What this is
- This study explores the experiences of Roma women accessing maternity services in Ireland.
- It identifies significant barriers such as language difficulties, discrimination, and cultural factors.
- The research employs a with community engagement to gather insights.
- Findings aim to enhance equity and cultural responsiveness in maternal healthcare for Roma women.
Essence
- Roma women face substantial barriers in accessing maternity care in Ireland, including language issues and systemic discrimination. Despite these challenges, many prefer Irish services due to respectful treatment.
Key takeaways
- Language barriers significantly hinder Roma women's access to maternity services. Many require translators, yet only one participant reported receiving interpretation support during care.
- Systemic discrimination contributes to mistrust in healthcare settings. Negative interactions with hospital staff foster feelings of exclusion and discourage Roma women from seeking timely care.
- Despite barriers, Roma women express a preference for Irish maternity care over Romanian services, valuing respectful treatment and essential postnatal support.
Caveats
- The study's small sample size of eight participants may not represent the full diversity of Roma women's experiences. Selection bias could arise from recruitment through a community organization.
- Self-reported data may be influenced by recall bias and social desirability, potentially affecting the accuracy of reported experiences.
Definitions
- co-design approach: Collaborative method involving stakeholders in the design and development of services to ensure their needs are met.
Simplified
Background
Maternal health is a fundamental human right, aimed at ensuring that all women have access to non‐discriminatory, equitable and quality maternal and reproductive healthcare. To ensure women's maternal healthcare rights, health facilities, goods and services should meet standards of availability, accessibility, acceptability and quality [1]. However, international research highlights significant barriers faced by Roma women across Europe in accessing these essential services [2, 3].
The Roma are Europe's largest and most marginalised ethnic group, facing extreme poverty, racial discrimination, undermining of their cultural heritage, and exclusion from main society [4, 5]. Van Belle and Hughes (2022) highlighted that Roma women experience lower prenatal care engagement than other ethnic groups and increased maternal and neonatal complications [6, 7]. Socio‐economic disadvantages such as poverty, low education, inadequate nutrition, housing, and accommodation instability contribute further to poor obstetric outcomes [8, 9].
Roma women tend to marry and have children at a younger age compared to the general population [10]. A higher number of teenage pregnancies, high birth rates (average of 3.54 surviving children per woman), combined with low utilisation of antenatal services, put both mothers and infants at a higher risk of complications such as preterm birth, low birth weight and postpartum infection [11, 12]. Language barriers and poor healthcare literacy discourage Roma women from seeking timely maternity care [13, 14]. Additionally, systemic discrimination, including negative interactions with healthcare professionals, racial profiling and lack of culturally appropriate care, deters Roma women from accessing maternal health services, further widening existing healthcare disparities [2, 13].
In Ireland, the estimated Roma population is 16,059 (Census 2022) [15]. Studies indicate that 70% of Roma have lived in Ireland for over 5 years, with 63.3% of children in Roma households born in Ireland [16]. Despite this, Roma women continue to experience significant barriers to maternal healthcare access [17].
A report by Pavee Point Traveller and Roma Centre identified poverty, lack of social protection, absence of culturally appropriate information, and inadequate translation and interpretation services in Ireland as key concerns [17, 18]. Findings from the National Roma Needs Assessment (RNA) 2018 further emphasise the severity of these issues [17]:
70.5% of Roma individuals reported experiencing discrimination when attempting to access healthcare services. Maternity care in Ireland is provided free under the Maternity and Infant Scheme. The scheme offers combined care—by a family doctor (also called a general practitioner [GP]) in the community, and a hospital obstetrician or midwife, qualified to provide care for women and babies. During pregnancy, the initial examination is typically conducted by a GP, preferably before 12 weeks, to confirm the pregnancy and to register the mother on the maternity scheme. Further five examinations during the pregnancy are alternated with visits to the maternity unit/hospital. GP visits typically include monitoring progress and conducting routine examinations like weight and blood pressure monitoring or urine tests, whereas detailed examinations like ultrasound scans are carried out at the hospital level [19].
