Information provision as a tool for social change within Roma communities
Andreea Mitrut, senior lecturer and researcher at the department of Economic at the School of Business, Economics and Law at Gothenburg University was recently published in the ‘Journal of Public Economics’ with the study “Bridging the gap for Roma: The effects of an ethnically targeted program on prenatal care and child health”.
The study looked at a health program implemented in Romania that targeted pregnant Roma women, one of Europe’s largest and most disadvantaged ethnic minority. The program analyzed here used health mediators from Roma communities in order to increase the provision of information about already existing, free of charge health services available for children and pregnant women.
What do you consider the most interesting find in this study?
‘The most interesting find was that the program was effective in the sense that it has significantly increased prenatal care take-up rates and the number of months under prenatal supervision, narrowing thus the gap in prenatal care take-up between Roma and non-Roma individuals. However, while we did not find any improvements in the indicators of health at birth like birth weight, pregnancy duration or preterm delivery, we showed that the program led to a significant decrease in the probability of death until the age of one. These findings may indicate that, while information provision may increase the take-up rate of medical services, this may not be enough to change the outcomes at birth for this group. You would need to complement the information provision policy with other incentives that would change Roma’s poverty level (e.g. nutrition, cash or in-kind transfers).’
Do you know what could have caused this increased survival rate at one years old, in spite of the unchanged health at birth?
‘We know that survival at the age of one is highly correlated with the weight at birth and pregnancy duration. However here we show that the decrease in infant mortality is more prevalent among complications arising in the perinatal period. Moreover, the program also increased the knowledge about free vaccination which may have been contributed to the decrease we see.’
Why would Roma women not take their kids to see a doctor?
‘There are at least three main reasons why they may not go to see a doctor prior to the implementation of the program. The first is lack of knowledge - you just do not understand the importance of certain preventive measures. Then there is the perceived discrimination, the fear that doctors will not treat you well, which was often the case. The third factor was the language barrier. Many of the Roma, especially the traditional ones who would only speak a dialect, would feel more confident if they went to the doctor with a health mediator. These factors together could explain why very few Roma women would go to see a doctor prior to the program.’
Why do you consider this study important?
'We think the findings of this study could be informative in various contexts where factors such as the lack of knowledge or perceived discrimination are obstructing the take-up rates of different programs. Here we try to understand whether information provision targeted toward ethnic minorities per se would help to decrease the gap between them and the non-ethnic minorities or between the new waves of refugees and the native population.
Many EU-programs have spent a lot of money trying to find ways to decrease these gaps. In our case, one feature of the program was essential: to hire as health mediators Roma women from the same communities as the treated women. This was cheap and efficient because Roma women would not feel comfortable talking about very sensitive problems such as prenatal care or medical visits with strangers outside their communities.’
What is the way forward from this study?
‘We believe that better information about available services and about their importance for various health outcomes could be extended in other different areas, such as education or labour market. This, in turn, may reduce the gaps in education, school enrollment, or labour market participation between the segregated or discriminated minority groups and the rest of the population.’