The Medical Detainment Of Roma Mothers In Slovakia

On 10 December, the Associated Press published an investigative article about Roma mothers being detained in hospitals in Slovakia after giving birth. The investigation found that mothers and newborns are routinely and illegally detained in hospitals across the country. Several Roma women told the Associated Press that they fled hospitals after being tied up, beaten, shouted at, or ignored when they required medical attention. A health assistant told the Associated Press that there were usually three cases a year in which abandoned babies were given to orphanages before their mothers could return to retrieve them. The investigation acknowledged that white Slovak women were also reported to be detained in hospitals after birth. However, they were not reported to be physically or verbally abused like Roma women. These incidents are reminders of the institutionalized discrimination and oppression that Roma communities across the European Union face from birth.

Recent research has suggested that medical detainment is not associated with a particular region, but an understudied and under-reported global human rights issue. In December 2017, Chatham House published a paper assessing the prevalence of medical detention on a global scale. The organization researched incidents of patients being detained for not paying hospital bills. The scope of this paper excludes medical detentions similar to those currently occurring in Slovakia, which are based on bribes rather than unpaid hospital bills. Chatham House reported that victims were also likely to endure verbal or physical abuse during their detainment. Chatham House reported that medical detention was an issue in the following countries: Nigeria, Kenya, Zimbabwe, Liberia, Uganda, Cameroon, Democratic Republic of the Congo, Indonesia, and India. The Associated Press’ investigation suggested that medical detainment also occurred in China, Thailand, Lithuania, Bulgaria, and several other countries in Latin America and the Middle East. The director of the Harvard Global Health Institute, Dr. Ashish Jha, told the Associated Press that medical detainment “is not something that is happening in a small number of countries, but the problem is that nobody is looking at this and it is way off the public health radar.”

Medical detainment is a blatant violation of Article 11 in the United Nations’ International Covenant on Civil and Political Rights. The article states that “no one shall be imprisoned merely on the ground of inability to fulfill a contractual obligation.” Medical detainment also has negative implications for mothers and their babies. The Health and Human Rights Journal reports that the practice is detrimental to the health of the mother and infant. They suggest that the threat of medical detainment can discourage women from going to hospitals to give birth. This often reduces antenatal care and increases the risks associated with childbirth. Chatham House’s investigation also reported that detained patients were often subjected to discrimination and abuse.

Chatham House found that medical detention tended to be motivated by “health financing systems that require people to make high out-of-pocket payments when they need healthcare” and “inadequate governance systems” that allow such practices to occur. Although the lack of academic research makes medical detainment a difficult issue to resolve, Chatham House suggests that it should be addressed by reforming current health financing systems and moving towards healthcare models based on publicly funded universal health coverage. Such models would require compulsory prepayment mechanisms, which would eliminate the need for hospitals to charge significant fees. They also suggest that unclear government definitions can make it difficult for hospitals to determine which patients are exempt from fees and which patients are required to make a payment. The Health and Human Rights Journal traces some of these root causes back to structural adjustment programs recommended by the World Bank in the 1980s. The journal proposes a similar strategy, but also suggests that international donors could help cover the initial costs of such programs.

Unfortunately, these proposed solutions will not resolve the problem in Slovakia. The medical detainment of Roma women in Slovakia does not seem primarily motivated by money, but by deeply entrenched discrimination and oppression. Zuzana Kriskova, a maternal rights activist, told the Associated Press that “detention in African hospitals is about money, but in Slovakia, it’s about power… Women are having their fundamental human rights violated when they have no freedom of movement and cannot decide how their child is to be treated.” These human rights violations will continue until it becomes socially and politically intolerable to discriminate against Roma peoples.

Many of these human rights violations against the Roma are systemic. Roma communities have been historically subjected to similar discriminatory practices and policies across Europe. Roma women and children have been especially vulnerable. In 2003, a report published by the Slovak Centre for Reproductive Rights found uncovered widespread human rights violations against Roma women that included coerced sterilization, abuse from medical health providers, and racially discriminatory access to resources and treatment. Under both the Nazi and communist regimes in Slovakia, the coerced sterilization of Roma women was carried out through government policies. However, the report suggests that coercive sterilization has continued in Slovakia since the fall of communism.

The Associated Press’ investigation supports this argument, reporting blatant discrimination and abuse towards Roma patients. A Roma mother told the Associated Press that doctors repeatedly slapped her face and legs during her deliveries and screamed that she did not know how to push properly. She also reported being subjected to racist taunts from the hospital staff. Knowing that hospital staff would stop her if she tried to leave after two days, the mother said that she waited until visiting hours to sneak out by herself. The Associated Press suggested that many hospitals have mandated four-day stays for new mothers in order in order to receive insurance reimbursements. The mother reported being charged an illegal 20 euro fine when she returned to pick up her baby a few days later.

Some shift the blame back onto Roma women, suggesting that they are leaving the hospitals early for selfish reasons. This reinforces problematic negative stereotypes. A head doctor told the Associated Press that Roma women are taking advantage of the hospitals because they know that the hospital staff will take care of their babies. In 2014, the government passed a law that withholds social benefits payments from mothers if they leave the hospital without permission after giving birth. Up to 800 euros can be withheld. The Associated Press investigation suggests that this penalty is not working. Such legislation and comments from authority figures are likely to make the situation worse for the Roma. These conclusions are consistent with Chatham House’s research, which found that the poorest members of society were most likely to be victims of medical detention, and that detention was likely to push these victims further into poverty.

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