ROMA WOMEN USUALLY DON'T DECIDE ABOUT THEIR REPRODUCTIVE HEALTH: THEY GIVE BIRTH AND DIE YOUNG

A LARGE NUMBER OF PREGNANCIES THREATS THE RIGHT TO FREEDOM OF CHOICE AND THE LIVES OF WOMEN FROM THE COMMUNITY

Đurđa RADULOVIĆ

If I get pregnant again, I could die. That's what the doctors told my husband and me, Milana (32) says for the Center for Investigative Journalism of Montenegro (CIN-CG). She got pregnant 11 times, gave birth to five healthy children, and had six miscarriages. She is in poor health and seems malnourished.

She had her first son at 16, and today she is breastfeeding her youngest child, born in 2021. She does not want any more children.

"If I could choose, I certainly wouldn't have given birth this many times," she says.

But she got married and had no choice.

"When you get married, you have to give birth."

Milana started using the contraceptive pill after her last delivery at the insistence of doctors, who consider her health condition serious. However, she does not take the pill regularly, which puts her at risk of becoming pregnant again. Her husband, she says, does not use contraception.

"In most developing countries, the poorest girls and women have the least power to decide whether or when to become pregnant," the United Nations (UN) reports stated.

The situation in Roma settlements in Montenegro proves that claim.

Three percent of women aged 15-49 who are currently married or in a union are satisfied with family planning with less frequent pregnancies, according to the study "Roma settlements in Montenegro" published by UNICEF in 2018. This percentage is also low among the general population but twice as high - six percent.

According to a statement by UN Women, reproductive rights allow women to have control over their bodies and decide when, with whom, and how many children they will have. Reproductive rights are human rights, and gender equality also depends on the extent to which women can exercise these rights, this organization states.

In 1997, the UN warned that denying reproductive rights kills millions of women worldwide, mostly in developing countries.

"Women of the Roma population usually do not come alone for examinations, but with one or more family members, which deprives them of their basic right to privacy. Young women generally don't speak, but their mother-in-law or mother speaks for them,'' Nataša Tomašević, a gynecologist-obstetrician from Podgorica Health Center, says in an interview for CIN-CG.

Tomašević worked for years at the Health Center in Konik, where the biggest number of members of the Roma population in Podgorica are treated.

"Women sometimes say they don't want a pregnancy, an abortion is scheduled, and then they come a few months later to give birth because their partner or family didn't allow them to have an abortion," she explains.

According to the UN Office for Human Rights, the intervention of a third party as an intermediary between a patient and a doctor when it comes to health services is a violation of reproductive rights.

According to Tomašević, the situation is particularly complicated for women who have had multiple cesarean sections.

"Caesarean section is a risky procedure for every future pregnancy, and after a cesarean section, neither natural childbirth nor a large number of subsequent pregnancies is advised. It is advisable to wait longer until the next pregnancy", she states.

However, Roma women often get pregnant quickly after cesarean section, which, as Tomašević warns, puts them at risk of uterine rupture, sepsis, and many other complications.

Uncontrolled pregnancies affect health

According to a 2018 UNICEF survey in Montenegro, 25.4 percent of Roma and Egyptian girls aged 15 to 19 gave birth. In the general population, that percentage is one percent. According to this study, the fertility rate in Roma settlements is four and a half, meaning that most women have four or five children. For comparison, the fertility rate in the general population in 2018 is less than two, and most women have one or two children.

However, it is difficult to get accurate data on the reproductive health of Roma women, Sadija Holaj, a gynecologist-obstetrician from the Health Center in Ulcinj, explains in an interview for CIN-CG.

"Roma patients often do not know their age or last menstrual period. Some say their current pregnancy is their sixth in a row, and there is no record of previous pregnancies anywhere,'' Holaj explains.

Roma women generally do not know their Rh factor, even though they have given birth several times, Holaj says.

The Rh factor, important information about the blood group, can pose a risk to life if the mother's and the child's factor do not match. Then therapy is necessary.

Their pregnancies are not regularly controlled, so sometimes they just come to give birth. That is why there is a greater risk of emergency surgeries, and the maternity hospital in Ulcinj does not have an operating room, Holaj explains.

CIN-CG has already investigated the consequences of underage pregnancies on the health of Roma women.

