Inequalities in the use of gynecological visits and preventive services for breast and cervical cancer in Roma women in Spain

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The Roma population in Spain makes up about two percent of the population and has worse health indicators than the general population. We analyzed both populations in 2006 and 2014 to discover whether there are differences in terms of gynecological visits and preventive services for breast and cervical cancer in Spain.


Cross-sectional study is based on the Spanish National Health Survey (SNHS) of 2006 and 2012 and the National Health Survey of the Roma Population (NHSRP) of 2006 and 2014.


Roma women used gynecological visits less than the general population in 2006 (ORa 0.5 [0.4; 0.6] and in 2014 (ORa 0.2 [0.2; 0.3)]. In addition, use of the mammogram was lower in Roma women (ORa 0.7 [0.6; 0.8]), especially in the ages of the screening tests, and they had lower probability of receiving cervical examinations in 2006 (ORa 0.5 [0.4; 0.6]) and in 2014 (ORa 0.7 [0.6; 0.9]).


This study shows that the inequality gap in gynecological visits and preventive services for breast and cervical cancer in Roma women has persisted during the years studied (2006 and 2014), despite Spanish prevention policies.

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  1. Andreassen T, Weiderpass E, Nicula F et al (2017) Controversies about cervical cancer screening: a qualitative study of Roma women’s (non)participation in cervical cancer screening in Romania. Soc Sci Med 183:48–55.

  2. Andreassen T, Melnic A, Figueiredo R et al (2018) Attendance to cervical cancer screening among Roma and non-Roma women living in North-Western region of Romania. Int J Public Health 5:1–11.

  3. Asociación Española de Patología Cervical y Colposcopia (2014) Prevención del cáncer de cuello de útero 2014. [Prevention of cervical cancer], Madrid. Spain

  4. Carrasco-Garrido P, López De Andrés A, Hernández Barrera V et al (2011) Health status of Roma women in Spain. Eur J Public Health 21:793–798.

  5. Cook B, Wayne GF, Valentine A et al (2013) Revisiting the evidence on health and health care disparities among the Roma: a systematic review 2003–2012. Int J Public Health 58:885–911.

  6. Dall TM, Chakrabarti R, Storm MV et al (2013) Estimated Demand for Women’s Health Services by 2020. J Women’s Heal 22:643–648.

  7. Djikanovic B, Stamenkovic Ž, Mikanovic VB et al (2018) Negative attitudes related to violence against women: gender and ethnic differences among youth living in Serbia. Int J Public Health 63:923–932.

  8. Escribà-Agüir V, Rodríguez-Gómez M, Ruiz-Pérez I (2016) Effectiveness of patient-targeted interventions to promote cancer screening among ethnic minorities: a systematic review. Cancer Epidemiol 44:22–39.

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

  10. European Union (2014) Roma Health Report. Health status of the Roma population, pp 1–152

  11. Fernández-Feito A, Pesquera-Cabezas R, González-Cobo C, Prieto-Salceda MD (2017) What do we know about the health of Spanish Roma people and what has been done to improve it? A scoping review. Ethn Health 7858:1–20.

  12. Firebaugh G (1997) Analyzing repeated surveys. SAGE Publications, Inc., Pennsylvania State University, Pennsylvania

  13. Fundación Secretariado Gitano (2009) Health and the Roma Community, Analysis of the Situation in Europe. Bulgaria, Czech Republic, Greece, Portugal, Romania, Slovakia, Spain

  14. García C (2006) Guía para la actuación con la Comunidad Gitana en los Servicios Sanitarios. Fundación Secretariado Gitano. [Guide for action with the Roma Community in Health Services], Madrid. Spain

  15. Gil-González D, Vives-Cases C, Álvarez-Dardet C (2007) ¿Es el racismo relevante para la salud pública española? Gac Sanit 21:431–432.

  16. Consejería de Sanidad. Gobierno de Cantabria (2015) Criterios de actuación para el cribado, diagnóstico y seguimiento radiológico de la patología mamaria. [Criteria of action for the screening, diagnosis and radiological monitoring of breast pathology], Santander

  17. International Agency for Research on Cancer (2017) Cancer screening in the European Union. Iarc 333

  18. Janevic T, Jankovic J, Bradley E (2012) Socioeconomic position, gender, and inequalities in self-rated health between Roma and non-Roma in Serbia. Int J Public Health 57:49–55.

  19. János S, Zsigmond K, Klára B et al (2017) The decade of Roma Inclusion: did it make a difference to health and use of health care services? Int J Public Health 62:803–815.

