by Elizabeth Bodenman –
Please note: within the context of this blog, the terms ‘women’ and ‘girl’ are inclusive to those who identify with these labels, and the term ‘mother’ is inclusive to anyone who gives birth. Additionally, this blog contains graphic first-hand accounts of the abuse Roma mothers face in Bulgarian hospitals, as reported by the ERRC/BHC in 2020.
In September, my partner and I took an anniversary trip to Bulgaria. It was a spontaneous decision to visit a country neither of us had been to, and we were immediately taken by the beauty, the interesting history, and the kindness of the people we met. Having little knowledge of the country we were visiting, I began doing some basic internet searches on Bulgarian society. It did not take deep digging to find some disheartening information about Bulgaria’s Roma, who comprise the country’s third-largest ethnic group behind Bulgarians and Turks. Though most recent census data shows the Roma to comprise 4.9% of Bulgaria’s population at 325,343 people, non-recorded estimates suggest there are anywhere from 370,000 to 800,000 Roma in the country. Distributed nearly equally between cities and the countryside, the largest Roma populations live in the districts of Montana, Silven, Dobrich, and Yambol. Within both city and countryside environments, Roma settlements are primarily isolated from their Bulgarian counterparts.
A historically marginalized group within Bulgaria and Europe at large, Roma communities have limited access to basic resources and social services. As of 2011, 9.5% of the recorded Roma population have completed secondary education, with only 0.5% completing a university degree. As of 2014, 40% of Roma homes do not have running water, and another 80% do not have an indoor toilet. When sick, Roma people experience greater difficulties in accessing adequate healthcare services due to a lack of insurance. A 2015 report by the Roma Inclusion Index shows 52% of Roma in Bulgaria are uninsured, increasing to 53% amongst Roma women specifically. Open prejudice against Roma people is common, with discriminatory rhetoric spread by country leadership (cp. Valery Simeonov, then Deputy Prime Minister of Bulgaria, 2014).
The Most Vulnerable
As with most communities of the modern world, the Roma are organized by patriarchal structures. These structures subject Roma women and girls to discrimination at all levels, beginning at home and extending to greater Bulgarian society. By Roma tradition, women adopt primary caretaker roles within the household and are given little say in their personal development and bodily autonomy. Familial duties bring Roma women’s education rates below men’s, limiting outside opportunities. A lack of familial and societal agency leads to high rates of trafficking and violence, as well as early marriage and pregnancy. A 2014 study by the Fundamental Rights Agency of the EU found that in all core aspects of social life from education, employment, and health, Romani women suffer more than Romani men. Unable to access the resources needed for quality pre-and post-natal care, among the most vulnerable of the Roma are pregnant women. The vulnerabilities of this group result in high rates of complications during pregnancy. According to the Bulgarian National Roma Integration Strategy, these complications result in high rates of disability and chronic disease within both children and parents, negatively impacting long-term health outcomes and the ability to work.
So what is being done to address such discrimination? Under the Bulgarian Constitution, discrimination against the Roma is illegal. Equal treatment is given “on the basis of ethnicity, sex, and personal or social status,” which extends into the healthcare sphere, where affordable or free medical care for all is guaranteed. The constitution even goes as far as to guarantee mothers free obstetric care. For those without medical insurance, maternity-related services are to be free as well.
The Bulgarian government has been formally aware of the discrimination against Roma people and the double discrimination against Roma women and mothers for some time. To combat these issues, the Bulgarian government established the ‘Law on Protection against Discrimination’ in 2004, which explicitly included multiple forms of segregation, discrimination, harassment, and persecution. The following year, in 2005, Bulgaria publicly declared it would embark on a ‘Decade of Roma Inclusion’. From 2012 to 2020 the government instituted the National Roma Integration Strategy and Action Plan, as well as the Regional Strategy for Roma Integration, then renewed both for 2021 to 2030. In 2021, a National Strategy of the Republic of Bulgaria for Roma Inclusion and Participation was also implemented. These strategies all rely on Priority 5, the Rule of Law and Non-Discrimination. Part of these strategies is that Bulgaria pledges to “take into account the needs and status of Roma women,” as well as ensure the “early registration of pregnant women, monitoring during pregnancy, and timely hospitalization of birthing mothers.” On paper, Bulgaria has been doing everything right to improve the treatment of Roma women and Roma mothers.