Many Roma women do not engage with maternity services early in pregnancy because they are unaware that the service is free and fear that care will be costly, compounded by fear of discrimination and communication barriers [18]. Discrimination and lack of culturally appropriate care negatively impact their experiences during pregnancy and childbirth [7]. Issues with translation and interpreter services in maternity units are particularly concerning and vary between hospitals, impacting Roma women's ability to attend appointments and communicate with healthcare providers [17].
Despite these challenges, there is a significant gap in research on effective interventions to improve maternity health services for Roma women [1]. To ensure that Roma women's voices inform healthcare service improvement, it is essential to actively involve them in shaping national maternity quality and safety services [20]. A more inclusive approach—one that prioritises accessibility, trust‐building and cultural appropriateness has the potential to significantly improve Roma maternal health outcomes [21].
The primary aim of this study was to capture the perceptions and experiences of Roma women on quality and safety in maternity services and to identify barriers to quality care. This study is part of a larger project developing quality and safety measures for maternity and neonatal services in Ireland. Recognising the importance of including marginalised groups in the development process, a targeted engagement strategy was co‐designed with Cairde (a community health organisation supporting marginalised populations) [22] to involve Roma women in shaping maternity care quality and safety measures. This approach ensures that their lived experiences can enhance service provision.
Methodology
This study utilised a co‐design approach outlined by Chauhan et al. (2021) to engage with Roma women in evaluating the quality and safety of maternity services [23]. To ensure meaningful participation, the research team collaborated with Cairde and recruited eight women originally from Romania who had given birth in Irish hospitals within the past five years.
A structured yet flexible methodology was adopted, including four online workshops and an online questionnaire co‐designed with Cairde's staff. Each workshop incorporated an educational component delivered by a Health Service Executive (HSE) Public Health doctor, followed by focus group discussions around antenatal care, care during labour and birth, and postnatal and neonatal care to capture the experiences of Roma women (Table 1). Language barriers were addressed through Romani translation provided by Cairde's staff, and literacy was addressed using graphics rather than words in education materials. Focus group discussions were conducted in small breakout rooms to encourage active participation using guided questions (Appendix A).
Ethical considerations, including informed consent and confidentiality, were upheld. To ensure accessibility and cultural sensitivity, participants received participant information leaflets (PILs) and consent forms (Appendices B and C), co‐designed with Cairde. Translation and interpretation support were provided by Cairde's staff to help participants fully understand the study process. Findings from the workshops were further validated through debriefing sessions. Upon completing the workshops, participants filled out an online questionnaire (Appendix D) to capture their background data and additional insights into their experience of maternity services using multiple‐choice and open‐ended questions. A descriptive analysis summarised key trends and highlighted patterns in healthcare utilisation and challenges faced by Roma women. The detailed methodology for this co‐design approach is outlined in a companion paper, which provides a comprehensive account of the engagement process [24].
| Workshop | Educational component | Topic for focus group discussions |
|---|---|---|
| Workshop 1 | You and your Pregnancy | Accessing antenatal care and barriers; language issues |
| Workshop 2 | Having your Baby | Accessing healthcare during pregnancy and labour |
| Workshop 3 | You and your Baby | Postnatal care, mental health and group session on designing a maternity service to meet the needs of Roma women and their babies |
| Workshop 4 | — |
TA Approach
We employed thematic analysis (TA) as outlined by Braun and Clarke in 2006 [25] to systematically develop themes to understand the lived experiences of Roma women within maternity services. Using an inductive approach, the transcribed interview data was collectively coded and analysed by members of the academic research team (J.D. and E.M.) using NVivo 20 software to identify key themes and sub‐themes.
Results
Sample Characteristics
Eight Roma women participated in focus groups to explore their experiences with maternity and neonatal services in Ireland (Table 2). Participants ranged in age from 21 to 39 years. The number of children per participant varied, with five women having more than five children. Three women were pregnant at the time of the study, and all had at least three children born in Ireland. Seven women reported becoming pregnant before the age of 18 years, and five women had experienced homelessness after the birth of their first child in Ireland.