  20. Jarcuska P, Bobakova D, Uhrin J et al (2013) Are barriers in accessing health services in the Roma population associated with worse health status among Roma? Int J Public Health 58:427–434.

  21. Kósa Z, Széles G, Kardos L et al (2007) A comparative health survey of the inhabitants of Roma settlements in Hungary. Am J Public Health 97:853–859.

  22. La Parra-Casado D (2009) Hacia la equidad en salud. Disminuir las desigualdades en una generación en la comunidad gitana. [Towards Equity in Health. Reduce inequalities in one generation in the Roma community], IUDESP, Universidad de Alicante

  23. La Parra-Casado D, Gil-González D, Jiménez A (2013) Social exclusion processes and the health status of the Roma people in Spain. Gac Sanit 27:385–386.

  24. La Parra-Casado D, Mosquera PA, Vives-Cases C, Sebastian MS (2018) Socioeconomic inequalities in the use of healthcare services: comparison between the Roma and general populations in Spain. Int J Environ Res Public Health.

  25. Latorre-Arteaga S, Gil-González D, Vives-Cases C, La Parra-Casado D (2017) Vision and Hearing Health Inequities in the Roma population: a National Cross-Sectional Study in Spain. J Immigr Minor Heal 19:1304–1314.

  26. López de Argumedo M, Bayón Yusta J, Mateos del Pino M (2016) Impacto de la implantación de un programa de cribado poblacional de cáncer de cérvix, siguiendo las recomendaciones europeas (prueba/intervalo) en relación a la situación actual. Minist Sanidad, Serv Soc e Igualdad Serv Evaluación Tecnol Sanit del País Vasco OSTEBA

  27. Masseria C, Mladovsky P, Hernández-Quevedo C (2010) The socio-economic determinants of the health status of Roma in comparison with non-Roma in Bulgaria, Hungary and Romania. Eur J Public Health 20:549–554.

  28. Ministerio de Sanidad. España (2010) Plan de calidad para el Sistema Nacional de Salud 2010. Plan Calid para el Sist Nac Salud

  29. Ministerio de Sanidad (2013) Informe del grupo de expertos sobre concreción de cartera común de servicios para cribado de cáncer. [Report of the expert group on the definition of a common portfolio of services for cancer screening], Spain

  30. Ministerio de Sanidad (2014) Estrategia Nacional para la Inclusión Social de la Población Gitana en España 2012–2020

  31. Ministerio de Sanidad Servicios e Igualdad, Dirección General de Salud Pública Calidad e Innovación (2018) Segunda Encuesta Nacional de Salud a la Población Gitana 2014. 258

  32. Ministry of Health (2017) 2012–2016 Evaluation: Summary of Progress and Proposals for Improvement. Conclusions of the reports: monitoring of the 2014-2016 Operational Plan and intermediate monitoring of the Strategy (evaluation)

  33. Molina Barceló A, et al (2016) Análisis del cribado del cáncer en España desde una perspectiva de equidad. [Analysis of cancer screening in Spain from an equity perspective]. Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana

  34. Usera-Clavero M, La Parra-Casado D, Caballero P et al (2019) Smoking prevalence inequalities among roma and non-roma population in Spain Between 2006 and 2014. J Immigr Minor Heal.

  35. Vives-Cases C, La-Parra-Casado D, Gil-González D, Caballero P (2018) Acceptability of violence against women among the roma population in Spain. J Interpers Violence.

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The authors give thanks to the interviewers and associations of the Roma community in Spain for participating in this study.


Ministry of Science, Innovation and Universities of Spain, European Regional Development Funds (ERDF) (“Comparative impact evaluation: Roma National Integration Strategies”, Project Ref. CSO2017-83787-P). Ministry of Economy and Competitiveness of Spain, European Regional Development Funds (ERDF) (“National Health Survey of Roma Population 2013–2014”, Project Ref. PI12/00842). University Research Institute for Gender Studies (IUIEG), for contributing economically in activities leading to doctoral theses that include a gender perspective (2017).

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Correspondence to Diana Gil-González.

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The authors have no conflict of interest.

Ethical approval

The research was approved by the Ethics Committee of the University of Alicante (Spain). Those interviewed were informed in writing and verbally of the objective of the survey, the voluntary nature of participation, the protection of anonymity and confidentiality, and of the institution and team responsible for conducting the survey. No incentive for participation was offered to respondents.

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Usera-Clavero, M., Gil-González, D., La Parra-Casado, D. et al. Inequalities in the use of gynecological visits and preventive services for breast and cervical cancer in Roma women in Spain. Int J Public Health (2020).

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  • Roma health
  • Mammography
  • Cervical screening
  • Screening programs
  • Gynecological visits
  • Inequality