Изучение литературных данных о состоянии репродуктивного здоровья женщин цыганской национальности выявило, что данная этническая группа требует к себе повышенного внимания со стороны медицинских работников из-за плохого состояния здоровья, обусловленного негативными факторами образа жизни и неполноценного использования ресурсов здравоохранения, особенно в отношении профилактических мероприятий. Женщин цыганской национальности репродуктивного возраста следует относить к группе риска из-за возможных неблагоприятных исходов родов, таких как преждевременные роды, задержка внутриутробного развития плода, гипотрофия плода. Большинство исследовательских работ проведено в странах Центральной и Восточной Европы, с целью выявления особенностей течения беременности и родов у женщин цыганской национальности. Несмотря на значительный размер этой этнической группы в российской литературе не найдено данных о состоянии репродуктивного здоровья женщин цыганской национальности. Растущая численность цыган, проживающих на территории России, делает актуальной задачу исследования состояния здоровья у женщин репродуктивного возраста данной этнической группы, с целью обеспечения благоприятного исхода родов. Основываясь на изученных данных, необходимо отметить, что женщины цыганской национальности требуют пристального внимания со стороны медицинского персонала при оказании до- и послеродовой помощи, в связи с повышенным риском неблагоприятного исхода родов.
цыгане, беременность, роды, контрацепция, курение
The Gipsies is one of the biggest ethnic minorities living in Europe totaling from 7 to 9 millions [1]. According to the population census conducted in 2002 the population of the Gipsy community in Russia numbered more than 180000 people, in 2010 – more than 200000 people. Growing number of the Gipsies living in Russian territory makes the issue of studying health conditions of reproductive age women belonging to this ethnic group for the purpose of providing positive birth outcomes burning. It may be assumed that characteristics of the lifestyle pattern of the Gipsy community undermine their health state. The following can be referred to dominant risk factors: marriages between close relatives, early sexual debut, absence of periodical medical examinations, alcohol consumption, low educational level, financial problems [2]. One of the information sources on health state of this ethical group is a retrospective analysis of history of pregnancy and deliveries of Gipsy women. Recently in the countries of Central and Eastern Europe several population studies for the purpose of identifying distinctive features of the courses of gestation and deliveries of Gipsy women were conducted [3].
The main reason for frequent negative birth outcomes of Gipsy women is ill health. In 2006 in Spain a research of health state of 527 Gipsy women aged 16 and older was undertaken. On completion of the study it was revealed that women of this ethnic group are more often overweight with a body mass index>30 (BMI), and also more often suffer have depressions and migraines [4]. In Hungary BMI of the Gipsy women is on the average about 21.8 kg/m2 [5]. Obesity in Croatia (BMI>30 kg/m2) was observed in 21% of cases, but was prevalent in the elderly age group [6]. The authors also note a high ratio of smoking women (more than 70%) among the Gipsy population, obtained numbers perfectly correlate with the data, obtained in the Czech Republic, where the Gipsy women smoke in 78% cases before and during pregnancy as compared with 42% of women of other nationalities [3]. Similar picture can be observed in Hungary [5], where almost half (47.3%) of the Gipsy women constantly smoke and in 89.3% of cases continue to smoke during pregnancy in comparison with 14.7% of the representatives of other nationalities. In Spain Gipsy women smoke far less (18.98%) than those of Spanish nationality (32.26%) [4].
The Gipsy communities differ noticeably from other social groups from the viewpoint of traditions, style of life and work, and, as a rule, Gipsy people consume more alcohol than the indigenous population [7]. Studies in Europe suggest that the Gipsy population is characterized by alcohol abuse [2]. In Spain the Gipsy women drink during pregnancy in 35.10% of cases by contrast to 16.51% among the women of the indigenous population [4]. But data, obtained in Czech shows the opposite. There the Gipsy women were drinking even less (31%) during pregnancy than women of other nationalities (48%) [3]. These results show that an explanation of ill health of the Gipsy women is more complicated and does not reduces itself to pernicious habits such as smoking and drinking.
The conducted studies indicate that one of the main reasons for negative birth outcomes is in no small part a low level of education among the Gipsy population. Thus, in the Czech Republic 81% of Gipsy women received only the elementary level of education or didn’t receive any education at all in comparison with 15% in the control group [3]. In Hungary only 27% of the Gipsy women have finished less than 8 grades, 60.3% of the Gipsy women have finished the elementary level of education, while Hungarian women haven’t received secondary level of education only in 1.7% of cases [5]. The similar figures were obtained during the research in Spain, where in 71.9% of cases the Gipsy women are uneducated. That explains the existence of different myths and fears in this ethnic group in relation to gynecological treatments and as a result – refusal to undergo planned preventive medical examinations. The percent of the Gipsy women who have been examined by Pap smear and mammography is extremely low as contrasted with that of the representatives of other nationalities [4].