UNICEF states that early childbearing is the most significant cause of death for girls aged 15 to 19.

"Due to psychophysical immaturity, uncontrolled pregnancy, and poor nutrition, Roma women are at high risk of premature births. Newborns are also at risk,'' Holaj says.

Dr. Tomašević believes specific problems, such as hernias, occur in Roma women due to frequent pregnancies.

Statistics show that women from this population may expect poor health conditions, a high percentage of diseases, and a significantly shorter life expectancy than the general population during their lifetime. The estimated life expectancy of the Roma population is 55 years, 21 years less than the average life expectancy in Montenegro, and 40 percent of members of the Roma-Egyptian population rate their health condition as poor, according to the 2021 analysis of the Institute for Public Health of Montenegro.

The high costs of birth-control

According to the results of a 2018 UNICEF study in Roma settlements, only eight percent of women currently married or in a union use a modern method of contraception, 87 percent of them do not use any contraception, and six percent use the form of coitus interrupts or occasional abstinence.

In the general population in Montenegro, the percentage of women who do not use contraception (or their partner does not use it) is also high - 79 percent, according to UNICEF research.

Podgorica Health Center said there is only one type of contraception at the expense of the Health Insurance Fund, while the patient has to finance all the others.

"The type of contraception is recommended depending on the number of children, age, and general condition of the patient," it is stated.

"As far as free contraception is concerned, we have one type of pill, but given the numerous contraindications for including this method, female patients mostly remain unprotected and very often have both legal and illegal abortions," Berane Health Center stated.

"Women don't prefer spirals and pills and are afraid of using it. They consider it unnatural and dangerous,'' Tomašević points out.

Some women start using the birth-control, and then at the persuasion of their family, they stop, she explains.

However, Roma women who go abroad for a while, for example, to Germany, use contraceptives much more often than members of the community in Montenegro, she says.

Married women or those in a union living in urban areas are more likely to use any method of contraception than those living in other areas, as stated in a UNICEF study.

Through the workshops of the Family Center, the Red Cross has worked for more than ten years to improve knowledge about family planning as part of workshops on health care, Snežana Radenović from the Red Cross of Montenegro stated for CIN-CG.

Contraceptives available on the market are often unaffordable for Roma women, so the Red Cross, with the support of various donors, used to procure contraceptives. There is progress in informing women about general health, maintenance of pregnancy, and childbirth, Radenović says.

"Now, almost all the women from this population give birth in the hospital and go for gynecological examinations. When it comes to family planning and pregnancy, which are the result of social pressure, we don't know enough about it, and it's a topic that needs to be investigated for the majority population as well," Radenović says.

Unplanned motherhood leaves serious consequences

Early motherhood among Roma girls in Europe impoverishes their lives, puts them at risk of poor physical and mental health, and precipitates school dropouts, according to the 2020 study "Empowering Roma Girls' Mattering through Reproductive Justice," which refers to several EU countries. Conditions of poverty and the social exclusionary processes they suffer have a significant explanatory weight in their sexual and reproductive decisions, the study states.

Milana regrets getting married and having kids early.

"If I could go back in time, I would finish my education and get married later," she says.

CIN-CG spoke with several young girls who recently married in the Roma settlement in Berane.

"I'm happy I got married here and ran away from a violent stepfather," says 20-year-old Sabina (real name known to the editorial office), who has two children.

She lives in poverty, as before marriage. Her husband occasionally earns a little by doing various kinds of jobs. They live from day to day.

"I don't have children, and I'm despondent about that," 18-year-old Almedina (also real name known to the editorial office), who has been married for two years, tells CIN-CG. She hopes to become a mother soon. She still needs to finish elementary school. She doesn't know what she would do except raise children.

Both girls say that their husbands are very jealous, and that's why they rarely leave the house, and that the outside world is "a dangerous place where you can encounter problems that other men would cause them," Almedina says.

These girls are under the strong influence of their husbands and the community, where the birth of numerous children is not called into question.

"Montenegrin society is patriarchal in general, and is expected in a marriage that a woman gives birth," Fana Delija from the Center for Roma Initiatives (CRI) says for CIN-CG. The problem of patriarchy is even more pronounced among the Roma and Egyptian populations, she explains.

