Associations between racial discrimination, smoking during pregnancy and low birthweight among Roma

Abstract

Racial discrimination may increase the risk of low birthweight (LBW), but has not been studied among Roma, the largest minority population in Europe. Moreover, few studies test both institutional and interpersonal forms of racial discrimination on health. Our objective was to examine associations between institutional and interpersonal racial discrimination with LBW, and to test potential mediation by smoking during pregnancy. In 2012-2013, Romani women interviewers surveyed 410 Romani women in Serbia and Macedonia. We measured institutional discrimination (neighborhood segregation, legal status of housing and neighborhood socioeconomic status), interpersonal discrimination [Everyday Discrimination Scale (EDS)], birthweight and smoking by self-report or interviewer report. We estimated relative risks for discrimination on LBW and separately on smoking during pregnancy using log-binomial regression, adjusting for age, parity, years at residence and wealth. The indirect effect of high EDS via smoking on LBW was estimated using inverse odds weighting mediation. Living in a low SES neighborhood showed a 2-fold risk of LBW [adjusted risk ratio (aRR) = 2.4, 95% CI = 1.2, 5.0]; aRRs for segregation and illegal housing were weaker (aRR = 1.8, 95% CI = 0.7, 4.3; aRR = 1.3, 95% CI = 0.6, 2.6, respectively). Institutional measures were not associated with smoking. High EDS was associated with LBW (aRR = 2.4, 95% CI = 1.1, 5.2) and smoking during pregnancy (aRR = 1.4, 95% CI = 1.1, 1.8); the indirect effect of EDS on LBW via smoking was not significant. Interpersonal discrimination and living in a low SES neighborhood were associated with LBW among Roma. Interventions to improve Romani health may benefit from a human rights approach.

The health of segregated Roma: first-line views and practices: a case study in Slovakia using ethnographic methods

“…This matches previous research on discrimination towards the Roma within CEE health care services in two respects: in alike prominent discrimination forms, including the persistence of racist concepts and labelling, and in the discrimination perpetrators' unwillingness to be identified as such (e.g. Andreassen et al 2017;Colombini et al 2011;George et al 2018;Janevic et al 2017). The finding of frontliners trying to justify their ethnically biased discrimination practices as experience-driven and rational is in line with studies showing the historical mutation of explicit racism within health care settings and beyond into less explicit, more indirect forms (Mistry et al 2009;Mullings 2005;Sue et al 2007).…”

“…Some previous studies on discrimination against CEE Roma have also identified the negative experiences of health care personnel with and negative stereotypes regarding segregated Roma (e.g. Andreassen et al 2017;Janevic et al 2017). Our study adds detailed accounts of how these phenomena might drive substandard practices via negative emotions, and how these mechanisms support each other.…”

“…Several studies identified a variety of discriminatory and racist practices towards the Roma across all organizational levels of the studied healthcare systems (e.g. Colombini et al 2011;George et al 2018;Janevic et al 2017;Janevic et al 2011;Rechel et al 2009). Recent comparative studies in this area also show specific contributions of discrimination (Janevic et al 2015;Kolarcik et al 2015).…”

“…Increasingly, studies have started to focus on whether discrimination within health care systems against Roma is involved (e.g. Colombini et al 2011;George et al 2018;Janevic et al 2017;Janevic et al 2011;Rechel et al 2009). These studies have identified indices of discrimination towards Roma across all organizational levels of the health care systems -institutional, personally-mediated and internalized.…”

Risk factors of preterm birth and low birth weight neonates among Roma and non-Roma mothers

“…According to the cross-sectional study conducted in Slovakia involving 452 Roma and 403 non-Roma respondents, men and women living in Roma settlements are more likely to smoke daily and are more likely to be strong smokers than the majority population (1,2). In the study by Janevic et al (28) who observed 410 pregnant Roma women, up to 36.1% of them smoked during the pregnancy. More frequent smoking during pregnancy among Roma women is confirmed by Bobak et al (1) and Balázs et al (2).…”