychosocial and structural pathways by which racism and discrimination affect access to prenatal and maternity care. Interventions to address maternal health inequalities should target barriers within all three levels of racism.
authors.affiliation: Department of Epidemiology, UMDNJ School of Public Health, 683 Hoes Lane West, PO Box 9, Room 209, Piscataway, NJ 08854, USA. janevite@umdnj.edu.
authors.forename: Teresa
authors.initials: T
authors.lastname: Janevic
authors.forename: Pooja
authors.initials: P
authors.lastname: Sripad
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Bradley
authors.forename: Vera
authors.initials: V
authors.lastname: Dimitrievska
references.citation: Health Serv Res. 2002 Oct;37(5):1221-42
references.pmid: 12479494
references.citation: Int J Public Health. 2012 Feb;57(1):49-55
references.pmid: 21814849
references.citation: Am J Community Psychol. 2007 Jun;39(3-4):381-92
references.pmid: 17404829
references.citation: J Health Care Poor Underserved. 2008 Aug;19(3):894-911
references.pmid: 18677077
references.citation: J Gen Intern Med. 2009 Nov;24 Suppl 3:548-54
references.pmid: 19842005
references.citation: Soc Sci Med. 2008 Aug;67(3):478-86
references.pmid: 18508171
references.citation: J Gen Intern Med. 2008 Oct;23(10):1679-84
references.pmid: 18649109
references.citation: Du Bois Rev. 2011 Apr;8(1):115-132
references.pmid: 25632292
references.citation: Ethn Dis. 1996 Winter-Spring;6(1-2):30-46
references.pmid: 8882834
references.citation: J Health Care Poor Underserved. 2008 Aug;19(3):697-730
references.pmid: 18677066
references.citation: Med Care. 2009 Aug;47(8):826-34
references.pmid: 19584762
references.citation: J Fam Pract. 2002 Nov;51(11):938-42
references.pmid: 12485547
references.citation: Ann N Y Acad Sci. 2008;1136:161-71
references.pmid: 17954679
references.citation: Ethn Dis. 2001 Autumn;11(3):554-63
references.pmid: 11572421
references.citation: J Health Soc Behav. 1995 Mar;36(1):1-10
references.pmid: 7738325
references.citation: BMC Public Health. 2010 Aug 22;10:509
references.pmid: 20727212
references.citation: J Behav Med. 2009 Feb;32(1):20-47
references.pmid: 19030981
references.citation: Health Policy Plan. 2004 Mar;19(2):69-79
references.pmid: 14982885
references.citation: Soc Sci Med. 2004 Jan;58(2):237-46
references.pmid: 14604610
references.citation: Am J Public Health. 2004 Dec;94(12):2084-90
references.pmid: 15569958
references.citation: Public Health Rep. 2001 Sep-Oct;116(5):404-16
references.pmid: 12042604
references.citation: J Gen Intern Med. 2010 May;25(5):390-6
references.pmid: 20146022
references.citation: Du Bois Rev. 2011 Apr 1;8(1):199-218
references.pmid: 24761152
references.citation: J Epidemiol Community Health. 2007 Nov;61(11):960-5
references.pmid: 17933953
references.citation: Health Serv Res. 2007 Aug;42(4):1758-72
references.pmid: 17286625
references.citation: Am J Public Health. 2000 Aug;90(8):1212-5
references.pmid: 10936998
references.citation: J Epidemiol Community Health. 2004 Jun;58(6):441-5
references.pmid: 15143107