However, doing things right on paper is not the same as doing things right in real life. As one of the utmost determinants of quality of life, access to healthcare seems to be a persistent issue for Romani women, despite ongoing strategies and action plans to better standards of living. A 2018 study by Manov and Baev explored the availability of women’s healthcare, interviewing 102 Roma women ages 18 to 65. Of the 102 women, 60% claimed to be uninsured, and 35% recounted instances of anti-Roma aggression on behalf of emergency medical personnel. A 2020 U.S. State Department report on human rights practices in Bulgaria found that Romani women, even those who had survived sexual violence, lacked access to contraception, HIV testing, and gynecological services due to poverty and lack of education. The report also found that it was legal for some Bulgaria municipalities to restrict women’s access to reproductive services based on their education level. The municipalities of Svilengrad, Vratsa, Kyustendil, and Veliko Turnovo require mothers to have completed their secondary education to access assisted reproduction programs. Svilengrad also only permits Roma women to give birth one time within municipal limits. Even in municipalities without such strict limitations, the high number of uninsured Roma women results in a lack of trained attendants at maternal bedsides. A 2020 report by the LARGO Association estimates that between 60 and 70% of uninsured women (of whom 57% are Roma) did not receive prenatal care or medical tests relating to their pregnancy. Banning medically assisted home births also keeps medical personnel from visiting Roma communities, where home birth is often the only comfortable option.
The most alarming study on Roma maternal care was a 2016 study conducted by the European Roma Rights Center (ERRC) and the Bulgarian Helsinki Committee (BHC). The ERRC and BHC organized an interview-based study on the treatment of Roma mothers who give birth in Bulgarian hospitals. Responses from 63 Roma mothers and 79 public hospitals were collected and analyzed, and testing hospital protocols through anonymous phone calls was the primary method of confirming the validity of interview results. By 2020, enough data was collected to reach some disheartening conclusions on the status of Roma maternal care in Bulgaria: total findings include instances of segregation, medical neglect, physical abuse, verbal abuse and sexual harassment, bribery, and general discrimination.
Of the 79 hospitals contacted, 78 admitted to practicing ethnic segregation. Instances of segregation include placing Roma women in gynecological and obstetrical wards separate from ethnic Bulgarians, as Roma are viewed as ‘dirty’ or ‘thieves’ by hospital personnel. These ‘Roma’ wards included heavily restricted or altogether banned visiting hours, dirty, small, and outdated rooms lacking private toilets and showers, toilet paper, hot water, or soap, as well as the absence of staff to sanitize bathrooms and change sheets. Instances of such segregation are also reported in the aforementioned studies by Atanasov et. al (2021), Manov and Baev (2018), and the U.S. Department of State (2020).
Interviews found that instances of medical neglect included a lack of affordable and accessible prenatal consultations, denial of anesthesia for perineal stitchings, refusal to provide menstrual products and diapers, and doctors and nurses who frequently ignored Roma mothers. One Roma mother recounts that after giving birth, personnel waited six days to inform her of her infant’s numerous health complications, causing extreme stress and anguish to the recovering patient.
Interviewees informed the ERRC and BHC that instances of physical abuse included mothers’ arms and legs forcibly restrained with rope and belts during labor, mothers being forced to expose their genitals in hospital public waiting areas to ‘check for pubic lice’, and mothers in labor being pinched, slapped, pushed and hit by doctors and nurses. One woman recounts the story of a drunk doctor who violently beat her during labor, to the point she fell to the floor and became unconscious with her infant already crowning. When she awoke on the hospital floor, her leg was broken and she and her infant were covered in large bruises. Though both mother and child survived the attack, the mother retains a large amount of mental trauma. In these accounts, verbal abuse was often a precursor to physical abuse. Numerous Roma mothers recount being threatened with violence and called ‘worthless,’ ‘stupid,’ ‘illiterate,’ ‘filthy’, ‘stinky,’ ‘scum,’ ‘swine,’ ‘bitch,’ and ‘welfare exploiter’. Abuse would also frequently escalate to sexual harassment, with mothers also being called ‘whores’, and ‘loose’. Many of the staff’s misogynist remarks regarding the sexuality of Roma mothers were included and can be read in the ERRC study.
