Understanding a Minority Group's (Roma) Experiences of Access and Quality in Maternity Services

Maternal health is a fundamental human right, ensuring that all women have access to non-discriminatory, equitable and high-quality maternal and reproductive healthcare. Minority groups and migrant populations face significant challenges in accessing maternity services. The Roma are Europe's largest and most marginalised ethnic group. Ireland has a sizable population of Roma migrants, and there is limited information on their experiences of maternal care in Ireland. Their participation in research and user panels is challenging as many lack proficiency in English and tend to have low levels of health literacy. By engaging Roma women in a unique co-design education and research process, this study aims to identify barriers to accessing care faced by this minority community and understand their experiences of maternity services to enhance equity, accessibility and cultural responsiveness in maternal healthcare.

This study employed a co-design approach in partnership with Cairde, a community health organisation, to engage Roma women in exploring their experiences while engaging with maternity services. Eight Roma women participated in four online workshops and completed a questionnaire to share their experiences of pregnancy, childbirth and postnatal care. Workshops incorporated information components, focus groups and Romani translation and interpretation to ensure accessibility. Ethical considerations were maintained, and inductive thematic analysis was conducted using NVivo 20.

The study involved eight Roma women aged 21-39, many of whom had their first pregnancy between the ages of 14 and 19 and experienced homelessness after the birth of their first child in Ireland. Proficiency in English was limited; five women reported needing a translator while engaging with maternity services. Key patterns identified in Roma women's experiences of maternity care included language barriers, inadequate translation and interpretation support, and systemic discrimination, which leads to delays in antenatal care and heightened emotional distress. Additionally, systemic discrimination manifested through negative interactions with hospital security and administrative staff fostered mistrust and disengagement from healthcare services. However, despite these barriers, many Roma women expressed a preference for Irish maternity care over Romanian services, citing respectful treatment from healthcare professionals, shorter hospital stays, and the provision of essential postnatal supplies.

This study highlights the significant barriers Roma women face in accessing maternity care in Ireland, including language barriers, financial constraints, cultural factors and discrimination. Limited English language proficiency, lack of translators and interpreters, and unfamiliarity with antenatal services often led to delayed or inadequate care, increasing health risks. Despite appreciating respectful treatment from healthcare providers, systemic challenges such as discriminatory practices and low health literacy persist. To address these disparities, it is essential to implement culturally tailored interventions, including the active recruitment and inclusion of Roma women across all levels of the healthcare system. This not only enhances the accessibility and quality of translation and support services but also fosters greater inclusivity, representation and culturally competent care. Future research should focus on expanding representation and designing and evaluating community-based health initiatives.

This study collaboration between academic researchers, staff from the Health Service Executive (HSE), and Cairde, a community health development organisation, aimed to involve all stakeholders, including members of the Roma Community, in the co-design approach that allowed the capture of the experiences and perspectives of Roma women on engaging with maternity services while giving birth in Ireland. Staff from Cairde, including members of the Roma Community, co-designed a series of workshops and a questionnaire and provided support on the set-up and delivery of the workshops and questionnaire. This collaboration resulted in the successful delivery of focus groups, informational sessions and a questionnaire, with full participation from the eight participants. Two of the eight Roma women who participated in the workshops were also involved in the co-design process. Staff from Cairde, including members of the Roma Community, also contributed to the interpretation of findings and drafting of the papers. Partnering with Cairde afforded privileged access to the Roma Community, allowing the research team to engage with this seldom-heard group. The many barriers to this engagement were addressed through partnering with an organisation with the trust of the Roma community and with the capacity to participate.