Establishing a connection between reproductive health services and the Roma community

Roma, commonly referred to as "gypsies" throughout Europe, often do not have information about family planning (FP) or access to services. They are particularly hard to reach by conventional FP information due to many factors including their low degree of integration within the rest of the population, discriminatory attitudes toward them from the majority population (including medical staff), and their dependence on traditional values and concepts. These characteristics, coupled with deep poverty, make the Roma one of the most vulnerable population groups for unwanted pregnancies and sexually transmitted infections.In order to reach the Roma, the Romanian Family Health Initiative (RFHI) developed targeted interventions to reach this population. One of the most effective techniques has been the involvement of representatives of the Roma community as community mediators. As an active interface between governmental and non-governmental structures and the community, community mediators not only transmit information and knowledge, but also soften the interactions between members of the community and service providers.

Interactive training activites for the Roma community help improve health care for this under-served population.

These general considerations were the starting point for a rewarding event on Roma community training and mobilization, organized in the Botosani district by the Regional Office of SECS (Society for Education on Contraception and Sexuality). SECS is one of many Romanian partner organizations collaborating on the RFHI, managed by JSI Research & Training Institute, Inc. With the permanent support and involvement of the Local Health Authority and Divano Romano, a local NGO, SECS organized a three-day training for Roma social and sanitary mediators to increase access to reproductive health and FP services for the urban and rural Roma population in Botosani district. At the end of the program, participants developed FP promotion activities for Roma communities in cooperation with the Local Health Authority FP teams.

The main topics presented during the training were the concept of healthy persons and communities, the importance of preventive medical services, basics of genital anatomy and physiology, methods of contraception and family planning, the consequences of unwanted pregnancies, and sexually transmitted diseases. Special attention was given to condoms and their crucial role in the prevention of both STI's and unwanted pregnancies. Using a wide range of interactive activities, the trainers also discussed the perception, attitudes and beliefs about sex and sexuality among the Roma population.

By the end of the training, several participants were able to formulate realistic projects and activities to be implemented in their communities. Though aware of the potential barriers involved in mediation and promotion activities, especially surrounding the sensitive issue of reproductive health, participants were optimistic about their capability to improve their personal, family and community life. At the end of the training, the Roma mediators gave a joint declaration stating, "We want to bridge the gaps between our community and the medical staff, to contribute to an increase in the health status of our community, to fight against the actual attitudes, misbelieve's and mentalities of the Roma population, and to improve the situation of the younger members of our ethnia."

The president of the Association Divano Romano, Mrs. Rubin Ferrari, who attended the training both as an organizer and a participant, requested that the experience be replicated and she asked to develop an institutional collaboration with the SECS Regional Office in Iasi. Her conclusions were presented to SECS and JSI and included several action steps that Divano Romano will take, including FP promotion workshops for association members and other local Roma organizations, youth FP and STI prevention education workshops, distribution of IEC materials, and a continuous relationship with local FP cabinets.

The Roma project is just one success of the Romanian Family Health Initiative (RFHI), a bilateral,USAID-funded,project implemented by JSI Research and Training Institute, Inc between 2001 and 2007. The RFHI was designed to increase the availability and utilization of high quality client-oriented services at the primary health care level, and to ensure sustainability of reproductive health services in Romania. In addition to the expansion of family services, the project also focused on implementing and strengthening cervical and breast cancer screening, HIV and AIDS and STI referral systems, and domestic violence at the primary health care level.