2019. október 16., szerda

The decline of infant and child mortality among Spanish Gitanos or Calé (1871−2005): A microdemographic study in Andalusia

https://www.demographic-research.org/volumes/vol36/33/36-33.pdf



The decline of infant and child mortality among Spanish Gitanos or Calé (1871−2005): A microdemographic study in Andalusia


Juan F. Gamella1 
Elisa Martín Carrasco-Muñoz2 

Abstract

 BACKGROUND 

Most Romani groups in Europe have experienced a decline in childhood mortality during recent decades. These crucial transformations are rarely addressed in research or public policy.

OBJECTIVE This paper analyzes the timing and structure of the decline of childhood mortality among the Gitano people of Spain.

METHODS The paper is based on the family and genealogy reconstitution of the Gitano population of 22 contiguous localities in Southern Spain. Registry data from over 19,100 people and 3,501 reconstituted families was included in a dense genealogical grid ranging over 150 years. From this database we produced annual time series of infant and child mortality and of the registered causes of death from 1871 to 2005.

RESULTS The analyzed data shows a rapid decline in infant and child mortality from about 1949 to 1970. The onset of the definitive decline occurred in the late 1940s and early 1950s. Child mortality was higher in the pre-transitional period and started to decline earlier, although it took longer to converge with majority rates. The mortality transition in the Gitano minority paralleled that of the dominant majority, but with important delays and higher mortality rates. The causes of death show the deprivation suffered by Gitano people.

CONCLUSIONS The childhood mortality decline facilitated the most important changes experienced recently by the Gitano minority, including its fertility transition and the transformation of Gitanos’ gender and family systems.

CONTRIBUTION This is one of the first historical reconstructions of the mortality transition of a Romani population.

1. Introduction 

The Gitanos or Calé of Spain are an ethnic minority related to the other Romani groups in Europe and America. Notwithstanding their common remote origin, Romani groups have adapted to the surrounding societies in all the regions where they have lived and present considerable sociocultural heterogeneity (Matras 2015; Piasere 2004; Fraser 1992). The Gitanos seem to descend from the first migratory waves of Romani groups into Western Europe, which were documented in the 15th century (Pym 2007; Leblon 1985). Their customs and life patterns are the product of a long coexistence with local Spanish populations, often marked by persecution, forced assimilation, and discrimination, but also by cooperation, hybridization, and by their creative appropriation of majority customs (Gómez Alfaro 1993, 1999; Leblon 2003; Gamella, Gómez Alfaro, and Pérez 2014).

 In the democratic and decentralized regime developed after the end of Franco’s dictatorship, Gitanos have gained access to free and universal health care, public education, pensions, and housing benefits. This has induced a remarkable process of social integration and cultural convergence with their Payo (non-Gitano) neighbors. Nevertheless, most Gitano groups have preserved a vibrant sense of themselves as a distinct cultural group, and have developed new forms of reaffirmation, resistance, and mobilization in cultural, religious, and political realms (San Román 1997; Gay Blasco 1999; Cantón et al. 2004; Mirga 2014; Gamella, Fernández, and Adiego 2015). 

Arguably, the most far-reaching transformation experienced by the Gitano people of Spain in the 20th century was the dramatic fall in their infant and child mortality patterns. Almost all newborn Gitano children survive today, whereas in 1950 about 200 per 1,000 died before their fifth birthday.3 The change is even more pronounced compared to previous decades: in the mid-1920s the risk of a Gitano child dying in childhood was about sixty times greater than in the early years of the 21st century (see Tables 1 and 2 below, and Gamella, Martín, and Quesada 20144 ). The improvements in child survival induced an unprecedented population growth that multiplied the size of the Calé population. In turn, this demographic expansion led to an intense Gitano migration from Andalusia and Extremadura to other more prosperous and industrialized regions of Spain and, later, to other European countries. These movements and resettlements altered the geographic distribution of Gitanos and therefore affected the identity of the new generations of Calé. Moreover, the drop in childhood mortality facilitated a decline in fertility that became generalized from the late 1980s. The intentional control and reduction of fertility is completing the distinct demographic transition of this minority. This process has enormous consequences for the entire Gitano community, including consequences that are rarely considered in reviews of the demographic transition (Lee and Reher 2011): convergence with the majority population and an increase in intermarriage.