Five participants had lived in Ireland for more than 5 years. Many still struggled with English language proficiency, with only two women reporting that they could understand and speak English very well. Unsurprisingly, language barriers emerged as a major challenge. Although five participants reported needing a translator or interpreter at some point during their maternity care, only one participant reported being provided with an interpreter, while the others had to rely on family members or were left without any interpretation support.
During their first pregnancy in Ireland, four of the eight women were aware that maternity care was free, and only one participant was aware of the recommended antenatal appointments. Five women attended little or no antenatal appointments before their first delivery in Ireland. Despite this, almost all participants attended postnatal visits and received public health nurse visits.
Infant feeding practices varied, with four women using formula exclusively, while one woman breastfed exclusively. Financial struggles were evident, as four women required assistance with baby essentials, receiving support from hospitals, charities and family/friends. Contraceptive use was reported by six participants at least once during their lifetime.
| Sample characteristics | No. of participants |
|---|---|
| Age (in years) | |
| 20–25 | 1 (12.5%) |
| 26–30 | 2 (25%) |
| 31–35 | 3 (37.5%) |
| Above 35 | 2 (25%) |
| Number of years lived in Ireland | |
| Less than 5 years | 3 (37.5%) |
| 5–15 years | 4 (50%) |
| More than 15 years | 1 (12.5%) |
| No. of children | |
| 1–2 | 1 (12.5%) |
| 3–4 | 2 (25%) |
| 5 and more | 5 (62.5%) |
| No. of children born in Ireland | |
| Less than 3 | 5 (62.5%) |
| 3 and more | 3 (37.5%) |
| Age at the time of first pregnancy | |
| Less than 15 years | 1 (12.5%) |
| 15–18 years | 6 (75%) |
| More than 18 years | 1 (12.5%) |
| Age of the youngest child now | |
| < 2 years | 2 (25%) |
| 2–5 years | 4 (50%) |
| > 5 years | 2 (25%) |
| Are you pregnant now | |
| Yes | 3 (37.5%) |
| No | 5 (62.5%) |
| Place of birth | |
| Romania | 7 (87.5%) |
| Other | 1 (12.5%) |
| Experienced homelessness since the birth of your first child | |
| Yes | 5 (62.5%) |
| No | 3 (37.5%) |
| Experienced homelessness in Ireland | |
| Yes | 5 (62.5%) |
| No | 3 (37.5%) |
| Level of English (understanding and speaking) | |
| Very well | 2 (25%) |
| Well | 3 (37.5%) |
| Not well or not at all | 3 (37.5%) |
| Level of English (reading) | |
| Very well | Nil |
| Well | 3 (37.5%) |
| Not well or not at all | 5 (62.5%) |
| Needed an interpreter at the hospital | |
| Yes | 5 (62.5%) |
| No | 3 (37.5%) |
| When needed an interpreter, how often it was provided by the hospital | |
| Always when asked | 1 (20%) |
| Never on asking | 3 (60%) |
| Never asked | 1 (20%) |
| During the first pregnancy, were you aware that maternity care is free in Ireland | |
| Yes | 4 (50%) |
| No | 4 (50%) |
| Awareness regarding the number of recommended antenatal appointments | |
| Yes | 1 (12.5%) |
| No | 5 (62.5%) |
| Knew about some but not all | 2 (25%) |
| At the time of first pregnancy, you attended a family doctor (GP) and/or hospital for pregnancy check‐ups/appointments before the birth of your baby in Ireland | |
| Yes, all or most of my appointments | 3 (37.5%) |
| Yes, one or two | 3 (37.5%) |
| No | 2 (25%) |
| Attend GP/hospital for a 6‐week postnatal check‐up | |
| Yes | 7 (87.5%) |
| No | 1 (12.5%) |
| Receive a visit at home from the public health nurse | |
| Yes | 8 (100%) |
| No | Nil |
| Method of feeding newborn | |
| Only breastfed | 1 (12.5%) |
| Only bottle‐fed | 4 (50%) |
| Both breastfed and bottle‐fed | 3 (37.5%) |
| Had everything needed to care for the baby after the birth of the first baby in Ireland | |
| Yes, I didn't need any help | 4 (50%) |
| Yes (hospital/charity/friends helped) | 2 (25%) |
| No, I did not have what I needed but I managed | 1 (12.5%) |
| No, I did not have what I needed, and I struggled | 1 (12.5%) |
| Contraceptives used | |
| Yes | 6 (75%) |
| No | 2 (25%) |
Qualitative Findings
Focus group data was refined into an initial set of codes and then categorised into potential sub‐themes and main themes (Table 3). This structured approach enabled the capture of key patterns of Roma women's experiences, providing rich qualitative insights into the barriers, challenges and their engagement with healthcare services.
