title: Discrimination against childbearing Romani women in maternity care in Europe: a mixed-methods systematic review.
abstract: BACKGROUND
  Freedom from discrimination is one of the key principles in a human rights-based approach to maternal and newborn health.
  
  
  OBJECTIVE
  To review the published evidence on discrimination against Romani women in maternity care in Europe, and on interventions to address this.
  
  
  METHODS
  A systematic search of eight electronic databases was undertaken in 2015 using the terms "Roma" and "maternity care". A broad search for grey literature included the websites of relevant agencies.
  
  
  METHODS
  Standardised data extraction tables were utilised, quality was formally assessed and a line of argument synthesis was developed and tested against the data from the grey literature.
  
  
  RESULTS
  Nine hundred papers were identified; three qualitative studies and seven sources of grey literature met the review criteria. These revealed that many Romani women encounter barriers to accessing maternity care. Even when they are able to access care, they can experience discriminatory mistreatment on the basis of their ethnicity, economic status, place of residence or language. The grey literature revealed some health professionals held underlying negative beliefs about Romani women. There were no published research studies examining the effectiveness of interventions to address discrimination against Romani women and their infants in Europe. The Roma Health Mediation Programme is a promising intervention identified in the grey literature.
  
  
  CONCLUSIONS
  There is evidence of discrimination against Romani women in maternity care in Europe. Interventions to address discrimination against childbearing Romani women and underlying health provider prejudice are urgently needed, alongside analysis of factors predicting the success or failure of such initiatives.
authors.affiliation: Sheffield Teaching Hospitals NHS Foundation Trust, Jessop Wing, Tree Root Walk, Sheffield, S10 2SF, UK. Helen.Watson@sth.nhs.uk.
authors.forename: Helen L
authors.initials: HL
authors.lastname: Watson
authors.affiliation: Research in Childbirth and Health (ReaCH) group, University of Central Lancashire, Preston, PR3 2LE, UK.
authors.forename: Soo
authors.initials: S
authors.lastname: Downe
mesh_terms: D005260:Female; D006293:Health Promotion; D006806:Human Rights; D006801:Humans; D008427:Maternal Health Services / Q000592:standards*; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D012383:Romania; D063508:Social Discrimination / Q000517:prevention & control*
keywords: Discrimination; Health mediation; Human rights; Maternity care; Mistreatment; Prejudice; Roma