‘Roma Segregated’ in Bulgarian Maternity Wards

As claims Roma women are routinely placed in separate ‘gipsy sections’ in maternity wards surface, it seems discrimination against Bulgarian Roma literally starts at birth.

“When you enter the maternity ward, to the left is the Bulgarian section and straight on is ours, the gipsy one,” says 29-year-old Galina*, a mother of five from the notorious Roma neighbourhood of Nadejda in Sliven, a city in southeast Bulgaria.

Like most women from Nadejda, Galina gave birth to all of her children in Sliven’s Ivan Seliminski regional public hospital. She delivered her youngest there in April this year.

“We have four, five rooms there. I don’t know how many there are for the Bulgarians – they would not let us in there. Who would ever let us in?” she says.

Galina’s real name and those of all the Roma mothers featured in this article have been changed because of the women’s concern that revealing their true identities may affect their access to public health services in the future.

Delivery rooms and rooms for new-born babies are mixed at the Ivan Seliminski hospital. However, some of the maternity ward’s 10 rooms appear to be regularly used solely by Roma patients. These are referred to locally as ‘Roma rooms’.

Three former and current employees and eight former patients told BIRN that Roma women are routinely segregated from Bulgarians in the ‘Roma rooms’ at Sliven hospital. Staff gave a variety of reasons for segregating Roma women, including hygiene, health concerns and claims that women of Roma origin prefer to share rooms with other Roma.

Furthermore, data collected by Bulgaria’s largest rights group the Bulgarian Helsinki Committee, BHC, and given exclusively to BIRN, suggests that this kind of segregation on maternity wards is commonplace across the country.

BIRN’s reporter visited the Ivan Seliminski maternity ward in July and found that rooms were either solely occupied by Roma women or predominantly by Bulgarians. Only one room was shared by a Bulgarian and a Roma woman.

There was no discernible difference between the rooms – all have three beds and a shared bathroom and toilet – or any obvious reason why the Roma women should be separated.

Aishe and Valentina are both Roma mothers who have given birth at the Sliven hospital. They said that Roma women are only placed with Bulgarians if the ‘Roma rooms’ on the ward are full.

As for putting a Bulgarian into a ‘Roma room’, that would be “impossible”, says Valentina, who delivered her child at the Sliven hospital four years ago.

In addition to the maternity ward rooms, there is a separate isolation ward at the Sliven hospital. This ward is comprised of three rooms, each with three beds, where women with registered or suspected infectious diseases, or poor hygiene, are kept under quarantine.

At the time of BIRN’s visit, there were five to six women – all of Roma origin – on this ward, which is referred to at the hospital as ‘the isolator’.

Many Roma mothers who have delivered their children at the Sliven hospital believe only Roma women are put in ‘the isolator’. Aishe and Valentina have both been placed in ‘the isolator’.

Aishe, who gave birth to her four-month-old daughter at the hospital, firmly believes: “It has never happened for a Bulgarian to be in the isolator.”

None of the eight Roma women BIRN interviewed complained about conditions on the ward or of personally experiencing ill treatment.

Aishe, however, said she had witnessed other Roma women being abused by medical personnel in the hospital, particularly younger – often teenage – mothers.

“Two years ago, when I was giving birth to my youngest son, they told one woman, ‘you Roma have many births, but you cannot keep up with the pain… They tell the young ones – you are children, and give birth to children. Shut up, don’t shout,” she says.

The CEO of the hospital, Dr Vasislav Petrov, denied there was any “official practice” of tougher treatment for teenage mothers, but he did not dismiss the possibility that some nurses or obstetricians might be harsher with them for giving birth at such early age.

“We explain to all underage mothers that they should wait more. Such births [to young girls] lead to problems, malformations. It is important that they learn this,” he said.

Dr Petrov added that he has never received complaints from teenage mothers or their relatives over alleged ill treatment by the medical personnel in the maternity ward.

Anti-Roma sentiment

The Roma population is hugely disadvantaged in Bulgaria – as is the case in many other Balkan states – and faces disproportionately higher levels of poverty, lower levels of educational achievement, and much higher than average unemployment.

Outcomes for those resident in exclusively Roma neighbourhoods such as Nadejda – a de facto ghetto – are usually markedly worse as living conditions are frequently deplorable. Large sections of Nadejda, for example, lack running water, modern sewers and basic healthcare. Nadejda is the Bulgarian word for ‘hope’.

The neighbourhood, which is separated from other parts of the city, is officially home to 10,342 people, according to the latest census conducted in 2011. However, locals estimate its real population is more than double the official figure.