"The fact that having many children in a community is considered the greatest wealth is worrying."

"It happens that girls are married very young and cannot stay pregnant, and they are most often returned to their biological family. Later, often, in the elderly years, they become mothers," Delija says.

"Gender inequality is maintained in a large number of cultures through the patriarchal ideal of motherhood, which isolates women, deprives them of their identity in other areas assign them all the work of raising children and set unattainable standards", is stated in the book "A Theory and Politic of Maternal Empowerment for the Twenty-first Century " by feminist Andrea O'Reilly.

In patriarchal societies, women who are mothers gain superiority and cultural prestige; she points out.

"Patriarchal concepts of women's roles within the family mean that women are often valued based on their ability to reproduce. Early marriage and pregnancy, or repeated pregnancies spaced too closely together—often as the result of efforts to produce male offspring because of the preference for sons—has a devastating impact on women's health with sometimes fatal consequences," it is stated in the UN Office for Human Rights.

Women are also often blamed for infertility, suffering ostracism, and being subjected to various human rights violations.

Milana hopes that she will not get pregnant again. For now, it's left to chance rather than severe family planning. "I cannot say no to my husband; he will be jealous. I will use the pills until they disappear", she concludes, apparently ready for all the difficulties that she could face if gets pregnant again.

'VIRGINITY TESTING': CONCERNING PRACTICE AND VIOLATION OF HUMAN RIGHTS

"Virginity testing," a violent and painful procedure banned worldwide, is still carried out in Montenegro, as confirmed by representatives of health institutions for CIN-CG.

Parents sometimes bring their daughters to a gynecologist to check whether the girl had sexual relations before marriage.

"Roma families who bring minor girls for a gynecological examination to determine whether they are 'ready for marriage' are referred to a social worker - both the girl and the parents," Jelena Knežević, a doctor from the Podgorica Health Center, told for CIN-CG.

"During the examination, we consider the rights of the patients and the confidentiality of the test results. We respect the decisions of patients", she says.

They did not answer additional questions regarding the practice of this procedure, which violates human rights.

The CIN-CG received a similar answer from the Health Center in Berane: "Girls and boys are indeed brought here to be checked for 'marriage readiness.' Not that often, but it happens. Providing such information is strictly confidential, even for a girl of only 13-14 years. Parents and guardians cannot receive such information from us".

From the answers above, it remains to be seen to whom the information after the examination is intended and why this harmful practice is carried out in the first place.

"These kinds of examinations are usually done in situations where rape is suspected," Dr. Tomašević said after CIN-CG asked why this examination is performed.

"The Ministry of Health does not know that virginity testing is being carried out in health centers in Montenegro. No legal regulation in the health care field prescribes the implementation of this examination, nor does it fall under the health care domain. If anyone has such knowledge, they are obliged to report it to the competent authorities for further action", the Ministry of Health stated for CIN-CG.

CIN-CG addressed the Institution of the Protector of Human Rights and Freedoms of Montenegro (Ombudsman) with a request to comment on this practice of violating human rights, but there was no official response.

"We are taken aback because we didn't know that such a worrying practice was carried out in Montenegro. This certainly requires further investigation", Duška Šljivančanin, adviser to the ombudsman, said in a telephone conversation.

The World Health Organization (WHO) and the UN, in an interagency statement "Eliminating Virginity Testing" from 2018, appealed to governments to prohibit all forms and methods of virginity testing and to medical personnel not to carry out this practice under any circumstances.

"Performing this harmful and medically unnecessary test violates several human rights and ethical standards, including the fundamental ethical principle: "first, do no harm." Furthermore, it is stated that "In the evaluation of victims of rape, the test is likely to cause additional pain, which leads to re-traumatization and re-victimization "and that "many women suffer from serious physical, psychological and social consequences due to this practice, as well as that "in extreme cases, women or girls may attempt suicide or be killed in the 'name of honor."

In addition, no scientific evidence that any "virginity test" can prove whether or not a woman or girl has had vaginal intercourse, explains WHO/UNICEF document. "The concept of virginity is not a medical or scientific term" but "a social, cultural and religious construct. The disproportionate social expectation that girls and women should remain "virgins" until marriage is rooted in stereotyped notions of female sexuality that have been harmful to women and girls globally," the document states.

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