Introduction
Across the European continent, few groups must endure the gravity of structural and societal discrimination more deeply than Roma women. Their everyday lives are moulded by experiences shaped by intersectionality, a term that describes how social identities such as race, gender, and class interact with one another to produce unique experiences of marginalisation. This means facing double discrimination, being female within patriarchal systems, and as Roma within societies marked by antigypsyism. This oppression is glaring as Roma women continue to endure an often underacknowledged form of violence: obstetric and reproductive coercion.
Spain is legally bound by a variety of international and national frameworks that aim to protect reproductive rights and gender equality. The Spanish Constitution, under Article 14, guarantees equality before the law regardless of “birth, race, sex, religion, opinion or any other personal or social condition”. Article 43 provides for a right to healthcare. Furthermore, Spain is also a party to the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), which creates obligations on state parties to eliminate discrimination in health care services, including reproductive health services.
Under Article 12 of this instrument and in conjunction with the CEDAW Committee’s General Recommendation No.24, state parties must ensure women’s access to adequate services relating to pregnancy, childbirth and postnatal care in the absence of coercion or discrimination. At the EU level, the EU Roma Strategic Framework for Equality, Inclusion and Participation, an initiative active from 2021 until 2023, explicitly calls upon member states to address antigypsyism in all its forms, mandating targeted responses in key areas such as education, housing and most significantly, health. The framework adopts a gender-sensitive approach, recognising that Roma women face compounded barriers due to both ethnic discrimination and gender inequality. Yet, despite these protections, Roma women continue to face obstetric violence in Spain.
Roma Population and Health Disparities in Spain
The Roma (Gitano) community is the largest ethnic minority in Spain, with an approximate population of 725,000-750,000 people (about 1.5 percent of the population). Socioeconomic marginalisation persists, with 2018 statistics indicating that around 98 percent of the Roma population live below the poverty line. The double discrimination that Roma women must endure translates into deterministically different health outcomes. They report worse overall health status than non-Roma women – 23 percent of Roma women over 16 describe their healthcare as “bad or very bad” compared to 19 percent of women in the general population of Spain (Newtral, 2022). The gap only widens as time progresses, with a reported 47 percent of Roma women over 50 years old reporting bad health, compared to 36 percent of non-Roma women. In a 2018 publication, the European Public Health Alliance found the infant mortality rate to be almost three times greater for Roma mothers (European Public Health Alliance, 2018).
Underscoring these phenomena are significant barriers to health care access for Roma women. Just over a decade ago, a national Roma health survey revealed that 25.3 percent of Roma women had never attended a gynaecological exam, in stark contrast to 17.6 percent of the general female population in Spain. The data also revealed that screening rates for women’s cancers were considerably lower for Roma women (Porres et al., 2014).
It is crucial to note that the 2014 percentage of access to gynaecological consultations was classified as a nine percentage point improvement from data collected in 2006. In 2020, a shocking 16 percent of Roma, when asked if they felt discriminated against when being seen in a medical centre in the last year, answered in the affirmative (Government of Spain, 2021). In the absence of supportive health care services, cultural norms in some Roma communities, such as an encouragement of early marriage and childbearing, can heighten health risks for young mothers.
Obstetric Violence
The term “obstetric violence” refers to the mistreatment of women during pregnancy, childbirth and postpartum care, and includes dehumanising treatment, non-consensual procedures, neglect, or abuse by medical personnel. This phenomenon has only recently entered the public discourse in Spain, yet studies suggest that it is widespread. A report published by a CHACHIPEN research team and funded by the European Union’s Rights, Equality and Citizenship Programme exposed disturbing findings on racialised reproductive control of Roma women in Spain.
One of the health experts interviewed recounted a meeting with doctors in the San Roque neighbourhood of Badalona, where clinicians openly expressed pride in having convinced Roma women to undertake preventive mastectomies and hysterectomies, under the guise of protecting them from future cancers. Rather than being based on evidence-based medical assessments, these procedures were performed on the basis of racially biased risk assessments conducted by the practitioners (CHACHIPEN, 2022).
