Examples of Recommendation sections
Recommendation section from a feasibility/recommendation report
Recommendation section from a feasibility/recommendation report
The microwave sintering method of producing advanced ceramic material is recommended as a commercially viable production technique given its superiority in terms of quality, cost and production rate as compared to the conventional sintering approach. This report has only investigated the commercial viability of the method of production; it has not made an assessment of the market demand or marketability of this product. It is recommended that these factors be assessed. Market demand should be quantified and analysed against production and set-up costs in order to establish the optimal scale of production. Further research is required to establish the validity of the claim that the smaller grain sizes resulting from the short, rapid cycle of the microwave sintering process are mechanically superior to conventionally-sintered ceramics as this will impact on the demand and marketability of this product.
A recommendation in reference to the purpose of the report
Further recommendations are made about action to be taken in light of the major recommendation above. These are somewhat hidden by the paragraph form used and have not been highlighted by the grammatical structure of the sentences since this is inconsistent
Look at a revised version of this recommendations section below. In the revised version the recommendations are much clearer and more powerful.
Revised version of the Recommendation section above
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Comments and questions should
be directed to Unilearning@uow.edu.au
SOCIAL EXCLUSION AT THE CROSSROADS
OF GENDER, ETHNICITY AND CLASS.
A VIEW THROUGH ROMA WOMEN'S REPRODUCTIVE HEALTH
UNDERSTOOD AS A HUMAN RIGHTS ISSUE IN
Research paper with policy recommendations
TABLE OF CONTENTS
Paper and research overview …………………………………………………… p.3.
1. The conceptual framework of the primary research …………………………. p.5.
1.1. Approaching reproduction and reproductive health
1.2. Understanding social exclusion at the crossroads of gender, ethnicity and class
2. The conceptual framework of the policy research ……………………………p.8.
2.1. Roma women’s reproductive health as human right and the stakeholders
2.2. The impact of (the lack of) reproductive rights on Roma women’s life
2.3. The need of mainstreaming gender and ethnicity in public policies
3. Methodological concerns ……………………………………………………. p.12. 4. Research results: parallel worlds and mechanisms of multiple exclusions….. p.13.
4.1. The socio-economic conditions of Roma communities
4.2. Roma women's conceptions, feelings and practices related to reproduction
4.3. Health care providers' attitudes towards Romani women
4.4. Roma policies. From gender-blindness to pro-natalist concerns
4.5. Reproductive health policies. From ethnic-blindness to racism
4.6. Roma women's organizing
5. Reproductive health of Roma women as a policy matter …………………… p.39.
5.1. The policy problem
5.2. The context of the policy problem
5.3. Policy recommendations
5.3.1. Principles guiding my policy recommendations
5.3.2. Expected results
5.3.3. Policy recommendations – general and specific
6. Conclusions ………………………………………………………………… p.45.
6.1. Main research findings
6.1.1. Roma women's discrimination in the context of reproductive health care policies and services
6.1.2. Roma women's exclusion from mainstream Roma policies and movement
6.1.3. Roma women's social exclusion on the base of their ethnicity, gender and social position
6.2. Representing Roma women's rights and entitlements
PAPER AND RESEARCH OVERVIEW
This paper addresses the access of Roma women to reproductive health as a socially, economically and culturally, but also politically determined phenomenon. It investigates it in the context of post-socialist as a problem through which one may have an understanding of the broader issue of social exclusion as it functions under the circumstances of post-socialist transformations (being revealed in Chapter 1). As such, it aims to have a contribution to theorizing on how exclusion works at the crossroads of ethnicity, gender and class while (re)producing inequalities, and on how does Roma women's multiple discriminations function turning them into the most underserved social categories of our society. In theoretical terms I would also like to take part in the debates about the ways in which structural factors, cultural conceptions and agency are working through each other while shaping women's everyday desires, claims and practices related to reproduction and reproductive health.
My analysis was founded on an empirical research carried out by the means of an ethnographic fieldwork and of the analysis of existing policies (its methodological concerns are discussed in Chapter 3). The former was conducted in two Romani communities from the city of , Hunedoara county, but also within the institutions of the local health care system, using the methods of participant observation, in-depth interviews and filming (its results are presented in Chapters 4.1., 4.2. and 4.3.). It was completed by interviews made with Roma women activists from Cluj, and (Chapter 4.6.). At its turn the analysis of policy consisted in the critical investigation of the current Roma policies and reproductive health policies from Romania from the point of view of the extent to which they do (not) consider Roma women's particular needs (Chapters 4.4. and 4.5.).
Altogether my aim was to describe the socio-economic conditions, institutional arrangements, policies and cultural conceptions that shape Roma women's (lack of) access to reproductive health, but also of their personal ways of dealing with the related problems. Most importantly I wanted to highlight how women felt, thought and acted under the conditions of being situated at the crossroads of several contradictory subject positions, which were prescribed for them by different discourses and institutions (like state policies, Roma policies, their own communities, health care providers) wanting them to have more, or – on the contrary – less children than they desired on the base of their material conditions, social relations and emotional ties.
Additionally (being discussed in Chapter 2), my research focused on reproductive health as an issue of human rights considering that reproductive rights of women included the right to have access to reproductive health care information and services, the right to sexual education and bodily integrity, the right to decide on the number of children and the time-spacing of births, and the right to decide on the contraceptive method most appropriate for their medical and social condition, but also the right to the enjoyment of sexuality as part of sexual health. Its recommendations (presented in Chapter 5) were referring to the need of mainstreaming ethnicity into the public health policy and of mainstreaming gender into Roma policy in order to overcome the effects of ethnic and gender discrimination in relation to reproductive rights and access to healthcare of Roma women, while recognizing that ethnicity and gender are not naturally given internal essences, but subject positions constructed socially and culturally.