Ultimately, as the burden of reproduction falls disproportionately on women, widespread child survival has had crucial long-term effects on the lives of Gitano women and on the gender arrangements within the group.

1.1 The death of Gitano children

For centuries the recurrent death of children was a common experience in the homes of Gitano people. This tragic reality often emerges both in the discourse of Calé women themselves (Gamella 2000, 2011) and in any cursory view of the corresponding civil and parish records. Infant and child mortality was also common among the majority population in Spain, but the higher fertility rates of Gitano women resulted in more early deaths per mother. In our records there are many instances of Gitano women that suffered the loss of a very high number of children. 

For instance, Salvadora B. was a Gitano woman born in the city of Guadix in 1852. In our review of the civil registries of Guadix and neighboring towns we found records of 11 children born to Salvadora in the 21-year period between 1871 and 1892. Eight of these children died before their third birthday. Surprisingly, when Salvadora’s husband, Juan, died at 48, his death certificate stated that he “was single, although for many years had lived as a married couple with Salvadora B. … [the] union of which resulted in three surviving children”.5 In the winter of 1924 Salvadora died from exposure. She was 72 and lived in a cave in miserable conditions. The civil and parish records contain traces of the dramatic life of this woman, whose common law marriage was not officially recognized and who was listed as castellana nueva (the official euphemism for Gitanos) in several entries. Therefore, the registered side of Salvadora’s biography reflects the bureaucratic ideology that stressed the separate ethnic identity of Gitanos while at the same time ignoring their own cultural definitions of marriage and relatedness. In the following decades Salvadora’s three surviving children registered 28 children themselves, of whom 15 died in childhood or adolescence. Hence, of Salvadora’s 39 children and grandchildren, only 41% lived long enough to marry and reproduce. Nevertheless, in our genealogical reconstitution we found 576 direct descendants of Salvadora, most of them alive today. Hence, the lives of Salvadora and her descendants show how the loss of many children was a common experience for Gitano women until fairly recently, but also how successful their reproductive strategies have been despite this loss. 

Even if it goes unnoticed by the world at large, the death of a child usually deals a terrible emotional and physical blow to the mourning parents. Today many Gitano women still cry when they remember the death of a child that occurred decades ago, and they still clearly remember the circumstances, symptoms, and events as they unfolded to their tragic end. Many women can also tell the stories of the deaths of their infant siblings based on their own or their relatives’ recollections. These narratives offer important sources of either confirmation or rebuttal of the archival data we gathered. Given the omnipresence of this crucial issue in the consciousness of Gitano women, it is surprising it has not received more scholarly attention and scrutiny.

1.2 Objectives

In this paper we will assess the structural dynamics of the decline in infant (under 1 year of age) and child (under 5 years of age) mortality of the Gitano people of 22 contiguous communities in the province of Granada in Southern Spain. We will use mostly records kept by the Civil Registry since its inception in 1871, but our analysis will concentrate on the period beginning in 1920 when the available data becomes more reliable.

This paper will provide a model of the infant and early childhood mortality transition in the Gitano community, including the timing of the onset of definitive decline, the intensity of change, the main phases of the process, and the relative growth in neonatal deaths. We will also compare our results to data reflecting both the entire province and the Spanish population at large.

Our model also includes data on the causes of child deaths as they were recorded in the researched archives, and tracks the changes in these diagnoses over time. The causes of death offer key insights into the underlying social determinants that affected the survival of children from the most underprivileged families. 

This study aims to situate the mortality transition of Spanish Gitanos in its social, political, and epidemiological context, and hence facilitate the analysis of the main “factors responsible for this ‘secular’ and seemingly irreversible decline” (Corsini and Viazzo 1997: xiii).

1.3 A gap in Romani studies

This study contributes to filling a gap in Romani Studies. The dominant representations of Romani groups have ignored the evolution of childhood mortality, as well as other key demographic transformations. This is especially remarkable considering that demographic differences are among the most salient aspects of the ethno-cultural contrast between Romani populations and mainstream majorities everywhere.