According to the expert, ethno-obstetric violence begins during pregnancy and continues through childbirth and postnatal care. It manifests through racist, infantilising, and judgemental language, targeting young Roma mothers. The report showed that healthcare providers frequently question their competence as parents and apply stereotypes about hyperfertility. Roma women are frequently pressured to adopt hormonal contraceptive methods with serious side effects, often without full informed consent (CHACHIPEN, 2022).
One witness described a pattern where tubal ligation was routinely offered immediately after childbirth, particularly in segregated or ghettoised neighbourhoods. A disturbing comparison between two Roma women illustrates the institutional bias: one woman, who did not appear “stereotypically Roma” and lived outside a Roma-majority area, was told she was too young to be sterilised after requesting the procedure. Another woman, living in a Roma neighbourhood, was advised to identify as Roma at a specific health centre in order to have the procedure approved without question or assessment (CHACHIPEN, 2022).
A publication by the European Commission entitled “Case studies on obstetric violence: experience, analysis, and responses” found that obstetric interventions in Spain continue to exceed the rates recommended by bodies such as the Spanish Ministry of Health and the World Health Organisation (Rozée et al., 2023). The study found that even when women have rejected medical intervention, cases of coercive or court-ordered interventions remain all too common. In fact, the first two resolutions on obstetric violence adopted by CEDAW in 2020 and 2022 found that Spain had failed to abolish customs and practices that discriminate against women in obstetric health care. The Committee found that cases of obstetric violence in Spain “has been shown to be widespread, systematic in nature and ingrained in health systems” (OHCHR, 2022).
In 2021, the Ministry of Equality proposed to include the term “obstetric violence” in the reform of Spain’s Organic Law 2/2010 on Sexual and Reproductive Health and Voluntary Termination of Pregnancy. However, due to opposition from influential professional bodies, including the Spanish Society of Gynaecology and Obstetrics (SEGO) and the General Council of Official Colleges of Physicians (CGCOM), as well as resistance from the Ministries of Health and Justice, the term was ultimately excluded from the final version of the law. This is despite the regional recognition of the term ‘obstetric violence’, such as in the Catalonian law 17/2020 of the Right of Women to Eradicate Sexist Violence.
Together, these findings paint a concerning picture. Despite growing awareness and activism, the Spanish state continues to fall short of fully recognising and addressing the specific forms of reproductive injustice experienced by Roma women (and women as a whole). This is in spite of the European Parliament, in their resolution to combat antigypsyism, emphasising,
discrimination against Roma women, who are often cared for in segregated and low-quality maternity hospitals, who face physical abuse, helplessness, and ill-treatment or poor treatment by health workers when trying to access sexual and reproductive health services, and those who do not usually have access to mobile units for medical examination (European Parliament, 2017).
In the same resolution, the European Parliament also urged member states to not only condemn the practice of forced sterilisation, but also issue compensation to the Roma women historically affected by this practice. Yet, in Spain, there remains no official statistical data on the phenomenon of obstetric violence against women (Olza et al., 2025).
Activists have criticised the stereotypes of Roma women as hypersexual, as providing undue ‘justification’ for medical practitioners to intervene in the decision-making processes of Roma mothers (Fernández, 2017). Roma women have frequently reported being stereotyped in this way. In medical encounters, they are occasionally met with demeaning questions, including “why do you have so many children?” or comments implying that they will misunderstand medical information communicated to them (Newtral, 2022). This maltreatment violates patients’ dignity and may even deter Roma women from seeking prenatal care or hospital delivery, which only serves to perpetuate a cycle of poor outcomes. A contributing factor for this approach towards Roma women, albeit unjustifiable, is a marked lack of intercultural competency training for Spanish health care professionals (Rodríguez-Camacho et al., 2025).
Sterilisations and Reproductive Coercion
The gravest violation of the rights of Roma women is forced or coerced sterilisation, which permanently ends a woman’s fertility in the absence of her full, informed consent. Europe has a shameful history of such practices targeting Roma women. While Spain did not implement systematic sterilisation campaigns like those documented in Central and Eastern Europe (Hutt, 2021), individual cases of reproductive coercion have nonetheless been recorded. Roma women living in Spain have recounted experiences where they were pressured by doctors or social workers to limit childbearing. Silvia Agüero, a prominent Roma feminist, recently revealed that after she delivered her third child at age 29, the attending doctors tried to convince her to undergo tubal ligation on the spot. “At 29 they wanted to sterilize me, something they wouldn’t dare suggest to a woman from Opus Dei, even if she has a ton of kids”, Agüero noted, pointing out the double standard (Mariño, 2025).