While using the language of rights my paper observed that it was not enough to claim reproductive health in terms of rights, but there was a need to understand why economic, cultural and social processes do make impossible of the de facto use of the formally recognized rights. That is why my research aimed to identify the obstacles of the reproductive health services usage both from the perspective of Roma women’s life conditions and from the point of view of the health care system. I could show that the Romanian reproductive health policies and the existing Roma policies were failing to respond to the interests and particular conditions of Roma women, and willingly or not transformed them into an underserved and multiple discriminated group. And eventually could observe that the few initiatives for militating for Roma women’s rights do not have yet the authority to impose a change in the way of thinking about and acting around this issue and to increase its legitimacy and prestige within the mainstream Roma policies.
Besides the empirical data, my policy recommendations were also based on the idea according to which the creation of circumstances under which these rights might be de facto used by any women, regardless of their ethnicity, age, sexual orientation and class would be of great importance for assuring everybody's reproductive health. Even if economic inequalities persist due to the structural processes of market capitalism, equity in the health system should be a key concern for governments, and health service delivery should be culturally sensitive and responsive to everybody, including the disadvantaged social categories. My recommendations are suggestions for non-governmental organizations and governmental agencies. They are related to the needed changes that might improve Roma women’s real access to reproductive rights and reproductive health care information and services and altogether they suggest the general necessity of mainstreaming ethnicity and gender into the Romanian public policies.
In addition to this paper the outcome of my research was a video-film of two parts (the first presenting the Romani communities, and the second dealing with Roma women's specific issues, including reproductive health). This is going to be used as a tool for advocating for the recognition of the need to make a change in the structural factors and cultural conceptions, which produce and maintain Roma women's multiple discrimination.
1. THE CONCEPTUAL FRAMEWORK OF THE PRIMARY RESEARCH
1.1. Approaching reproduction and reproductive health
The conceptual framework that I am relying on in this research paper is one developed by the anthropological and feminist literature on reproduction. Among others this is revealing that biological reproduction (and implicitly women’s body) always and everywhere stays at the core of the societal, political and economic life, is one of the domains through which one may understand why the personal is political, and vice versa. Its control – together with the control of production –, structures the position (including roles, chances and life trajectories) of women of different ethnicity and class both in the private and public spheres. Moreover, the ways in which the state and the medical system (through its legislation, policies, ideologies and actual practices) are dealing with (the control of) reproduction, are also talking about the formation and maintenance of the ethnicized and gendered social inequalities.
Within cultural (and in particular medical) anthropology there were developed many approaches towards reproduction. Symbolic anthropology was dealing mainly with fertility rituals and different cults for curing reproductive problems without considering the broader social and economic forces. The political economy of health linked a historically informed approach with an ethnographically grounded study, so it placed for example the analysis of the social mediation of the shared cultural beliefs about the body in the context of political and economic changes. There are investigations that besides the ethnographic details and the broader focus use a comparative perspective between, for example, Western and non-Western practices related to infertility. The issue of social personhood and agency is addressed widely by these works and opens up challenging questions about how cultural ideologies of personhood and the socially interdependent self are interpreted differently by different persons (women and men) while trying to act as autonomous agents. In order to understand why it is possible for an individual to be at once a social person and an agency, some anthropologists propose to conceive for example bodies as not belonging to persons but being composed of the relations of which a person is constituted while not precluding women's sense of bodily autonomy or self-control. Especially Marxist approaches treat reproductive issues as embedded into the context of explicit and variable material conditions… and broader economic relations, class divisions, the nature of health care and access to it, and the types of birth control that are available. Alongside, the notion of stratified reproduction highlights the unequal social ordering of reproductive health, fecundity and birth experiences. And the concept of reproductive entitlement is focusing attention to women's moral claims in the area of reproduction, which are articulated in relation to social expectations referring to fertility, sexuality and motherhood. Moreover, for example in the context of anthropology on Eastern Europe, reproduction was also treated in terms of its politics and/or as an issue through which one may understand, for example the re-construction of post-socialist politics in Hungary or the functioning of the socialist regime in Romania in terms of people's duplicity and complicity with the state regulations.
1.2. Understanding social exclusion at the crossroads of gender, ethnicity and class
The identities of women and men of different ethnicity are constituted at the crossroads of the subject positions prescribed for them by ideologies, policies and institutions, and of their subjectivities (everyday experiences and meanings through which they perceive themselves within their significant social relations). So I am not treating ethnicity and gender as naturally given internal essences that shape one's destiny, but as socially and culturally constructed subject positions that are constituted by cultural representations and social locations where people are situated also due to the ways in which society builds up hierarchies according to the social expectations and cultural prejudices regarding ethnic and gender differences.
The ethnicized and gendered construction of the order within which people's life is embedded is a cultural and social process. Through this – on the one hand – women and men are defined and classified on the base of some characteristics supposedly determined by their ethnicity and sex as if these were their natural and inborn essences. On the other hand – through this mechanism – women and men are located in certain social and economic positions (and consequently are having access to or are excluded from specific material and symbolic resources) according to the hegemonic representations of their ethnic and sexual belongings. These processes might be observed inside different institutions and in the context of their complex relationships, including different sites of everyday life.
This paper is an attempt to describe and understand the construction of the social order at the crossroads of several systems of classification (ethnicity, gender and class) as performed by concrete people in their everyday life and lived through their personal experiences. More precisely views this process as mediated by access to reproductive health. Eventually it deals with the relationship between ethnicity, gender and class, understood as systems of classification and as social organizations of cultural differences. This relation – among other mechanisms not addressed here – structures the social order in a particular spatio-temporal location, and – as such – defines and positions women and men within private and public hierarchies, at their turn being under the impact of broader economic and political changes. But this regime could not function if it would not be sustained from below. People not only adjust their expectations and performances to its norms, they do not automatically take up certain roles, but also interpret, negotiate and act out them within their personal relations with the “significant others”.