On top of severe social and economic disadvantages, Roma also face widespread discrimination, with many Bulgarians unwilling to share public spaces such as swimming pools, cafes and schools with people from Roma origin. In its 2016 Human Rights report for Bulgaria, the US State Department described “the marginalization of and societal intolerance towards the Romani minority” as “the country’s most pressing human rights problem”.

A 2016 study by the Open Society Institute in Bulgaria found that Roma were most frequently the target of hate speech, accounting for 92 per cent of all reported cases. A 2015 Gallup survey qualified negative attitudes held by Bulgarians towards Roma as “a matter of principle”. Over 70 per cent of survey participants said they would not vote for a Roma politician or take a job in an organisation led by a person of Roma origin. Only four per cent of ethnic Bulgarians said they would marry a Roma person.

Speaking on condition of anonymity, current and ex-staff at the Sliven hospital said that, unofficially, ‘Roma rooms’ exist at the Sliven hospital maternity ward.

“Among each other, we know there are Roma rooms but this is not specified anywhere,” says a former employee, adding there were numerous reasons for segregation including that Roma women “prefer to stay with each other”.

Two Roma women BIRN interviewed in their homes in Nadejda said they had been asked by hospital staff whether they preferred to share a room with Bulgarians or Roma.

“They asked me: ‘Where do you prefer to be? With the Bulgarians or with the gypsies?’ And, of course, I said I prefer the gypsies,” says Magdalena, a mother of one.

As for using ‘the isolator’ solely for Roma women, the former employee said only mothers who were “dirty and with bad hygiene” were placed in the isolator because “we cannot put them in a normal room”.

Another employee explained that more Roma women are put in ‘the isolator’ because they often do not have health insurance and have not, therefore, undergone essential medical examinations during pregnancy that would identify whether they were carriers of infectious diseases.

The employee said Roma women are only placed in ‘the isolator’ as a preventive measure to protect other mothers.

However, when BIRN reporters visited, there was no discernible difference between the maternity ward rooms – ‘Roma’ or otherwise – and ‘the isolator’ rooms. A point that was acknowledged by one of the former staff members.

Segregating patients solely along ethnic lines is against equality and healthcare legislation in Bulgaria. When asked to comment on allegations this happens in Sliven, the hospital management denied Roma women were segregated.

“The Ivan Seliminski hospital – Sliven does not divide the women in childbirth between Roma and Bulgarians. We do not have such practices… I do not think there is any reason for anyone to complain of discrimination in our medical facility,” hospital CEO Dr Petrov said.

‘Institutionalised segregation’

While the testimonies at Sliven suggest habitual segregation, NGOs believe that segregating Roma mothers in public hospitals is an institutionalised practice across Bulgaria.

According to interviews with Roma women conducted in 2016 and 2017 by the BHC, 84 per cent of 63 participants said they had been separated from Bulgarians in maternity wards.

The group interviewed Roma women who had given birth in the last three years in five locations: Septemvri, Vetren and Rakitovo (three small towns in the south Bulgarian region of Pazardzhik) and the cities of Sliven and Varna.

To further measure the scale of suspected institutionalised segregation of Roma in Bulgarian maternity wards, members of BHC’s legal team posed as fathers-to-be and telephoned 79 of the country’s 81 public hospitals with maternity wards to check if their fictitious partners might have to share a room with a Roma woman.

BHC researcher called each hospital twice, first speaking to a random obstetrician or doctor and second putting the same questions and answers to the head of the ward for verification. Two other members of the BHC team were documenting the findings. In more than 96 per cent of maternity wards across the country, BHC researcher recorded segregation practices.

The results of the research, obtained by BIRN, suggest that segregation is firmly institutionalised in 78 hospitals – amounting to 98.7 per cent of all tested hospitals and 96.3 per cent of all public hospitals with a maternity ward in the country.

BHC researchers documented responses to the question of whether their ‘partner’ would share a room with a Roma women as including: “People of colour are separated. Completely separated” and “God, no, please, don’t talk nonsense. How could she be in a room with Roma women?”

One obstetrician is quoted by BHC as saying: “Never in a lifetime would we put them [together with Bulgarians]. We have the opportunity to select patients.”

The transcript of another call documents one hospital doctor recommending a BHC ‘father-to-be’ ensures his wife stayed on the 12th floor ward that is exclusively for Bulgarian mothers, rather than one on the 7th floor that is mixed.

“Our study goes beyond documenting individual instances of abuse, providing a comprehensive picture of all public hospitals, exposing segregation of Roma women giving birth in this country as universal and deeply entrenched,” Margarita Ilieva, human rights lawyer and director of BHC’s legal team during the research period, told BIRN. Ilieva designed and directed the research.