Roma women reported challenges at every level, from engaging with healthcare services to applying for social support and child benefits.
Four key themes emerged from the data analysis:
| Themes | Sub‐themes |
|---|---|
| Challenges of engaging with maternity services | Challenge of language and translator/interpreter availability |
| Hospital expectations to bring their own translator/interpreter | |
| Reliance on family and friends | |
| Local healthcare and family constraints | |
| Experiences with maternity healthcare services and its impact | Perception and experiences of discrimination |
| Emotional distress due to communication barriers | |
| Mistrust due to uncertainty around treatment | |
| Preference for Irish maternity services in comparison to Romanian services | |
| Cultural identity and maternity care needs and preferences | Preference for female health professionals for culturally sensitive communication |
| Cultural identity and norms | |
| Mental health stigma | |
| Poor health literacy and limited awareness of services | Limited awareness of maternity services |
| Resource constraints | |
| Experience of using contraceptives |
Challenges of Engaging With Maternity Services
Roma women experienced significant challenges when engaging with maternity services. Their interactions with the healthcare system were shaped by multiple barriers, including language difficulties, travel constraints and family responsibilities at home. Many women reported delays in accessing antenatal care or seeking healthcare for pregnancy complications.
Challenge of Language and Translator/Interpreter Availability
A recurring challenge for Roma women was communicating with healthcare professionals due to limited English language proficiency. Many participants missed antenatal appointments because they were unable to understand the instructions provided or communicate their needs effectively due to the non‐availability of translators and interpreters, leaving them reluctant to attend hospital visits on their own.
Past pregnancy experiences where no translator/interpreter was provided led them to assume they would not receive this support in future pregnancies, reinforcing their hesitancy to seek care.
Some Roma women faced significant barriers in accessing birth registration services for their newborns due to the absence of interpreters.
Hospital Expectations to Bring Their Own Translator/Interpreter
Many women reported that hospital staff assumed Roma women would bring their own translator/interpreter, thus placing an additional burden on them. In many cases, women were left without any language assistance despite repeated requests.
These challenges discouraged Roma women from attending regular check‐ups and hampered communication during hospitalisation.
Reliance on Family and Friends
Due to low literacy rates, Roma women often rely on family members, neighbours or friends to read hospital letters, accompany them to appointments, and act as translators during hospital and public health nurse home visits (p4, p7).
Local Healthcare and Family Constraints
Access to healthcare facilities was another major concern, particularly for women living in areas far from GP clinics or hospitals. ‘I've been only to the hospital because my GP is far from where I live. So, I only see the doctor at the hospital’ (p3).
Many Roma women felt that maternity services offered by GPs were limited, with the provision of services like urine testing, weight and blood pressure monitoring ‐ not meeting their expectations for pregnancy care. This led them to seek care directly at hospitals, contributing to delayed antenatal visits.
Additionally, Roma women often prioritise family obligations over their healthcare and seek care at the final stages of pregnancy—‘just at the time of delivery’, (p4) or when urgent medical issues arose: ‘when I had very sore pain and lost liquid’ (p2).
To improve healthcare access, participants suggested recruiting Roma women as interpreters and using communication channels, such as WhatsApp groups, to share information with pregnant Roma women in their own language.
Experiences With Maternity Healthcare Services and Their Impact
Roma women's experiences with maternity healthcare in Ireland reveal both negative and positive encounters, shaped largely by language barriers, perception and experiences of discrimination, and uncertainty around treatment.
Perception and Experiences of Discrimination
Roma women reported experiencing discrimination from hospital security staff, making them feel unwelcome in healthcare settings. However, others reported positive interactions with doctors and nurses.