On the base of the above described conceptual framework I address the formation of the post-socialist order (in ) as consisted of the processes of social differentiation and the underlying cultural mechanisms that produce and legitimize the newly constituted hierarchies. Above the individuals’ will and control, the former shape their chances of participating with success in the (classificatory) struggles around positions and resources, which – at their turn – are including ideologies and practices of inclusions and exclusions. Obviously, this whole system functions with the complicity of the individuals, but one should note that – most importantly – out of these processes some gain privileges, and others get blocked in disadvantaged positions. On this stage gender, ethnicity and class – beside being prescribed subject positions and lived experiences – are functioning as intertwined classificatory tools, markers of differences and processes of socially organizing cultural differences. Otherwise, the gendered and ethnicized social differentiation is nothing else than the hierarchical distribution by gender, ethnicity and class of society’s economic and social resources. My research views these processes in the context of and through the issue of reproduction and reproductive health.
2. THE CONCEPTUAL FRAMEWORK OF THE POLICY RESEARCH
2.1. Problem definition
Roma women’s reproductive health as human right and socially determined phenomenon
In a policy framework my paper addresses the access of Roma women to reproductive health in as a socially determined phenomenon and as an issue of human rights central to general well-being and crucial for achieving equity and social justice. Here I am not dealing with the health situation of Roma in statistical terms, but relying mostly on my primary ethnographic research, nevertheless also considering the available secondary sources regarding this issue.
I am subscribing to the definition according to which "reproductive health is a state of complete physical, mental and social well-being…in all matters relating to the reproductive system". In terms of physical well-being its mostly used indicators are: fertility rate, infant mortality rate, and maternal mortality rate, the proportion of births attended by skilled health personnel, contraceptive prevalence, and occurrence of abortions, cervical cancer and breath cancer. As health in general, reproductive health in particular is socially and culturally conditioned. In the case of Roma communities it is shaped by structural discrimination, cultural prejudices, school segregation and school abandonment, poverty, disparities in income distribution and unemployment, inadequate housing and food, lack of clean water and sanitation, lack of official documents and of medical insurance in many cases. In my ethnographic research I was focusing on the ways in which the use of contraceptives and abortion was shaped by Roma women’s life conditions, by the cultural conceptions dominant within the investigated communities and by the nature and functioning of the local health care system, but, on another level, also by the existing public health and Roma policies.
Most importantly as a policy study my paper treats the issues of reproductive health as part of the problem of reproductive rights, and considers that reproductive rights include:
- women’s “right to have control over and decide freely and responsibly on matters related to their sexuality, including sexual and reproductive health, free of coercion, discrimination and violence",
- the right to the highest standard of reproductive health,
- the right to have access to reproductive health care information and services,
- the right to sexuality education and bodily integrity,
- the right to decide on the number of children and the time-spacing of births,
- women’s right to decide on the contraceptive method most appropriate for her medical and social condition.
A whole range of stakeholders are involved into the issue of Roma women’s reproductive health as human right. Among them governmental agencies (most importantly the Ministry of Health and the National Agency for Roma of the Romanian Government) and non-governmental organizations working on the domain of sexual education and reproductive health (like the Society for Sexual and Contraceptive Education, and the Romanian Family Health Initiative), but also on the domain of Roma women’s rights (like the Association of Roma Women from Romania, the Association for the Emancipation of Roma Women, and the Association of Gypsy Women for Our Children). But obviously this issue is also in the interest of a larger community of people dealing with Roma communities, among them Roma health mediators, Roma schools mediators, local Roma experts and other (formal or informal) community leaders.
I consider that Roma women's organizations are playing a huge role in empowering Roma women within their own communities, and – at their turn – the mainstream Roma organizations do have the responsibility to support them in this endeavour. That is why my recommendations do refer to this aspect of policymaking, too. Only the empowerment of women could turn them into individuals able of taking decisions about their reproductive health and of really using their reproductive rights regardless of the requirements of different (patriarchal and/or racist) authoritarian discourses and institutions that put a pressure on them, for example wanting them or to make more, or to make fewer children.
2.2. The importance of the problem
The impact of (the de facto lack of) reproductive rights on Roma women’s life and on Roma communities
Reproductive health is defined and recognized by the international community and by the Romanian government as an important dimension of public health. But the human rights discourse is hardly shaping the public talk and practices regarding reproductive health, and there is a reduced concern with the de facto access of Romani women to health care information and services. That is why there is a need to raise public awareness about reproductive health as a reproductive right both within Roma policies and within public health policies, and about the necessity to consider the social determinants of Roma women’s health and access to health care.
Reproductive rights are important because the presence or absence of these rights has a huge impact on how people live and die, on their physical security, bodily integrity, health, education, mobility, social and economic status and other factors that relate to poverty. Reproductive health underpin the other goals relating to gender equality, maternal health, HIV and AIDS and poverty alleviation, and are crucial to the achievement of the goals overall.
Women belonging to marginal groups (among them Romani communities) often lack the rights or opportunities to make choices around reproduction even if Romanian laws are formally ensuring these rights. Their general living conditions, the racism of the majority population inscribed among others into the public health care system, the pressures coming from their own family members, the existence of different social and cultural norms related to women’s body and sexuality, to gender roles and relations, in particular to women’s status or to the desired number of children may restrict their options. They may have difficulties accessing at all family planning services, or preventive medical consultations, or proper treatments of illnesses. They easily become victims of the use of inappropriate contraceptive methods or of the destructive effects of repeated abortions, or even targets of a racist fertility control. This proves that women’s reproductive rights are not only referring to them as women, but are also strongly linked to the rights and the well-being of the Roma communities in general. As usually, in this case, too, women’s issues are not concerning only women, but men and the whole community as well, so everybody must have the interest and the obligation to work on the improvement of their condition. On the other hand the advocacy for Roma women’s reproductive health might have a contribution to mainstreaming gender into public (health) policies, in particular to generally advocate for women’s reproductive rights.
2.3. Statement of intent
Mainstreaming gender and ethnicity into public policies. Ethnicizing reproductive health policy and gendering Roma policy
This paper aims to have a research-based contribution to the development of a reproductive health policy and of a Roma policy, which consider reproductive health as a human right of women and treat it as a socially and culturally determined phenomenon. The ethnic awareness of reproductive health policy and the gender awareness of Roma policy should be based on the recognition of the fact that ethnic and gender differences are not naturally given, but are produced, maintained and turned into inequalities by several social and cultural factors and mechanism.