Nutrition is also an important determinant influencing health, as well as the gestation course and its outcome. Balanced diet throughout pregnancy affects not only mother’s health but baby’s as well [8,9]. The concentration of folic acid, retinol, β-carotene and α-tocopherol in the blood stream is ex
1. The World Bank World Bank and the Roma/ Available at: http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/ECAEXT/EXTROMA/0,contentMDK:20333806~menuPK:615999~pagePK:64168445~piPK:64168309~theSitePK:615987,00.html Accessed: 2007: May 24.
2. Hajioff S. The health of the Roma people: a review of the published literature // J Epidemiol Community Health. 2000. №54. P. 864-869.
3. Bobak M., Dejmek J., Solansky I., Sram R.J. Unfavourable birth outcomes of Roma women in the Czech Republic and the potential explanation: a population-based study // BMC Public Health. 2005. №5. P. 106.
4. Carrasco-Garrido P., Loґpez de Andreґ s А., Hernaґndez Barrera V., Jimeґ nez-Trujillo I., et al. Health status of Roma women in Spain // European Journal of Public Health. 2010. Vol. 21. №6. Р. 793-798.
5. Balaґzs P., Raґkoґczi I., Grenczer A., Foley K. Risk factors of preterm birth and low birth weight babies among Roma and non-Roma mothers: a population-based study // European Journal of Public Health. 2012. Vol. 23. №3. P. 480-485.
6. Škarić-Jurić T., Martinović Klarić I., Smolej Narančić N., Drmić S., et al. Trapped between Tradition and Transition – Anthropological and Epidemiological Cross-sectional Study of Bayash Roma in Croatia Croat // Med Journal. 2007. V. 48. P. 708-719.
7. Ekuklu G., Deveci S., Eskiocak M., et al. Alcoholism prevalence and some related factors in Edirne, Turkey // Yonsei Med Journal. 2004. V. 45. P. 207-214.
8. Rush D. Maternal nutrition and prenatal survival // Nutr Rev. 2001. V.59. P. 315-326.
9. Siega-Riz А.М., Herrmann T.S., Savitz D.A., Thorp J.M. Frequency of eating during pregnancy and its effect on preterm // Am Journal Epidemiol. 2001. V. 153. P. 647-652.
10. Dlouhy´ P., Rambouskova´ J., Wiererova´ O., et al. Iodine saturation of Roma neonates in Prague is not at an optimum level // Ann Nutr Metab. 2006. V. 50. P. 242-246.
11. Rambouskovaґ J., Dlouhyґ P., Andel M. Dietary consumption assessment and evaluation of nutritional status of Roma pregnant women and their newborn babies. Monitoring Health Status of Vulnerable Groups in Europe: Past and Present. Pecs, Hungary: Compostela Group of Universities and Phoenix TN, European Thematic Network on Health and Social Welfare Policies, 2006.
12. Rambouskovaґ J., Dlouhyґ P., Krızova E., Prochazka B., et al. Health Behaviors, Nutritional Status, and Anthropometric Parameters of Roma and Non-Roma Mothers and Their Infants in the Czech Republic // Journal of Nutrition Education and Behavior. 2009. V. 41. P. 1.
13. Semerdjieva M., Mateva N., Dimitrov I. Sexual culture of gypsy population // Department of Social Medicine, Higher Medical Institute, Plovdiv, Bulgaria. 1998. V. 40. P. 72-75.
14. Masseria C., Mladovsky P., Herna ndez-Quevedo C. The socio-economic determinants of the health status of Roma in comparison with non-Roma in Bulgaria, Hungary and Romania // Eur J Public Health. 2010. V. 20. №5. P. 549-554.
15. Reig Majoral S., Curуs Torres S., Balcells Chiglione J., Batalla Martínez C., et al. Contraception: gypsy versus non-gypsy women // Centro de salud Dr. Pujol i Capçada, El Prat de Llobregat, Barcelona. 1999. V. 15:23. №2. Р. 63-67.
16. United Nations Development Programme. UNDP releases largest ever survey of Roma. UNDP; 2005. Available at: http://vulnerability.undp.sk. Accessed: 2007:October 4.
17. Ветрова Ю.В., Гуськова-Алексеева О.В., Морозов В.Н., Хадарцев А.А. Неспецифические (синтоксические и катотоксические) механизмы адаптации к длительному воздействию холодового раздражителя // Вестник новых медицинских технологий. 2000. № 3. С. 100.