Particularly, in the best ethnographic monographs available, little or no attention is paid to the issue of the death of children, even when the experience, celebration, and commemoration of death is a crucial topic in these works (Sutherland 1975; Okely 1983; Williams 1993; Stewart 1997; Engebrigtsen 2007).

Nevertheless, the decline in infant and child mortality also seems to have occurred in other countries of Central and Eastern Europe, such as Romania, Hungary, Slovakia, and Bulgaria, which have large and varied Romani populations (see Ladányi and Szlényi 2006; Scheffel 2005; Kohler and Preston 2011; Burlea 2012). However, we do not know much about it, or how these processes have diverged from those occurring among neighboring majority populations.

References to infant and child mortality are scattered throughout publications concerning health status and access to health care, or surveys on living conditions and official demographic data (Cook et al. 2013; Ringold, Orentstein, and Wilkens 2005; Kalibová 1993, 2000; Costarelli 1993). Most of the studies are cross-sectional. For instance, some studies compare mortality rates across a particular country and recurrently find much higher rates of infant mortality in the regions where Roma populations are concentrated (Rychtaříková and Dzúrová 1992: 630) and in urban neighborhoods with a high proportion of Roma residents (Rosicova et al. 2011: 526−528). Recently, Kohler and Preston (2011) made an important analysis of differential mortality patterns among religious and ethnic groups in Bulgaria, using nominal data in 1990s’ censuses. However, their analyses “were restricted to the noninstitutionalized adult population aged 20 and over” and thus they “avoided potential problems in measuring mortality of children in the census-based data set” (Kohler and Preston 2011: 93).

In the rapidly increasing literature on Romani groups, very few publications are devoted to childhood mortality, much less from a historical perspective. Childhood mortality is rarely treated as a key variable in other epidemiological, social, and economic transformations. Even in important papers on the anthropological demography of Romani groups there are no references to infant mortality (Durst 2010, 2002). One important exception can be found in the work of Ladányi and Szlényi, who studied the transformation of a village in northeastern Hungary from a multiethnic peasant village into a segregated Roma ghetto, and were able to collect demographic data of considerable quality and detail for 1857 to 2000. They also were able to follow the long-term evolution of infant mortality and its major shifts, concluding “the dramatic decline in infant mortality between 1951−1988 was one of the most spectacular achievements of socialist policy. The success of these policies places the blame for high rates of Gypsy infant mortality squarely on the shoulders of pre-war public health authorities” (Ladányi and Szlényi 2006: 67). This study proves that local registry data often includes Romani people and can provide extraordinary results if studied patiently and in an integrated form. However, historical studies such as this are rare.

In sum, the literature on the demographic history of Romani peoples is very limited in scale and content and demographic concepts and models have been ignored by most historical or cultural studies of these groups. Their potential, however, is obvious, both in terms of theory construction and in the analysis and design of public policy. 

2. Methods and data sources

The study of the history of infant and child mortality presents severe technical difficulties and data problems even for larger and better-known populations (Corsini and Viazzo 1997; Schofield, Reher, and Bideau 1991). Regarding Spanish Gitanos, some historical developments compound the task. First, a Royal Order in 1783 prohibited references to the ethnic identity of Gitano people in Spanish public records.

This interdiction was followed, albeit irregularly,6 and for the last two centuries there is no aggregated official data that can be used for the demographic study of this minority.

ggregated official data that can be used for the demographic study of this minority. Secondly, the relatively small Gitano population has been dispersed in numerous localities in all regions where they have lived. For instance, in 1785 the last available census of the whole Gitano population gathered data on about 12,500 persons living in over 650 localities in almost all Spanish regions (Gamella, Gómez Alfaro, and Pérez 2014). Today the roughly half a million Gitanos live in more than 1,000 villages, towns, and cities all over Spain (Fundación Secretariado Gitano 2008).

Thirdly, most experts have assumed that Gitano families did not register the births or deaths of their dear ones until very recently (see, for instance, San Román 1997; Ramírez Heredia 2005). This assumption was in line with the popular misrepresentation of Romani groups as essential nomads; that is, people who maintained weak and uncertain links with their places of birth and residence. Contrary to this assumption, we have found that Gitano families have been registering their births, deaths, and official marriages in the parish registers of Andalusia since the beginning of the 18th century, and often before.7 This practice was reinforced by the establishment of the Civil Registry in 1871, and became commonplace in the 20th century. Some underregistration, however, was common in the first decades of the functioning of the Civil Registry. Under-registration of infant deaths among the Gitano people may have been important at least until the second decade of the 20th century. On the other hand, common law marriages by ‘Gitano law’ were obviously not registered until they were sanctioned by Catholic and civil authorities, a process that increased during the 20th Century (Martín and Gamella 2005).