Ironically, as Roma are often stereotyped within Bulgarian society to be immoral thieves and tricksters, it appears Bulgarians themselves shamelessly engage in such behavior. Bribery in the hospitals was mentioned in multiple interviews, with hospital staff refusing routine service and care to Roma mothers without extra, informal payment. Families of mothers were told they could not visit them without ‘treating’ doctors and nurses to soda, liquor, candy, coffee, cigarette, and cake. While mothers were in labor, their families were also told that without additional payment (reportedly anywhere from 50 to 500 leva), doctors and nurses would refuse to perform life-saving cesarean sections, provide anesthesia, or give necessary stitching. If families were not at the hospital to be coerced into bribery, mothers in labor would be told by nurses they would not help her unless she promised to give additional payment later. Oftentimes, women who did not have the money were beaten. Aside from segregation, medical neglect, physical abuse, verbal abuse and sexual harassment, and bribery, general discrimination was found to occur in the form of age-related discrimination for underage mothers, and language-based discrimination for those unable to speak Bulgarian, or who spoke Bulgarian with an accent.
The ERRC and BHC, as well as studies from Atanasov et. al (2021), Manov and Baev (2018), and the U.S. Department of State (2020), found that despite the healthy amount of strategies and action plans the Bulgarian government has adopted since 2004, conditions for Roma mothers remain inhumane at best. Most instances of discrimination against Roma go unreported in Bulgaria, making me wonder exactly how many mothers have faced deep trauma in their segregated maternal wards. So what is being done with the data we do have?
Organizations such as the ERRC are launching formal complaints against the Bulgarian government before the European Committee of Social Rights. The ERRC is alleging there has been a violation of Bulgaria’s constitutional right to reproductive and sexual health assistance, as well as the constitutional guarantees against ethnic discrimination. Though legally valid, fighting for Romani rights within Bulgaria’s legal and governmental systems is difficult, as Roma citizens take no part in these systems. There is also a lack of legal professionals who have been trained in anti-discrimination and human rights law, leading to Bulgarian judges being admittedly ignorant of the conditions of the Roma.
While there needs more national and international attention brought to these horrific human rights violations, along with sweeping systemic changes to improve the conditions of Romani communities, there are some short-term changes that I think could be highly effective within 3-5 years.
- The municipalities of Svilengrad, Vratsa, Kyustendil, and Veliko Turnovo should immediately repeal their eugenicist policies concerning who is allowed to give birth, and where they are allowed to give birth. These laws harm Roma communities, particularly Roma mothers, who already struggle with access to family planning and basic medical services.
- The state should incentivize the 0.5% of Roma degree holders to continue their higher education with free law schools, specializing in anti-discrimination and human rights policy. By increasing the number of ethnic Roma with law degrees, the Bulgarian judiciary can at last gain some much-needed Roma representation.
- Bulgaria needs to mandate comprehensive anti-discrimination training for all professionals within its judicial system. Currently, such training is not widespread enough to be effective. Anti-discrimination should become a foundational part of educating all judges and lawyers. This training should also include the testimonies of Roma community members to increase community platforms and humanize Roma in the face of bigoted professionals.
- Lastly, Bulgaria must create a widespread and accessible helpline in the Romani language for women, girls, and mothers. This helpline should not only provide immediate assistance to those in danger but also collect data on underreported violations. The current lack of data on Roma women and mothers leads to inadequate resource allocation and perpetuates cycles of oppression.
While there is much more work to be done, these four simple changes will lay the groundwork for broader systemic change in Bulgaria. If this blog inspired you, follow these Roma-centric organizations making waves in Bulgaria:
Liz Bodenman is an American NMRZ intern and Research Affiliate of the WomanStats Project. She recently graduated from Texas A&M University with a Master’s in International Affairs, and is interested in topics concerning sustainability, gender equity, and conflict.