The Council of Europe, in the Convention on Preventing and Combating Violence Against Women and Domestic Violence, mandates parties to take measures to criminalise non-consensual abortions or surgeries with the aim of ending a woman’s natural reproduction (Council of Europe, 2011). The CEDAW Committee has further clarified that by virtue of Article 12 CEDAW, state parties are required to ensure equal access to healthcare and that forced sterilisations are a breach of said article (CEDAW Committee, 1992). Until recently, Spanish law permitted non-consensual sterilisation in cases involving “legally incapacitated” persons. This provision of the criminal code was repealed by Ley Orgánica 2/2020, aligning Spain with international human rights standards that condemn forced sterilisation as a form of gender-based violence and cruel, inhuman, or degrading treatment.
However, this legal development fails to acknowledge the softer forms of coercion that women continue to face in healthcare settings. Informal and systemic pressures on Roma women to curtail their fertility remain widespread. This is largely due to the skewed public perceptions of Roma women and their maternal role within their own community.
Reclaiming Power: Spanish Roma Womanhood Between Oppression and Pride
The discourse surrounding Roma women has often painted them as passive victims: overburdened, oppressed, and in need of rescue (Herrero-Arias, 2023). These narratives have centred around a critique of the traditional roles that Roma women hold and have depicted them as overburdened caregivers, subjected to early marriage, domestic violence and extreme poverty. While these notions may be grounded in legitimate concerns regarding gender inequality and social exclusion, they also risk reinforcing orientalist and paternalistic assumptions (Herrero-Arias, 2023), which obscure the lived experiences of Roma women by reducing them to mere stereotypes. They fail to capture the strength and the agency found within Roma communities. As iterated by Aiella et al. (2024), many Roma women in Spain reframe traditional roles such as homemaking and motherhood as achievements and sites of pride and power.
Encarnación, a Spanish Roma woman, stated:
I believe that being a woman is to be the pillar of the home… I’m the one who takes care of everything… the children, the house, the husband, the worries, everything (Herrero-Arias, 2023).
The women interviewed in the above study did not reject these roles, with many women in the community embracing them as manifestations of cultural continuity and social worth.
Being a gitana woman is the most beautiful thing that can happen to you… when I say I’m feminist, it’s because I stand up for women’s rights and equality… I feel very good when my husband comes from work, and I serve him food. I like it, and it makes me feel good. (Herrero-Arias, 2023).
This apparent rejection of hegemonic feminism is grounded in an understanding that female empowerment may be present in culture, solidarity, and a non-rejection of tradition. For Roma women to be meaningfully considered agents of change or community leaders actively participating in public life, one must take into account Romani feminism. Western feminist discourses have long prioritised ideas of secularism and liberation from patriarchal customs in the journey towards gender equality. Romani feminism, in contrast, insists on a contextual understanding of liberation and a deep engagement with their traditions.
Conclusion
Human rights breaches do not just scream. They often whisper, found in the societal cracks where prejudice encroaches on a person’s everyday interactions. In the case of Roma women in Spain, these prejudices can be found in coercion, everyday biases, and a failure to respect bodily autonomy. Obstetric violence and reproductive coercion are the result of intersecting forces: antigypsyism, gendered stereotypes, and a lack of cultural competence within Spanish healthcare institutions.
Spain has made progress. Yet the lived experiences of Roma women expose a gap between Spain’s commitments under frameworks like the CEDAW and the EU Roma Strategic Framework and the realities on the ground. These gaps not only violate international obligations but also serve to perpetuate cycles of mistrust, health disparities, and exclusion.
At the same time, Roma women continue to resist and redefine narratives of womanhood and motherhood, asserting cultural pride and agency in ways that challenge mainstream feminist paradigms. Recognising and valuing Romani feminism, with its emphasis on community, tradition, and self-defined empowerment, is essential for creating solutions that resonate with Roma women’s lived realities.
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