Emotional Distress Due to Communication Barriers
Due to poor communication, women felt ignored as they were unable to describe their symptoms clearly, leading to frustration and emotional distress.
The fear and stress were further amplified when medical procedures explained by healthcare practitioners were not understood by the individuals, leaving them confused and terrified.
Mistrust due to Uncertainty Around Treatment
Most women were happy with the care provided at the hospital, and they believed ‘doctors and nurses were good and provided them with true and correct information and reassurance’ (p1, p3, p8), gaining their trust.
However, in some cases, language barrier and lack of translator/interpreters resulted in delays in receiving medical care, as doctors refuse to proceed without an interpreter, leaving women in pain or untreated.
This uncertainty surrounding their treatment adds to their feeling of insecurity, especially when they cannot read consent forms or understand medical procedures.
Following negative experiences, these women ‘chose not to complaint and remain silent’ (p1, p5) as they were ‘unaware of the complaints process’ (p3, p8) and ‘feared negative consequences’ (p2).
Preference for Irish Maternity Services in Comparison to Romanian
Most participants had strong preferences for Irish maternity services compared to Romania. They appreciated the respectful treatment and affordability of Irish maternity services in contrast to the Romanian system, where ‘if you pay the doctor money, the doctor will help you’ (p1, p8).
Other reasons for preference of Irish healthcare were ‘shorter duration of hospital stay, provision of basic services like food for mother and baby, nappies in the hospitals and allowing husband to accompany during the appointments and delivery’ (p1, p8).
Cultural Identity and Maternity Care Needs and Preferences
Roma women's cultural identity and traditional maternity practices significantly shape their experiences. Their beliefs, customs and social norms influence their engagement with maternity services.
Preference for Female Health Professionals for Culturally Sensitive Communication
Roma women feel embarrassed and ashamed when discussing reproductive health issues with male doctors or male interpreters, resulting in reluctance to seek care or discuss health concerns. They strongly prefer female doctors for pregnancy‐related treatments, childbirth and gynaecological procedures, due to cultural and religious beliefs (p1).
Cultural Identity and Norms
Most Roma women strongly identify with their cultural heritage and take pride in their language, traditions and clothing. They feel a deep connection to their Roma identity.
Sometimes hospital environments conflict with their cultural values and traditions, leading to discomfort, for example, the requirement to wear hospital gowns.
Roma women adhere to traditional maternity customs passed down through generations, which sometimes differ from modern medical practices, for example, ‘wrapping newborns tightly in blankets for 6 weeks to strengthen their bones and not buying baby clothes before birth due to superstitions about bad luck’ (p1, p2), and ‘relying on knowledge passed down from their mothers and grandmothers’ (p6).
Mental Health Stigma
Seeking mental health support is stigmatised within Roma communities. Women are reluctant to attend specialists or therapy, fearing judgement from others in their community.
While many feel overwhelmed by their responsibilities, they do not openly acknowledge mental health difficulties. Instead, they internalise these, choosing to stay silent whilst focusing on household and childcare responsibilities to avoid dwelling on emotional struggles.
Poor Health Literacy and Limited Awareness of Services
Roma women have limited awareness of healthcare services and social supports available, leaving them without essential supplies during pregnancy and postpartum. Additionally, decisions about birth control are heavily influenced by personal experiences and informal discussions with family/friends.
Limited Awareness of Maternity Services
Most were unaware of antenatal classes or additional maternity services that could improve their pregnancy experience. They often rely on word‐of‐mouth recommendations when choosing a maternity hospital, limiting their exposure to a broader range of healthcare choices available.
Some women indicated that, due to their low literacy levels, they cannot read the postnatal care information pamphlet provided to them.
Resource Constraints
Many Roma women felt unable to explain their financial difficulties to hospital staff or social workers due to their limited English, and they struggled to access social support and child benefits due to a lack of knowledge about application processes and criteria.
Experience of Using Contraceptives
Their decisions about contraception usage were often based on fear of side effects, personal experiences, and advice from family and friends rather than healthcare staff, leading to misconceptions.
