The Patrin Web Journal - Gypsy Mothers and Hungarian Health Care
FrenchGermanItalianPortugueseSpanish   Gypsy Mothers and theHungarian Health Care Systemby Mária Neményi In this article, based on a study suggested and sponsoredby the Hungarian Office of Ethnic and National Minorities, the author arguesthat perceptions, misperceptions, and cultural differences between healthcare providers and traditional Roma affect the quality of health care providedby the Hungarian health care system.In the spring of 1998, we carried outan empirical research on the topic of the health of the Hungarian Gypsypopulation. Because of the restricted budget of the survey, and even morebecause of my personal interest and professional background, I chose asocial-psychological approach to the topic. We decided to observe the relationshipbetween young pregnant Gypsy women, young mothers with small children,and the representatives of the health care system, focusing on severalissues. The problem of this relationship seemed to be relevant for severalreasons:1. Prevention is the most important factor of effective healthcare. Caretaking of pregnant women, providing adequate conditions for childbirthand the care for young children, and the ability to recognize illnessesas early as possible, are the main items in that process.2. Care for pregnant women and young mothers is a proper field for ourpurposes because this field is one of the best documented in Hungarianhealth care, where each member of the concerned population has contactwith health care representatives.3. Finally, the topics of childbirth, pregnancy, and procreativity ofthe Gypsy population are very much associated with their poor health conditions,with their short life-expectancy in comparison to the majority population,etc.Typical explanations of this phenomenon are the higher rates of prematurebirth, in connection with early, frequent or late deliveries, and consequently,dystrophy, mental and physical disabilities, and sensitivity for severalillnesses occuring among Gypsies.It is a legitimate question why this well-covered field of the healthcare system where representatives have in every case a personal contactwith their patients, is not more effective, why it is not able to intervenein these negative phenomena, and why have not more significant changesoccurred in the last few decades.According to our hypothesis, besides the well-knownsocial, financial, economic and educational disadvantages of the Gypsypopulation, and the special case of health care (as in education), poorcommunications between Roma women and health care representatives contributesto the lack of success. Interactions and communications lead to misinterpretationson both sides, which result in deepening mistrust, and consequently, theeffectiveness of curative support is weakened. But inadequate communicationcan have a further consequence in health care. Troubles and misunderstandingsoccur in an "authority-client" relationship. In an optimal case, uniformcare as a universal condition could strengthen equality for everyone, otherwiseit may increase segregation and marginalization of Gypsies, instead ofhelping them to integrate into Hungarian society.We wanted to analyze the relationship between the two sides. Thereforenaturally, we wanted to have information about both sides. The method ofour research was interviews, hoping that this would lead us not only todiscover facts, but opinions, explanations, and beliefs, as well. We questionedpersons in health care who were in everyday contact with Gypsy mothers:district nurses, midwives, gynecologists and family doctors. From the otherside, we interviewed 80 mothers of four sub-samples, 20 women in each group.The four groups were selected by ethnic background, choosing the threemajor Gypsy ethnic groups in Hungary: Vlach, Boyash, Romungro (HungarianGypsies or musicians), and as a fourth, so-called control group, the Gypsiesof Budapest were selected.The topics of the conversations were the history of pregnancy, childbirth,the care for the newborn baby at home, and curing their illnesses. Neitherrepresentatives of the health care system nor the Gypsy mothers were consideredby us to be more objective in any given topic. We assumed that both healthcare representatives and Gypsy respondents based their experiences, or"knowledge", on personal events, individual experiences constructed bytheir own wider and narrow communities' values, explanations, and habits(professional in the former case, traditional in the latter). We also assumedthat narration of any topic would not be equivalent, communication betweenthe two sides would result in misunderstandings and misinterpretations.But because of the fact that Gypsy mothers are seeking advice, help, andcare by health care representatives, who - according to their profession- intervene in order to lead their patients to a required behavior, inaccuratecommunications hindered the effectiveness of care.Questions of our research included the following:1. Whether stagnant and poor morbidity and mortality ratesof the Gypsy population can be a result of inadequate communications betweenhealth care representatives and Gypsies?2. What is the relationship between health