My policy recommendations refer to the need of mainstreaming ethnicity into the public health policy and of mainstreaming gender into the Roma policy in order to overcome the effects of ethnic and gender discrimination in relation to reproductive rights and access to healthcare of Roma women. They seek having a contribution to the general aim of mainstreaming gender and ethnicity in all public policies from .
One of the conclusions of this paper in the context of policy recommendations is that the problem of women’s reproductive rights is a highly sensitive issue within Roma communities, within the Roma movement, but also within the public health care services providers. That is why my recommendations are also referring to the need:
- of empowering women within Roma communities and within the Roma movement in order to turn the public talk about women’s body, sexuality and related rights into a legitimate issue;
- of liberating Roma women from the authority of pro-natalist concerns in order to be free for feeling entitled and acting accordingly in decisions concerning reproduction;
- of excluding the risk of the emergence and functioning of a racist fertility control, which claims that it provides Roma women with reproduction control methods while actually is working with the aim of “preventing Roma over-population”.
3. METHODOLOGICAL CONCERNS
As already mentioned my research was based on the recognition of the fact that Roma women's (reproductive) health was determined socially, economically and culturally, and was shaped by mechanisms of social exclusion that function in our society. Due to the latter this issue was also talking about the lack of reproductive rights or about the lack of opportunities to make use of these rights, embedded within the social conditions, institutional arrangements, policies and cultural conceptions regarding Romani communities. That is why my analysis was shaped by a social, cultural and critical approach. Otherwise was based on a primary empirical research done in the summer of 2004 (in cooperation with the Society for Sexual and Contraceptive Education from Cluj), and between June 2005 and March 2006 (with the support of the International Policy Fellowship Program).
As health in general, the state of reproductive health is shaped by the social and economic conditions of Roma women’s life, but also by the cultural conceptions/prejudices about Roma women existing within their own groups and within the broader society and in particular within the community of health care providers. I managed to reveal these aspects of the problem by the means of an ethnographic research done within local Roma groups and the local community of health care providers (family doctors, gynecologists, and medical assistants) in the city of from Hunedoara county. Participant observation and in-depth interviews were the main methods used at this stage of the research. The out-coming results are discussed in Chapter 4.1., 4.2. and 4.3. The same techniques were used for identifying the perspectives related to the importance, strategies and limitations of representing Roma women’s rights within several Roma non-governmental organizations from Cluj, and . They are presented in Chapter 4.6.
As the access to reproductive health depends also on how politics and policies treat this issue, in order to investigate documents reflecting the reproductive health policy and Roma policy from I also used the method of discourse analysis. The aim was to identify how opened they were towards Roma women’s health in particular and Roma women’s condition in general. My participation on the Roma Health Conference organized in December 2005 by the Presidency of the Decade of Roma Inclusion in made possible to get further ideas about the internal debates on gender-related issues and about the state of affairs in the development of current Roma policies. The out-coming results of this part of the research are presented in Chapters 4.4. and 4.5.
4. RESEARCH RESULTS.
PARALLEL WORLDS AND MECHANISMS OF MULTIPLE EXCLUSIONS
4.1. The socio-economic conditions of Roma communities
During my fieldwork I spent more time within the non-traditional băieşi Roma community from Digului district than within the Romanes-speaking corturari from the nearby hill called Bemilor. However, I made interviews and was filming there, too but during my stay I could approach basically only two families whom invited me in their houses. Nevertheless, in this paper I am also referring to them, because in the local context it is important to understand how the two communities are referring to each other while identifying whom and how they are.
The Roma community from Dealul Bemilor is a traditional group whose members descended themselves from traveler ancestors and spoke Romanes. They settled down here at the end of the 1960s and are called by local Romanians and other Roma groups as “corturari”. The 40 persons, out of whom 10 are children below the age of 14, are living in 20 households and their houses without utilities (10 houses are having electricity) are situated on the hill near the rubbish heap at the periphery of the city. Half of them do "own" the houses where they live (but they do not have house contracts with the city hall!), while others live together with their relatives. Nobody is employed, none of the children are enrolled into school, only 5% of the adults graduated primary school, and only 7 families are receiving social allowance for which they do community work. Some of them are occasionally working abroad, others are collecting plants during summer, and many do collect scrap-iron. 25% of people above the age of 14 do not possess identity card, and 10% of the total inhabitants do not have birth certificate. Up to other causes, the lack of identity cards is due to the fact that even if their houses were built by them or were inherited from their parents they are not having house contracts with the local administration and until when they are not paying taxes on these houses, identity cards are not going to be issued for those living there, who – moreover – as people without identity cards will not be eligible for receiving social allowance. The houses are connected to the city's electric line, but the community does not have its own source of clean water, people have to go down on the hill and even further for bringing water for their daily supplies.
Due to the fact that they wear traditional Roma costumes and speak Romanes everywhere are easily identified as “Gypsies” and are exposed to discrimination and negative prejudices.
Some of the “corturar” families which became wealthy due to their occasional migration for work to or were moving down from the hill into the city, buying houses on the streets nearby, but not within the Digului district known in the city as the Gypsy neighborhood (“ţigănime”). Those who move out try to disrupt any relations with "those up on the hill", however the latter are visiting by time to time their relatives living "downstairs". Living on the hill becomes part of a past, which is worth to forget.
Formally this community is ruled by a buljubasa, but today he happens to be a man who does not practice the traditional duties of such a leader, so the community is practically not represented by anyone and does not have access to the resources that are supposed to serve the Roma communities’ needs. It is a well-known fact throughout the whole city that this community did not benefit from any of the projects that were supposed to improve Roma’s life condition.