Some participants reported that physical side effects made them uncomfortable and led them to stop using birth control entirely, while some associated contraceptives with infertility issues.
These experiences highlight the need for culturally sensitive contraceptive education, where healthcare providers can address concerns, provide accurate information, and ensure women make informed choices about family planning.
Discussion
In this research study, eight Roma women shared their experiences of maternity and neonatal services in Ireland. Most had early pregnancies before the age of 19 years, large families, and limited English proficiency, with many requiring support. While awareness of free maternity care and attendance at antenatal services was low during their first pregnancies, postnatal care was more consistently accessed. Financial hardship, infant feeding practices and contraceptive use varied among participants. Participants faced challenges in accessing maternity and social services due to low health literacy, previous experience and cultural preferences.
The study findings align with international literature, which highlights that Roma women are 23 times more likely to give birth as minors (< 18 years) compared to their non‐Roma counterparts—a factor associated with increased risks of preterm birth, low birth weight and higher maternal mortality rates [8, 26]. These outcomes are further compounded by systemic disparities in maternity care experienced by marginalised ethnic communities, shaped by intersecting factors such as ethnicity, race, religion, socio‐economic status, age, marital status and sexual orientation [2, 8, 13, 27]. For many Roma women, pregnancy marks their first sustained engagement with the healthcare system, making these early interactions critical for building trust and influencing future health‐seeking behaviours. Failure to provide this may lead to long‐term disengagement from health services and persistent health inequities [28].
Roma women reported multiple barriers to accessing care, including limited awareness of services [10, 29], transport barriers, financial constraints [29, 30], and relying on family/friends due to a lack of interpreters/translators. Studies show that language barriers prevent effective communication with healthcare professionals, leading to missed antenatal appointments and delays in care [2, 8, 13]. Reliance on family members to act as translators compromises the quality of information exchanged, reducing trust in healthcare providers and raising concerns regarding medical confidentiality when discussing sensitive matters [2, 6, 10].
Some described feeling ignored or neglected during labour because they could not adequately explain their symptoms due to the language barrier. Others encountered traumatic experiences of refusal of care or undergoing treatment without a clear understanding of what was happening, leaving them in distress for prolonged periods. Previous research also highlights that the lack of clear communication heightens the feelings of fear and vulnerability among Roma women [29, 31].
Roma women reported feeling unwelcome due to instances of discriminatory and distrustful behaviour by some hospital staff. This reflects wider European antigypsyism [32, 33] behaviour where Roma women have reported being discriminated [34], physically and verbally abused [35], not treated with respect [10], being ignored or abandoned in hospitals [31, 36], denied treatment [31, 37], or receiving lower‐quality care due to racial prejudice [26, 28]. However, Roma women in this study also expressed their overall satisfaction with the treatment provided by doctors and nurses in comparison to Romania, indicating that while systemic barriers persist, most healthcare professionals in Ireland provided compassionate and respectful care [6, 16, 29].
Cultural identity and traditional practices significantly shape the preferences and experiences of Roma women. They expressed discomfort with male doctors assisting during childbirth, citing cultural and religious reasons, which is consistent with literature citing that Roma women prioritise gender‐matched healthcare providers for reproductive and maternity care [13]. Research suggests that healthcare systems that fail to accommodate cultural beliefs risk further alienating Roma women from formal maternity care [10, 13].
Many of the women reported prioritising family responsibilities over personal well‐being, leading to emotional exhaustion, but dismissed their emotional well‐being, stating that they have no time to focus on their emotions. This aligns with other research studies indicating that mental health is a low priority within Roma communities and is often overlooked due to cultural stigmatisation, with many individuals experiencing frequent mental distress but not seeking support services [13]. The reluctance to seek professional assistance highlights the need for community‐based interventions that normalise mental health discussions and provide culturally appropriate support mechanisms.
Limited health literacy was a common challenge, with many Roma women in this study relying on word‐of‐mouth recommendations. Available literature depicts that this limited awareness of available services, including antenatal classes and supports, social and child benefits, and contraceptives [38] prevent Roma women from fully utilising maternity services [17, 18].