In a previous paper we have described the methodological and technical strategies followed in our genealogical and familial reconstruction. Readers are referred to that paper (Gamella, Martín, and Quesada 2014). Below we summarize its main points.

2.1 Gitano identity and identification processes 
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MULTIPLE INDICATOR CLUSTER SURVEY BOSNIA AND HERZEGOVINA ROMA SURVEY 2011-2012

https://mics.unicef.org/files?job=W1siZiIsIjIwMTUvMDEvMjcvMDgvNTIvNTgvNDUxL01JQ1M0X0JpSF9Sb21hUG9wX0luZm9ncmFwaGljcy5wZGYiXV0&sha=b0bf1d7cc6a13a2f

MULTIPLE INDICATOR CLUSTER SURVEY BOSNIA AND HERZEGOVINA ROMA SURVEY 2011-2012



Roma Health Report Health status of the Roma population Data collection in the Member States of the European Union

https://ec.europa.eu/health/sites/health/files/social_determinants/docs/2014_roma_health_report_es_en.pdf
Roma Health Report Health status of the Roma population Data collection in the Member States of the European Union

Executive Summary
 Introduction 

This study was carried out by Matrix Knowledge in collaboration with the Centre for the Study of Democracy, the European Public Health Alliance and individual national researchers on behalf of the Consumers, Health and Food Executive Agency and DG SANCO. The purpose of this report is to provide an evidence-based review of literature on Roma health, covering 2008-2013 and the following indicators: 

1. Mortality and life expectancy 
2. Prevalence of major infectious diseases 
3. Healthy life styles and related behaviours 
4. Access and use of health services and prevention programmes 
5. Prevalence of major chronic diseases 
6. Health factors related to the role of women in the Roma community 
7. Environmental and other socio-economic factors

The methodology used was based on two steps: (i) Desk Research based on the review of secondary data (a literature review); and (ii) Fieldwork collecting primary data through semi-structured interviews.

Background and context

 There has long been a consensus that compared with the non-Roma population in Europe Roma have poorer health. The poor health of Roma is closely linked to social determinants of health. The social inclusion and integration of Roma communities is a joint responsibility of Member States and the European Union. The Commission monitors progress made by Member States through the EU Framework for National Roma Integration Strategies1 . The EU has been also supporting international network initiatives e.g. Roma Summits and the Decade of Roma Inclusion (2005-2015). The Enlargement Countries have been encouraged to shape their strategies to support the integration of Roma (including health) based on Commission Communication of 2011. Results for better inclusion of the Roma population have been limited2 . In particular, issues related to health have been only partly addressed.  

The first Commission assessment of the NRIS reported some limitations regarding the possibility of measuring the potential impacts of the stated objectives3 . There is a need to establish specific targets, attainable goals within the timeframe set and measureable deliverables through an effective system of monitoring and evaluation of the implementation of the national policies4 . The second assessment of the Commission in June 2013 reiterated Member States need to make stronger efforts to set up sound monitoring and evaluation methods to assess the results and impacts of Roma inclusion measures, including health, in order to enable policy adjustments when necessary. 

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The European Public Health Alliance (EPHA) is currently undertaking an evidence-based literature review on the Roma life expectancy gap, based on the following indicators:

https://epha.org/wp-content/uploads/2018/10/closing-the-life-expectancy-gap-of-roma-in-europe.pdf


The European Public Health Alliance (EPHA) is currently undertaking an evidence-based literature review on the Roma life expectancy gap, based on the following indicators:

 1. Life expectancy gap between Roma and non-Roma 2. Roma children and infant mortality 3. Determinants of life expectancy

The poor state of health in Roma communities is prevalent—and largely ignored—across Europe. Some Roma are completely excluded from health care, while most face hostility and discrimination within healthcare settings. Available literature on Roma and health agrees that:

Roma people suffer from poorer health and unhealthier living conditions compared to majority populations;
• better data is needed to explain the Roma health gap and design better interventions to reduce this gap;
• the poor health of Roma is closely linked to the social determinants of health¹.

