Macedonia’s Roma population, despite being formally recognized in the country’s 1991 Constitution, continues to suffer huge inequalities and human rights deprivations. Nowhere is this more evident than among the women of Šuto Orizari – a municipality of the capital Skopje that is the world’s largest concentration of Roma – who continue to be deprived of proper access to reproductive health services.
The country’s appearance before the United Nations Committee on Economic, Social and Cultural Rights in late June provided an important opportunity for the government to be held to account for its obligations in this regard. CESR has been working closely with the Macedonian Health Education and Research Association (HERA), which took a leading role in a coalition of civil society organizations participating in the Committee’s session. The organizations involved were determined to call out the government’s failure to ensure equitable access to sexual and reproductive health and rights in Macedonia, including comprehensive sexuality information in schools, and access to contraceptive and abortion services.
As a member of the International Planned Parenthood Federation, HERA provides health, social and legal services to thousands of women—most of whom are Roma—as well as promoting the inclusion of sexual and reproductive health and rights in national legislation, policies and plans. A particular focus of this work has been the use of data collected through community scorecards and other outreach activities to highlight shortcomings and dysfunctions in the delivery of sexual and reproductive healthcare services for Roma women. These include denial of services, charging of illegal fees, and the lack of a primary healthcare gynaecologist in Šuto Orizari, which is home to nearly 20,000 people.
Despite some progress, political conditions in Macedonia have limited the impact of advocacy work carried out by NGOs at the national level on these issues. For this reason, HERA and its partners have been increasing their engagement with international human rights mechanisms as a way to bolster their advocacy.
In order to maximize the impact of their engagement with the country’s appearance before the Committee, HERA proposed collaborating with CESR on a series of activities in both Macedonia and Geneva. This began with a three-day capacity-building workshop in Skopje on advocacy with United Nations human rights treaty bodies. Through a series of brainstorming activities facilitated by CESR, HERA and its partners—including the Initiative of Roma Women living in Šuto Orizari and other community-based activists—mapped out the recommendations they would most like to see from the Committee. Information the Committee would need to form the basis for those recommendations was identified and the most effective way to present that information was explored using CESR’s OPERA Framework for monitoring economic and social rights. CESR also provided feedback and input on draft submissions, advised on advocacy strategies and assisted representatives from HERA and the Initiative of Roma Women living in Šuto Orizari when the time came to attend the session.
What was particularly notable about this partnership was its focus on ensuring that civil society engagement in Macedonia’s review was community driven. Roma women defined their strategy for engagement throughout the review cycle, while CESR played a ‘bridging’ role, offering support to HERA and its community partners in how to present evidence of health rights deprivations, and how to translate their issues and concerns into the ‘language’ that an international human rights body would find persuasive.
The Committee paid considerable attention to sexual and reproductive health and rights during its dialogue with the government delegation and its recommendations addressed all of the issues raised by the civil society coalition, directly echoing their concerns on access to sexual and reproductive health education, information and services, including affordable contraception and safe and legal abortion. Notably, the Committee specifically highlighted the situation in Šuto Orizari as needing urgent attention.
HERA’s experience also highlighted the importance of civil society participation in the Committee’s sessions; NGO representatives can be on hand to clarify and contextualize the data presented in their submissions, as well as to respond to answers given by the government delegation during the dialogue which may be inadequate or misleading.
During the dialogue, the state delegation made two new commitments aimed at addressing the shortage of gynaecologists in Šuto Orizari: to increase state subsidies for gynaecologists and to reserve two scholarships for medical students who work in this municipality. The organizations that had engaged in the review held a press conference a few days after the concluding observations were published and, on the very same day, the Minister of Health Nikola Todorov publically announced that his Ministry will start to implement measures to increase the number of gynaecologists so that women have access to gynaecological health services within their municipality. Being mindful that similar announcements have been made in the past and not implemented properly, civil society groups will closely monitor whether the Minister of Health moves promptly to fulfill this promise.