“Segregation is normalised to the extent where medical personnel are willing to openly declare that it is part and parcel of maternity ward care conditions,” she added.

The group said it was forced to use such research methods in order to secure evidence for the purposes of launching legal action against hospitals because no Roma women who said they had been subject to segregation in maternity wards would entertain the idea of lodging complaints or testifying as witnesses in any court action.

The women are wholly dependent on their local hospitals for paediatric and maternity care in the event of future pregnancies.

On July 19, the BHC launched legal action against the Multi-Profile Hospital for Active Treatment in Pazardjik together with the European Roma Rights Centre, ERRC.

The two organizations have initiated a public interest civil lawsuit claiming a declaration by the Pazardjik Regional Court that racial segregation is at hand in the hospital, as well as an injunction on respondent to refrain from further engaging in the impugned conduct.

BIRN reporter asked the Pazardjk Regional Court for further details on the court case, but according to the court, such cannot be obtained without an approved freedom of information request – a procedure which usually takes around a month.

In a written response, Bulgaria’s Healthcare Ministry quoted article 85 of the Bulgarian Health Act, which bans discrimination against patients based on their “age, gender, spoken language, national, racial or political affiliation, education, beliefs, culture, sexual orientation, personal, public or material position, disability or type of disease”.

“Dividing the rooms of maternity wards in hospitals into rooms for people of Roma ethnic origin and rooms for all other people would be a breach of the legal principle for providing medical aid,” the statement continued.

Dr Stoyan Borissov, Secretary General of the Union of Bulgarian Doctors and a gynaecologist with 33 years of experience, called the claims “totally absurd” and dismissed the BHC research as an “attempt to make a fuss about nothing”.

“In the University Obstetrics and Gynaecology Hospital Maichin Dom, where I am head of team, 50 to 60 per cent of the pregnant are from minorities. There is no different attitude towards them,” he said.

“If anyone has dared to do this, then they have breached the law. The Doctors’ Union does not stand behind such practices. Such doctors should be punished according to the ways foreseen by law.”

However, Borissov acknowledged that some Bulgarian patients would dislike being placed in the same room as Roma women.

He suggested that because hospitals depend on the volume of patients in order to secure their funding, staff feel under pressure to get as many patients as possible, perhaps even if it means making promises they cannot or have no intention of keeping.

“There is a huge fight for patients currently. On the phone I can promise you anything, just to have your daughter come to give birth [in my hospital]. When she comes I would say ‘sorry, there is not enough space’,” he said, questioning the method the rights group used to test whether hospitals have institutionalised the practice of segregating Roma.

At the same time, Borissov did not dismiss the possibility of putting women of the same ethnicity or nationality together where the mothers might benefit because, for example, they speak the same language.

“Sometimes, people from the minorities do not even understand Bulgarian… If there are two Bulgarians, two Roma and two Russians giving birth at the same time, what is the problem to sort them this way?” he asked.

However, Ilieva from the BHC is certain that any separation of Roma mothers-to-be in hospitals would have negative effects both on them and their children.

“Segregation is acute, deep stigma. Such intense stigmatisation is pathogenic, inevitably breeding an anguished mentality of inferiority and isolation,” she says.

Ilieva believes Roma women’s own willingness to be placed in rooms with other mothers from their ethnic group is the logical result of fear of hostility and harassment.

“In Sliven’s poorer Roma district, in particular… segregation is fierce and pervasive and, accordingly, internalised as the norm… For a very poor person, a target of extreme racialisation, already radically challenged by surviving economically in a hostile environment, the slur of segregation might well be the safer option,” Ilieva explains.

For Stela Kostova, director of the Roma Academy for Culture and Education, a Sliven-based NGO, BHC’s findings are nothing new.

She told BIRN that Roma organisations have tried to raise the issue of maternity ward segregation for over a decade, but their voice has remained unheard.

“Not only in Sliven but in the whole country, the problem is that our women are being separated from the Bulgarians. As if they are not mothers, but second-class women,” she says.

“After that the kids are segregated in the kindergartens, in schools, then in the workplace and it goes on for life.”

According to Kostova this practice “equals cynicism” and has remained unchanged since Bulgaria’s Communist regime, which ruled the country until 1989.

A Roma woman herself, Kostova is convinced that things will remain the same “if concrete measures are not taken and if nobody is punished”.

Her view seems to be borne out by the Roma women in Nadejda BIRN spoke to. They see no problem with the current situation.

“We want to be with other Roma women because we get along with each other. We talk, we share things. Bulgarians would not want to communicate with us anyway,” says Valentina.

*The names of Roma women interviewed for this article have been changed at their request.

Mariya Cheresheva, BIRN, Sofia