The urban Roma community investigated by me in the city of more deeply, whose ancestors were brick-makers (cărămidari), was settled down on the margins of the city near the river. This location became a ghetto-type space (called cartierulDigului after a dike, dig, was made on the river) close to the road that goes up to the hill where the “corturari” are living. Their presence here is dated back to the 19th century. The travelers are calling them “băieşi”, which is a denigrating term that refers to their inability of speaking Romanes and keeping alive Romani cultural traditions. Before the 1960s usually whole families were gone out on their carriages for brick-making to different villages in the larger surroundings from spring to early fall. As people remember, they were never ever speaking Romanes and slightly became "like Romanians": during the 1970s and '80s they were living in the close neighborhood of and were factory colleagues with the latter. By than the whole Digului district was not so over-populated, basically was composed of two major streets, Digului and Muzicanţilor (populated not only by Roma, but also by Romanians, whom moved out after a while). Because in time the new generations had no place where to leave (only some families got apartments during socialist times in block of flats), they remained in the district, building up houses and kinds-of-shelters (şoproane) of plank and/or of plastered mud in-between the already existing buildings or on the two margins of the river. I could also observe how six families (at least of 5-6 members each) living in a former city stable separated the space by building up fences of plank, leaving free a corridor which now started to be populated by newcomers. This group of people (not necessarily relatives) acted like having a separate identity from the other Roma groups. They were those whom could not find a place to live in the Digului district or other-where in the city and – for different reasons – could not either stay in their parent's houses.
Today, in the total of 125 houses composed of 1-2 premises there are living 800 persons, grouped in 180 families, figures that give a sense about the high density of people living within this cramped space. 50% of the total population is composed of children below the age of 14, and 85% of the school-aged children are enrolled into schools. 135 families are living on social allowance performing community work on the behalf of the city (they are allowed very-very rarely to work in their own district). 15% do not possess identity card, and 2% do not have birth certificate. 10 men are employed as sweeper and 2 got jobs at one private brick-factory. 60% of the population does receive social allowance, 20% declare that they are collecting scrap-iron, almost 5% are collecting plants and 7% do receive pension. The majority of the latter are having sick-pension, because, even those who were working 30-35 years were not at the age of retirement when the socialist industries collapsed starting with the 1990s. During the socialist regime their majority (both men and women) was employed in one of the main factories of the city, out of which, after 1990, but mainly during the 2000s all collapsed partially or totally leaving them unemployed for a long period of time (with very few changes for reemployment) and without state pensions. Many of people's current illnesses were due to the pollutions to which they were exhibited while working in the chemical industry (Întreprinderea "Chimica"), or metal works (Uzina"Mecanica") or the leather and fur-coat factory (Vidra). Due to the pesticides used in the nearby plant factory (Întreprinderea "Fares"), which is still functioning, the water from the few existing fountains became also polluted.
The whole community has only one source of clean water – put into function somehow illegally –, 80% of the houses do not have toilets of any kind, and the slop water is thrown out in the mound from the middle of the “street” or into the river together with the garbage (being a permanent source of infections and a cause of several illnesses). 90% of the houses are having electricity, and the big majority of the families (even the poorest ones) do invest in providing a television, while some also do have CD-, video, and DVD-players. Besides their practical utility, these objects are also part of people's symbolic status and prestige within the community. Obviously those who are working abroad are doing better in these terms.
Relationships within this community are structured by several factors, among them by economic differences. Poor people (defining themselves as desperate ones, “necăjiţii”) are taking loans from the wealthier families (named “cămătarii”) and have to pay back the double of the credited amount. Those who are doing better – the families of the very few employed, of the retired people with pension and of workers abroad – are proud of being Gypsies, of having a relatively acceptable life despite the fact of being Gypsies and of proving for everyone that a Gypsy is a good worker and a honorable man. They try to isolate themselves from the rest of community and do sustain at their turn the belief in the system of meritocracy within which, as they say, those who are lazy and do not want to work deserve to live in misery, “like a Gypsy”. Moreover, they recognize the fact that one of the main obstacles of their inclusion into the Romanian society is rooted in the prejudices that treat them as members of a stigmatized community, and not as individuals who are different than the “stereotypical Roma”. They are critical towards Romanians for this reason, among whom, – as they say – one may also find criminals and thefts and people living in misery. One man was telling me that he is Gypsy for twice: once because he is of Gypsy origin and second because he was born in . In the second part of his statement he was using the category of Gypsy as a general stigma in order to denigrate what’s happening in today.
One may observe that the meaning of Gypsyness is shifting from a proudly assumed identity to a stigma, so it functions as a category of classification even within one Roma community and also in the relationship between two different Roma groups. These multiple meanings of Gypsyness probable result from the parallel existence of the desire of self-respect and of the internalized stigmatization, from the ambivalence of identifying with a community and taking a distance from it at the same time, and from the latent will to find always an Other relative to whom one may feel "properly". This explains why someone self-identifying as a Gypsy, at the same time blames Gypsies for being dangerous, or dirty, or lazy, and so on and so forth. While being there, we were warned from different directions about the “dangerousness” of the Other: this was stressed by “corturari” about “băieşi”, and vice-versa, and within the “băieşi” community by “necăjiţi” about “cămătari”, and vice-versa.
People from this community do report acts of discrimination experienced whenever they apply for jobs and are declaring their address from , and/or discriminatory acts encountered by their school children. It happens very often that Roma children are let failing an elementary grade for three times, or are negatively "evaluated" by a psychologist after the fourth grade in order to be sent to a special school, which, in a hidden way, reproduces segregation, but actually is even worth because it functions as a school for mentally disabled, where normal children accumulate more and more disadvantages. Or it happens that Roma children with high performances are undervalued in the grading process in order to be excluded from the group of the leading pupils of their class. These phenomena, together with the dropout of girls and boys at a younger age from school definitely maintain the disadvantaged position of Roma people and increase the already existing social inequalities between them and the majority population. Dropouts are having different reasons: there is a need for the help of the children for taking care of the youngsters or helping in housework or going for wooden in the forest or collecting medical plants on the surrounding plains or collecting scrap iron or doing other types of works on a daily basis (among them begging) for a living. Up to this for girls the early marriage and the early birth are among the most frequent causes for dropout.
