Association for Public Policy Analysis & Management

Health disparities often begin in utero and intensify throughout life. We report findings from a phenomenological qualitative study aiming to describe the structural disadvantage experienced by women in rural communities in Romania, focusing on Roma communities and drawing on the theory of intersectionality. The primary research questions are (1) how do women in these communities experience pregnancy, (2) what health-related structural disadvantages do they face and (3) what role does ethnicity play? We also focused on how to best measure and capture intersectionality in this context, specifically in regards to women’s self-identified ethnicity and what ethnicity they were perceived to be (i.e., Roma or Romanian). Between December 2015 and June 2016 we conducted 42 semi-structured interviews with key informants, seven narrative interviews with disadvantaged women in a rural area, and one focus group with Roma women in a rural area. We conducted 31 interviews in English and 19 in Romanian, and all were audio-recorded after attaining informed consent. In interviews with postpartum women, collected 25 demographic questions meant to capture self-identified ethnicity and perceived ethnicity. Interviews were transcribed and translated into English. Data were analyzed using thematic analysis, assisted by the NVivo package. We identified critical dimensions associated with women’s pregnancy experiences in disadvantaged, rural areas: women perceiving pregnancy as natural and normal, providers’ and society’s negative view towards these women, disconnects in prenatal care expectations between women and providers, and facilitators and barriers to care. This work highlights the importance of capturing intersectionality in women’s pregnancy experiences in both qualitative and quantitative work moving forward. It also showcases how women’s experiences are affected based on what ethnicity others perceive them to be and what sociocultural environment others perceive them to be in. In sum, women’s pregnancy experiences did not seem to differ as much by their ethnicity as they did by their socioeconomic status and more general sociocultural environment. This study in Romania has broader implications for studying the health of marginalized groups and what we can understand when we dive more deeply into peoples’ experiences by measuring the intersection of their many identities and different aspects of ethnic identification.