care representatives andGypsy communities with different ethnic backgrounds?3. Is there any conflict between prescriptions of health care representativesconcerning life patterns, health conceptions, etc., and that of Gypsies,based on their own traditions?4. Does the knowledge - facts, beliefs, prejudices - about Roma playany role in the relationship of health care representatives and Gypsy clients?The main difference in the perception of health carerepresentatives and Gypsy mothers we observed was in the field of procreativity.Medical doctors, nurses, and midwives mostly assumed that the fertilityof Gypsy women is due to their lack of family planning, ignorance, pooreducation, etc. - they are only living their biological life, surrenderingto their natural and unconscious destiny. Gypsy mothers in their eyes areso-called "natural human beings", "wild-women", a population in transitionfrom a semi-civilized life to "normal" culture. Elements of that "wild-women-ness"are an early sexual life, easy pregnancy and delivery, prolonged breastfeeding,etc. In their opinion, the obstacle of giving them information and adviceoriginates on one hand from a real communication gap, sometimes becauseof their different language, sometimes only because of their under-education.On the other hand, they observed Gypsies' theatricality, their over-sensitivityto recognizing prejudice everywhere, etc. They admitted to not having enoughknowledge about Gypsies, and some of them also admitted that persons inthe health care system have prejudices against different people, especiallyGypsies. They have not learned to handle these difficulties, never havinglearned any communication or conflict-solving techniques.On the other side, in interviews with Gypsy mothers, we observed a dualityof effects behind their family planning processes. This observation wasbased on the analysis of the whole sample and by comparing the four differentsub-samples. This duality of effects, two different vectors sometimes functioningin parallel, sometimes in conflict with each other, is a scale of tradition-modernity,and a scale from spontaneity and ignorance at a high level of consciousness.This duality is present in every case, and it is sometimes difficult toseparate this two different kinds of influences on fertility. If we supposethat in Romani communities high numbers of children in families and anacceptance of fertility without any consideration is typical, it is uselessto expect a rational choice according to the majority's opinion in familyplanning. Logically speaking, we may assume that on the one hand a highnumber of children per family in a traditional community is a rationalchoice, while in the same community a low family size can happen only bychance, or is a deviant behavior according to tradition. On the other hand,among families without strict traditional customs, a low number of childrenis a sign that these families followed the norms of the majority, and thehigh number of children is deviant. Not only traditions, but ignorance,the above mentioned spontaneity, or "primitivism", can influence fertilityrates and can hinder the educational work of health care authorities. Inthese cases individual destiny is relegated to biology, to social influenceswithout the possibility of self-defense.We do not believe that majority of our respondents live in this way.It is true that women in our sample are different in their fertility habitsfrom the average Hungarian women. This difference is significant only inthe case of Boyash and Vlach Gypsies, but in these two sub-samples differentcauses are working in the background. On the scale of tradition, VlachGypsies are more traditional, with large families and higher numbers ofchildren due to their rational choice. In this group family planning andthe use of contraception (artificial abortion, as well) is more frequentthan in the other groups. The sub-sample of Boyash Gypsies seems to bemore dependent on their biological fate. Abortion did not occur in thisgroup, family planning is unknown, or only after several children did theydecide to use some contraceptive method, sometimes following the adviceof the health care representative. In the group of Romungro Gypsies, likein the Budapest control group, although the average number of childrenis higher than in the whole population, this number and their attitudesare not different from the similar stratum of Hungarian families characterizedby the same level of education, working situation, and social situation.The Budapest group showed the highest level of consciousness in familyplanning, although they started to plan their fertility after the firstor second child, usually giving birth at a very young age. Members of thisgroup had a very mixed ethnic background and many of them came from unstable,broken families, sometimes spending their childhood in state-run institutions.Their fertility habits are mostly influenced by non-traditional mediatorssuch as age-group, neighborhood, school, media, and following the normsof the majority in the field of family planning.We were aware of being only able to give a non-representativereport about the contact between Gypsy mothers and representatives of thehealth care