Nonetheless, this community has an informal representative and in the recent past did benefit from some supportive projects assuring different community services. Their representative was a candidate at the last local elections, but unfortunately did not receive enough votes. Moreover – even if he is recognized both by the community and by the local administration as a Roma expert, and even if according to the governmental strategy for the improvement of Roma’s situation a Roma expert should be hired by the local government – he is only used by the later as an informant about the community and as a mediator in several cases, but is not hired on a paid position and is not involved into decision-making. His wife is hired as a school mediator and the two of them together are committed to make a change in the situation of their community, and would like to get more support in terms of information and empowerment from Roma organizations distributing resources. They are convinced that Roma identity should be assumed proudly, that is why he is teaching the youngsters Romanes language, culture and history, collects money from selling scrape-iron for making them traditional costumes and takes Roma kids to several festivals where they are appreciated due to their dancing and singing abilities. Both of them consider that integration of Roma into the Romanian society should start with their inclusion, and that is why they cannot agree with any phenomenon of segregation wherever it occurs (schooling, housing, etc.). However, they consider that special programs and even affirmative action should be directed towards improving Roma’s life conditions and empowering them by strengthening their self-esteem and cultural pride.
Learning about how identification processes are going on and how the category of Gypsyness is structuring social relations I realized again that one of the main obstacles of constructing a positive Roma identity is the ethnicization/racialization of negative social phenomenon (like poverty, criminality, lying, stealing, dirtiness, laziness and so on and so forth) and the internalization by Roma of the practices that are blaming the victim and are naturalizing/legitimizing acts of discrimination against them. In the case of Roma men and women the processes of social exclusion are not only functioning through class differentiation and social stratification, but also due to their culturally devalued ethnicity marked by a darker skin color on the base of which they are discriminated and excluded from vital resources (like education and employment) that are crucial for living in dignity and providing a self-respect needed for making future plans.
When I am referring to ethnicization I am referring to the mechanisms by which everything what is bad and deviant is labeled as being Gypsy-related, and accordingly is excluded from "normality". But I am also thinking about the fact that – due to the described structural discrimination – Roma people are much more exposed to the risk of impoverishment on the base of being defined as "Roma" (a category referring to, as mentioned above, all the negative features one may have including the "dark skin"), and – on the extreme – to the "choice" of assuring their survival by illegal means, which, at its turn, re-enforces their social exclusion and cultural devaluation.
4.2. Roma women's conceptions, feelings and practices related to reproduction
During my fieldwork I could observe that besides the social and economic conditions and the cultural devaluation of Romani people described above, Roma women's reproductive health (and choice to have a control on this) was also shaped by the (gendered) cultural conceptions dominant within their own communities. As it always happens, in this case too, the "structural factors, including the distribution of economic, political and institutional resources" do not only act in themselves, but are "both experienced directly by individuals and interpreted and made meaningful through cultural processes." These include views on gender relations, on women's role in family and in public life, on their role in sexual relations and their body, on the proper number of children, girls and boys, but also religious beliefs that might criminalize not only abortion, but the use of any contraceptive method and sexuality altogether.
Moreover, views and conceptions do not function alone while shaping women's choices regarding reproduction. Feelings do have their own role in decision-making, because – especially regarding issues that belong so much to intimacy and privacy – women cannot make abstraction of their emotional ties, which link them to their children, spouses and other kin whom they consider as significant others of their life. Furthermore, the economic conditions in which they live, or more properly said, the ways in which they think that they might cope with poverty do shape Roma women's decision-making regarding reproduction, its control, and implicitly, their reproductive health. One may conclude that eventually "social, emotional and economic issues are linked in women's desires, claims and practices related to reproduction", so Roma women do not conceptualize their thoughts regarding reproduction in terms of rights, but mostly in the terms of their material conditions, social relations and feelings.
As I was told, in the community from Digului district girls usually marry early and give birth at an early age, abandoning school at the age of 13-15: there is no girl in our district who graduated high school, and at the best they had ten grades during Ceausescu, but after revolution is good if they graduate eight grads, usually dropping out after the fourthor even never enroll.
They do not marry officially (nevertheless this is a recent development), giving many reasons for this, among them the following: I do not like to change my name; we do not have our own home, he stays with his parents and I am staying together with my children at my mother's house; if we do not marry, I may receive the social allowance and make the community work, while he might find all kinds of works on a daily basis without being blamed for also taking the social allowance; this is how is happening here; he can abandon me anyway if he wants.
However, women refer to their partner as my husband, or even more often as my man (bărbatul meu). As a rule, the family and the community consider them married (due to what they name legămînt) after having slept with their partner in one of the parent's house. Before "marriage" they meet and are together during the nights on the dark corners of the streets, so one may observe many young couples near each other kissing or even making love.
Girls feel free of choosing their husband, however there are more rules regarding a women's sexual behavior than a men's: she needs to be a virgin; it is a shame to leave your husband and to look for another and having children of two kinds;women who change their husbands are blamed by their community together with their whole family. It happens more often that a man leaves her woman for another one, and in this case the first "wife" moves back to her parent's house and the "new wife" moves in the men's or the men's parent's house. But it also happens that a woman tries to run away (usually due to the frequent acts of domestic violence), but her attempt is much more difficult to fulfill: she might be accepted back by her mother but risking to be labeled negatively by the community; or might try to leave from the district and even from the city, but each time being afraid of being followed, founded and returned back by the angry man who cannot accept to be abandoned.
Usually in a year after marriage – even if at an early age – girls give birth to their first child. And after that moment, children continue "to come" yearly: the year and the child, they say. Breastfeeding creates a huge dependency between the mother and her child. It goes on for many years, even up to three or four. Even if this means that the mother always have to carry her child after herself, this is part of her proudness: I am giving breast (ţîţă) wherever I am going, whenever it is needed, when my child is hungry, or nervous, or cannot fall asleep, on the street, on the bus or in the shop, it's no shame about this.