Implications and Recommendations
Findings of this study emphasise the urgent need for systemic interventions to improve maternity care for Roma women. Key recommendations include:
Strengths and Limitations
Integrating healthcare education into the FGDs provided context for the participants to relate their experiences, as well as simultaneously imparting knowledge to these women. Structuring sessions around the pregnancy journey provided structure and focus. Partnering with Cairde greatly facilitated engagement with the Roma community, overcoming language and literacy challenges and improving data quality. The online format, supported by the provision of necessary digital devices, further enhanced accessibility and improved participation.
While offering valuable insights, this study is limited by its small sample size of eight participants, which may not reflect the full diversity of Roma women's experiences. Recruiting through Cairde may have introduced selection bias, excluding less‐connected individuals. Self‐reported data from focus groups and online questionnaires may be affected by recall and social desirability bias. Language barriers and informal interpretation methods may have led to miscommunication. Though the online format enabled participation by reducing barriers like childcare and travel, it may have limited the depth of interaction. Future research should involve a larger, more diverse sample to strengthen findings.
Conclusion
This study highlights the significant barriers Roma women face in accessing maternity care in Ireland, including language difficulties, financial hardship, cultural factors and discrimination. Limited English proficiency, lack of interpreters and unfamiliarity with antenatal services often lead to delayed or inadequate care, increasing health risks. Systemic issues—such as discriminatory treatment by hospital staff, lack of culturally competent care, and poor awareness of available services—further compound these challenges.
Despite these challenges, many Roma women appreciated the respectful treatment provided by Irish healthcare staff. However, low health literacy, reliance on informal information sources, and stigma around mental health underscore the need for targeted interventions.
Addressing these disparities requires professional, culturally appropriate interpretation services, culturally tailored health education through Roma peer networks, improved access to services, and policy reforms to counter institutional discrimination. Future research should include comprehensive health equity assessments, considering broader social determinants like housing, education, employment and health behaviours. Prioritising culturally responsive care and building trust can help ensure equitable, high‐quality maternity care for Roma women.
Author Contributions
Jaspreet Kaur Dullat: conceptualisation, methodology, investigation, formal analysis, visualisation, writing – original draft preparation, writing – review and editing. Thérèse McDonnell: conceptualisation, project administration, methodology, investigation, formal analysis, visualisation, validation, writing – review and editing. Louise Hendrick: resources, validation, methodology, writing – review and editing. Léan McMahon: writing – review and editing. Gemma Moore: validation, writing – review and editing. Marianna Prontera: project administration, resources, methodology, validation, writing – review and editing. Emily Murphy: resources, project administration, methodology, validation, writing – review and editing. Carmen Nae: resources, project administration, validation. Danut Nae: resources, project administration. Eilish McAuliffe: conceptualisation, formal analysis, funding acquisition, writing – review and editing.
Ethics Statement
This study has received ethical approval from UCD Human Research Ethics Committee‐ Sciences (Reference Number: LS‐LR‐23‐184‐McAuliffe) and the Research Ethics Committee Midlands Area and Corporate (Regional Health Area B) of the Health Service Executive (Study: Evaluation of development and proposed implementation of the Quality and Safety Signals Proof of Concept in Maternity and Neonatal Services, Ref: RRECB1123 L.H.).
Conflicts of Interest
The authors declare no conflicts of interest.
Supporting information
Acknowledgements
The authors would like to thank the eight Roma women for their enthusiastic, open and honest engagement in sharing their experiences of using the public maternity service in Ireland. This study forms part of the QS Signals Project, which aims to design and implement a national dashboard to monitor quality and patient safety within the Irish healthcare system, the Health Service Executive (HSE). This study is funded by the National Quality and Patient Safety Directorate of the HSE, which is responsible for the delivery of QS Signals (NQPSD Collaborative Research Award ‘NQPSD RA2/2022’).
Data Availability Statement
The anonymised data that support the findings of this study is available upon reasonable request from the corresponding author.
References
Associated Data
Supplementary Materials
Data Availability Statement
The anonymised data that support the findings of this study is available upon reasonable request from the corresponding author.