system. Our first statement is that these two sides are fromtwo different environments. The two kinds of narration about the same life-experiencesof these mothers seemed to happen in different universes. According tothe interviews made among health care representatives, the Gypsy populationis something very different from the whole society, they are in betweenprimitivism and civilization. Interviews with Gypsy mothers convinced usthat the sample is very mixed but does not deviate much from the socialstratum which has the same social characteristics. What is different, isthat these women suffer by the simultaneous claim of the broader and thenarrower community to follow their norms, and these two sometimes contradictoryeffects can result in a conflicting perception of their procreativity.We also observed that the myth of "wild-women" influenced the self-perceptionof Romani women negatively.Ignorance, spontaneity assumed by health care representatives seem tobe true only in one part of the sample. In the majority of cases when weobserved fertility habits different from the majority, it was due to thetraditional values. Only in the smaller part of the sample did we experiencethat ignorance or subversion to biological destiny was the reason for earlychildbearing or for the high number of children per family.A third element of the health care authority observed was prejudicein Romani client relationships. Our interviews with health care representativesexpressed this prejudice only in a few cases, but in their discourse, intheir expressions, we discovered a kind of prejudice which appeared towardthe image of "wild-women", under-civilized people. But they also accusedtheir clients with such characteristics as aggression, over-consciousnessof their differences, and that they assumed prejudice even where therewas only an expectation of "normal" behavior. Interviews with Gypsy mothersconvinced us that their everyday experiences with health care representativesis that they feel perceived through the prism of prejudice, instead asindividual beings with their own behaviors, problems, that they are onlymembers of a discriminated group.Neither the group of health care representatives, nor the group of Gypsymothers was homogenous. Even the small group of health care representativesjustified that the higher the contact with Gypsies, the more personal andadequate was their perception of Gypsies. The seldom and low-rate contactof health care workers with Gypsy clients leads to a mythical perceptionof that population, full of prejudices and misunderstandings. That means,district nurses had the most empathetic and understanding relationshipswith their clients, and only this group seemed to be able to adapt themselvesto Gypsies' traditional or community-based habits. Gynecologists, medicaldoctors in hospitals had the greatest distance from their Gypsy clientsand their false views led them to construct a wall of prejudices.Inconsistency of Gypsy attitudes was due to our method, choosing fourgroups of different ethnic backgrounds. In comparison to the uniform imageof health care authorities, we observed four widely differing groups whenconsidering habits in choosing partners, family planning, fertility customsand child rearing, from the point of view of spontaneity-consciousnessor tradition-modernity. Differences in these groups and the similarityof behavior of health care representatives called our attention to thefact that a universal-rational approach of experts and the prejudicialview of Gypsies results in inadequate communications in the majority ofcases.Finally, we suggest considering one more point. We did not seek to analyzeGypsies' perceptions of health care workers, our purpose was only the comparisonof two points of view of the same events: pregnancy and childbirth by Gypsymothers, and their child-rearing habits. We assumed that adequate communicationsand effective advisory work is only possible if the two images createdby the two different sides overlap each other, in other words, if the expertknows his or her patient in an objective way. We did not intend to analyzethe Romani's "doctor-image". However, several experiences mentioned inthe Gypsy interviews called our attention to one danger, that advice, instructionsand directions of health care representatives can only be effective ifthe person giving them is trustworthy and genuine. The Gypsy experienceof a thoughtless, negligent, or inept medical doctor, working only forextra money, can only lead to a false over-generalization of health carerepresentatives, hindering effective medical advice and treatment, damagingefficient doctor-client relationships.Mária Neményi is a researcher at the Instituteof Sociology of the Hungarian Academyof Sciences.Copyright © by Mária Neményi, e-mail h13249nem@ella.hu.This article is reproduced by the Patrin Web Journal with permissionof the author.Posted 06 January 1999.   Home - History- Culture -Traditions- Organisations - Rights- Holocaust -Guestbook- Search©1996-2000 by the PatrinWeb Journal. All Rights Reserved.URL:<http://www.geocities.com/Paris/5121/health-hungary.htm>E-mail:<webmaster@patrin.com> geovisit();
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