Being a mother, altogether, is a prestigious role in the community, and it is actually the way by which a girl starts to be recognized as an adult person. Up to this, if she gets her own home or at least her own bad that has not to be shared with her little brothers or sisters but with her husband she may experience the increase of her status. Having many children is considered a sign of the powerfulness of the Roma family and masculinity of a man is judged according to the number of the children he made in a lifetime. Women who have to take care of their family and household, but also of the relationship between family and public institutions (being in charge with taking children to school, to doctor, or to make the necessary arrangements at the mayor’s office) might have other opinions about the “proper” number of children. But in the cases of communities where tradition is strongly shaping people’s life and choices, their voice is hardly heard. They might have power to decide (and they do it secretly), but this power lacks authority and is considered an illegitimate one.
The responsibility of having children is assumed actually for the whole life: anything would happen to me I need to take care of my children; I just feel wonderful when I am together with all of mine six children in the bed; I need to give him first to eat and see him well; if my daughter wants to come back in my house, she is always welcomed, but I told her that it is wrong to leave her husband till the children are small; you have to stay near your man and suffer if you need to, even if he beats you when he is drunk, for the sake of your children… anyway, where would you think you could go together with them; children gave me the strength of going further on and survive; I take them to the doctor whenever they are sick, but I am not really going there for myself. Responsibility is expressed also in the terms of not desiring to have more children: I wanted to have these four kids, especially during Ceausescu when we had where to work and we had a stable income, but now I cannot afford to make more, I cannot dare to watch them being hungry.
Almost every woman whom I met from this community was having information about the modern contraceptive methods, but – due to many other reasons – they made several abortions during their life-time. The sources of information were the family doctors, the gynecologists, or women friends and neighbors.
There was no open and public talk about contraceptives, abortion or, generally, about reproduction and sexuality, nor even among women themselves: I'm ashamed to discuss about this; if I suddenly get fat or to the contrary become thinner the community starts to whisper that this was due to the pills; if they would find out that I am using condoms would blame me of being a prostitute (traseistă); they say that I give myself airs (mă dau mare) if they hear that I am doing this. The "public opinion" which was mostly whispered and not openly expressed, but still, as such, was having the function of a community control was having a huge importance in shaping the opinion about the “proper” contraceptive method: my friend got fat from using the pills; when I took those pills I lost weight; there was someone who died after the injection; my neighbor made cancer after she used the intrauterine device (sterilet). All these rumor-type information were having some kind of truth on their base: some got fat, others lost weight, a woman who made injections died (but for other reasons) and the cervical cancer was there, but caused by other medical factors.
The mixture of all of these knowledge – under the conditions of which woman do not dare to talk about these problems openly and doctors for many times do not listen to them or do not answer to their doubts – turns the whole issue of contraceptives into a mystical topic, a problem that one needs to face if she wishes to avoid having more children or abortions, but also one which – due to the related stress – she wants to forget altogether.
The connected frustration is even bigger because of the contradictory "messages" a woman receives from different authorities and the experiences she lives out regarding reproduction: the community would expect women to give birth to as many children as they can; it is said that you are more powerful if you have more children; if God wants you to remain pregnant, you have to give birth to the child; it is said that you, as a woman, have to respect your parents and your man, so, if for example he wants to have many children, you have to make them; how can I make more children in this booth?; it is unbearable for a mother to watch their children freezing or hungry; once you have children you have to labor and to worry all the time, you seen I have to carry all my four children after me all the time; it is a sin to make abortion and use contraception so even now, in my forties I would give birth to a child if he would come.
Under the conditions of this limited and quite complicated access to contraceptive methods (having all kinds of uncontrollable side effects) abortion remained for very many Roma women “the best”, or at least the “most practical” solution for unwanted pregnancy. The majority of women whom I talked stressed that making an abortion is a practical decision: I could not have raise more children; if you don't want him, because you don't have the material conditions, it is better not to give birth, it is more acceptable to make an abortion, because it would be far worse to torture him afterwards. Almost everybody considered it a sin: you kill a soul, and this will affect you all along; God will not give you to eat after you die; you feel like a murderer. Nevertheless, abortion was requested as a last resort: it is like a war inside your body, it is difficult to decide, but finally you opt for it if there is no other way.
Otherwise, the "option" for this intervention harmonizes with the dominant strategy of going to doctors. As going to doctor (and especially for reasons related to reproductive organs) is an unpleasant event linked to several taboos regarding body and sexuality, and thinking and acting preventively is not really part of the dominant health culture generally in our society (and not only within Roma communities) abortion (as a concrete intervention in the case of an emergency) is more “favored” than the use of contraceptive methods (which impose, among others, a regular control and supervision, involve more costs, and, as I discussed above, are full with several tensions and unknown aspects): as far as now I did only one abortion, I can still make two or three, I'll just go to the doctor, now it is allowed and it is cheep at the state hospital, and make a request for it.
The act of making an abortion sometimes is considered to be the manifestation of women’s power, a moment that is controlled by her, which might be done secretly: I do not tell him about this, this is my problem, and I have to deal with it. Paradoxically, this kind of power is "achieved" by a woman after her man failed to take care, as he was supposed to do. It is a kind of ironically taking back the control from the hands of a man who proved to be unsuccessful, or who let her woman pregnant without her will. Under the conditions of a shortage micro-economy within which they live, or of a bad social relation that threatens even their bodily safety and does not offer emotional pleasures making an abortion is about escaping from further troubles. If this is the case, its side effects are less or not at all considered, are a luxury topic that is far behind the elementary survival. This again proves that – due to several factors – Roma women do not take care of their bodies and do not consider reproductive health a crucial issue of their life till they do not really get sick.
The case of women who together with their family join some sort of neo-protestant church (and this is a phenomenon that becomes more and more usual within the Roma communities and implies a very strict community control) is totally different in these terms. From their point of view not only abortion, but also the use of any contraceptive method is a sin and – due to cultural reasons – contraception for them is not an available tool for controlling reproduction.
