Overlapping inequalities in health and reproductive outcomes among Romani women in Croatia

Background

Romani women experience multiple intersecting disadvantages related to gender, ethnicity, and socioeconomic position that shape their health. Although studies have examined the Croatian Romani population across health, employment and education, population-level evidence on health inequalities, especially among women, remains limited. This study examines differences between Romani and non-Romani women in health and reproductive outcomes.

Methods

We conducted a comparative analysis of Romani and non-Romani women using 2023 real-world data from national databases and registries. Age-standardized rates (ASR) and standardized rate ratios (SRR, 95% CI) were calculated for hospitalizations, births, and miscarriages. Additional indicators included maternal age, antenatal care, education, and employment.

Results

Romani women experienced higher age-standardized hospitalization rates across multiple diagnostic groups than non-Romani women, with the largest disparities in infectious (SRR=3.06, 95% CI 1.40–6.67), respiratory (SRR=2.70, 95% CI 1.77–4.14), and endocrine, nutritional, and metabolic diseases (SRR=2.17, 95% CI 1.25–3.75). Elevated rates were also observed for mental and behavioural disorders and circulatory diseases. Romani women had higher rates of births (SRR=1.95, 95% CI 1.72–2.20) and miscarriages (SRR=2.96, 95% CI 2.27–3.86), were more often younger than 30 (85% vs. 41%), and had limited antenatal care, with 26% having three or fewer visits (vs. 1%). Socioeconomic disparities were pronounced, with 64% having only primary education (vs. 2%) and 65% being unemployed or homemakers (vs. 12%).

Conclusions

Romani women in Croatia face substantial inequalities in health, reproductive outcomes, and access to care. These disparities are shaped by socioeconomic, ethnic, and gender disadvantages, suggesting that single-risk approaches will be insufficient and public health responses must address their combined and mutually reinforcing determinants.

Key messages

• Romani women in Croatia have higher hospitalization, birth, and miscarriage rates, and poorer antenatal care, highlighting significant inequalities in health and reproductive outcomes.

• These disparities reflect overlapping social determinants, showing that public health responses must address intersecting structural and social determinants, not single risks.