Studies have consistently found that Roma health is worse than the health of the majority populations or other ethnic minority groups. Estimated life expectancy for Roma is consistently lower than corresponding national averages. Infant mortality among Roma is estimated to exceed national averages by several percentage points. Roma are less likely to be covered by health insurance. Roma do not appear to enjoy preventive health care on equal footing with non-Roma and instead are more likely to rely on emergency services. Academics and advocates identify inadequate living conditions, poverty, limited education, and pervasive discrimination against Roma by health care professionals and the public as the key reasons for the poor health of Roma².

Like all Europeans, Roma represent patients, caregivers, and families. Yet on average, Roma will die ten - fifteen years earlier than most Europeans. Roma are less likely to be vaccinated, have fewer opportunities for good nutrition, and experience higher rates of illness. In some countries, six times as many of Roma infants do not make it to childhood. If they do, they will have experienced more infections and diseases than other groups living in similar economic conditions³.

In order to identify the Roma life expectancy gap in the literature, a search was carried out using terms such as life expectancy, mortality, early childhood development, infant mortality and determinants. Both qualitative and quantitative studies were included. English and national language published articles were selected. Reports, surveys, statistics, strategy and discussion papers sources were also consulted. Different databases using a combination of specific terms were also searched.

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https://epha.org/wp-content/uploads/2018/10/closing-the-life-expectancy-gap-of-roma-in-europe.pdf


Roma children

https://www.unicef.org/bih/en/roma-children

Challenge

According to official estimates, in Bosnia and Herzegovina live between 25,000 and 50,000 Roma people. They are recognized as the largest, most neglected and most vulnerable minority in Bosnia and Herzegovina. They are recognized as the largest, most neglected and most vulnerable minority in Bosnia and Herzegovina and the conditions in which the majority of the Roma families in Bosnia and Herzegovina live can be characterized as a state of chronic, multidimensional poverty.
The gap between the Roma and the majority of the population, in terms of housing, employment, education, and healthcare, is very noticeable, and Roma women are in a particularly difficult situation.
Key indicators for Roma children show that these children are three times more likely to live in poverty than their non-Roma peers, five times more likely to be malnourished and twice as likely to be lagging behind in growth. The enrollment rate in primary school is lower by one third than among the non-Roma population, and the rate of immunization is only four percent compared to 68 percent among the majority of the population.
A Multiple Indicator Survey (MICS) of the Roma population for 2011 and 2012 in Bosnia and Herzegovina has shown that:
  • The infant mortality rate among Roma is 24 per 1,000 live-born children, while the likelihood of dying before the age of five 27 per 1,000 live-born children.
  • 21 percent of Roma children are of short stature, while eight percent of children are seriously lagging behind in growth.
  • Only two percent of Roma children aged between 36 and 59 months are enrolled in organized early childhood education programs, while only four percent Roma children that are enrolled in the first grade of primary school attended pre-school institutions in the previous year.
  • Only one-half of Roma children (47 percent) that are old enough to be enrolled in the primary school attend the first grade of primary school.
  • Over one-half of Roma children aged between two and 14 years were exposed to some form of psychological or physical punishment by their parents or other adult members of their households.
  • Solution

    UNICEF Bosnia and Herzegovina, in cooperation with its partners, provides support to the Ministry of Human Rights and Refugees in Bosnia and Herzegovina in implementing the Multiple Indicator Survey (MICS) about Roma in cooperation with the Agency for Statistics in Bosnia and Herzegovina.
    The fourth cycle of the global MICS research in 2011 and 2012 included for the first time a special research on health, nutrition, education, child protection and other indicators related to the lives of Roma in Bosnia and Herzegovina.
  • As a signatory of the Convention on the Rights of the Child, Bosnia and Herzegovina has committed itself to respecting and guaranteeing the rights of children listed in the Convention without any discrimination in respect of child’s race, color, sex, language, religion, political or other affiliation, national, ethnic or social origin, property status, disability or other status.
  • ....