What is happening with Romani women living under the conditions of severe poverty in terms of reproductive health looks to be a vicious circle from which one may not easily escape. On the base of their material conditions they do not want to have many children. But men are not really preoccupied with not letting their wives pregnant (they do not accept to use condoms) and women – if they rely on their partners – do need to make abortions in the case of any unwanted pregnancy. Not being married officially and hardly having their own home (sometimes on the one hand men and on the other hand women with their children stay separately in their parent's houses) women cannot rely on their "husband's" help in raising children. Nevertheless, women do know about contraceptives, but their information are not necessarily medically based and – due to the existing taboos – they hardly talk about this openly nor even among each other, not to speak about how they feel talking about this in the presence of strangers. Doctors are more than willing (we are going to talk about this in Chapter 4.3.) to administer to Roma women for free the contraceptives that are at their disposal (mostly injectables, whose secondary effects are only very vaguely known). Under these conditions women "choose" to use the contraceptives that are for free because they do not afford buying others (which might be more proper for their health) and they better take something/anything that is available for free (despite its negative consequences) than making more children under their given material conditions (that they do not even imagine to change).
Romani women take decisions regarding reproduction according to their views, feelings but also to the social expectations that they wish to fulfill as wives and mothers. This is why it might look odd to discuss in their context about reproductive health as a human rights issue. Nevertheless, one may make – as I do this paper (seee Chapter 5.3.) – recommendations by using the language of human rights. The reasons for this are multiple: this is discourse that is legitimate in the realm of policy-makers and, as such, should be used as an advocacy tool for making them aware about Roma women's needs and about the social, economic, cultural and political processes that turn them into one of the most underserved categories; this is a language, which emphasizes Roma women's rights as humans regardless of their gender, ethnicity and class, while being conscious about the fact that gender, ethnicity and class as systems of power and socially constructed identities do shape their destinies by excluding them, as individuals and groups from the de facto access to resources (example to reproductive health); eventually this a discourse that claims the right of Roma women to be entitled to decide (among others on reproduction) on the base of their material conditions and emotional ties regardless of the pro-natalist or fertility control policies that try to subordinate them to "higher instances", like those of family, community, nation or God.
The majority of the women whom I have met within the Romani communities expressed a powerful desire towards taking their destiny in their hands (or acting as agency), nevertheless were having very limited choices for doing this. On the base of what they considered to be a right decision under the given material conditions and within the social relations in the context of which they were living they felt (and were) morally entitled to decide, for example, on the number of children, on making abortion or using contraceptives. Their desire might have been to act as powerful individuals and they did make moral claims on the base of which they took their decisions regarding reproduction, but this decision-making was strongly limited by structural factors, social expectations and cultural conceptions witch they could not control. In this way their choice was not totally theirs among others due to the fact that they were excluded on the base of their gender, ethnicity and class from the resources that could ensure their reproductive health (an aspect which is going to be discussed in the terms of medical services in the following chapter). But also because it was always important for them to be accepted and respected individuals within their group and their autonomy was limited by very strict community expectations regarding womanness and motherhood.
4.3. Health care providers' attitudes towards Roma women
As part of my research I conducted individual and group interviews, but I was also having informal discussions with those local health care providers who had to deal with women’s reproductive health: family doctors, gynecologists, their medical assistants, but also staff of the County Health Directorate, including the community medical assistants.
It is to be mentioned that in the city of there was no Roma health mediator and no centre for family planning. In a way the role of the Roma health mediator was played by a community medical nurse, but she was a woman not belonging to the community (as a Roma health mediator was supposed to be) and did not have much authority nor in the eyes of the community, or in the eyes of the family doctors and gynecologists, and Roma were only the few among her large number of patients (2.000) whom she had under her supervision. She was directly subordinated to the County Health Directorate, had her own office belonging to the city hall, and was in good relations of cooperation with the department of social work. When I met the (female) director of this public service she got very excited about the fact that my research was linked to the issue of reproduction and use of contraception. She exposed very quickly her ideas – otherwise shared with the mentioned community nurse – about the need of making a “campaign of fertility control” among Roma women (campanie de injectare) using the injectable contraceptives, being convinced that the main causes of Roma poverty (and of the troubles that the city hall and she personally has to face day-by-day) were rooted in the Roma “over-population”. During the formal interviews done with them, none of them was mentioning this idea any more, so they proved that they knew it was not politically correct to use such a language. Moreover, this was not an "officially sustained" position, so I may not assume that such a campaign is going to be announced as such. Nevertheless, these hidden opinions might be very harmful and dangerous, as far as they are held by persons who are in a position from where they might manipulate Roma women and might not serve their reproductive health, but some other causes. The lack of real communication between health care providers and Roma women symbolically is well illustrated by the following story. When the Society for Sexual and Contraceptive Education planned to publish some advertising materials regarding contraceptives, whose information might have been understood also by Roma women, the latter were asked by the community nurse about the photo that they would like to see on the cover page of such a booklet. Roma women with whom I talked remembered that they were expressing their desire of having both a Roma and non-Roma woman, but eventually the local organizers said that women and accordingly they too opted for the picture of a blond hair middle class woman.
Out of the thirteen family doctors of the city of in 2004 four were part of the network through which contraceptives were distributed for free, but (due to the training organized by the above mentioned S.E.C.S.) in 2005 the coverage with family planning services reached more than 90% of the medical services available at primary health care. The Roma communities were allocated to those who did belong to this network. But due to the huge number of their patients, to the administrative work related to the distribution of free contraceptives and to the fact that they do all this work on a voluntary basis, they do not really have time to offer a serious consultation in family planning. As already mentioned, they mostly advised Roma women to take injectables. On the base of my discussion with them, but also with their patients, I may conclude that besides the material conditions under which these women are living, there are many cultural beliefs and attitudes, which prevent women from the use of contraceptives, such as: the fear of becoming fat (resulting in the rejections of pills); the fear of cancer (resulting in the rejection of intrauterine devices); the fear of the deregulation of menstruation (rejection of injectables); the sexual taboos within the community (and the resulting fear of family and community control); the shyness in the front of medical doctors as strangers; the lack of confidence towards the health care system as part of the un-friendly state authority; the disregard of health under the harsh conditions of poverty; the dominant religious beliefs; the passive role of women in sexual relations (as a result of which men are supposed “to take care”, but if they fail to do so, women are supposed to find a solution).