Bulgaria: Providing The Freedom To Choose - Doctors of the World

Bulgaria: Providing The Freedom To Choose

In the small town of Sliven, Bulgaria’s largest Roma community faces isolation, social stigma, and a lack of adequate access to medical care

Doctors of the World has been working with the Roma community in the Sliven neighbourhood of Nadejda for over 14 years

The vast majority of the 25,000 Roma in Nadejda live in extremely precarious conditions. Half of the population are unemployed and very few are covered by adequate health insurance or have access to welfare services.

Our team’s main priority is to provide Roma women and girls, one of the most marginalized communities in Europe, with access to sexual and reproductive care. We provide information about birth control, the prevention of sexually transmitted diseases, and different types of contraception to the Roma community free of charge.


The vast majority of Roma girls in Nadejda do not attend school and get married very young. “For many parents, their daughter’s most valuable asset is her virginity and her fertility,” says Agathe Simonin. “They marry them very young, as soon as a girl gets her period. She must then have children very quickly so that she is not rejected by her in-laws. Few Roma girls have access to family planning because there is a lack of access to sex education, there are fears about the effects of contraceptives, and the practice is often opposed by family members. Girls often have multiple pregnancies one after the other that are not widely spaced and not always planned or desired.”

Zina, 32, is already the mother of 3 children

Today she is pregnant with her fourth, and she would like to have an IUD inserted. “I did not want to have any more children, I do not have money to take care of them. Many women in Nadejda choose to use intrauterine devices, a method that is often initially feared but ultimately considered less restrictive and more effective.”

Our team faces many challenges that include overcoming the social stigma associated with family planning, and reassuring patients that contraceptive methods are safe. A large part of their work is centered around raising awareness about sexual and reproductive health issues from within the community, by working in the streets of Nadejda and making house calls. They also conduct group information sessions, including ones specifically designed for men.


“One of the biggest challenges our team faces is overcoming the social stigma associated with family planning”


Many women and girls from Nadejda are apprehensive of attending medical appointments. In addition to concerns about their health, the often unsanitary conditions and lack of available water to wash with often leaves them feeling reluctant to visit a doctor.

As a result, our teams installed showering facilities at our clinics. “That way they can wash and feel clean and comfortable when we take them to their appointment with the gynecologist,” said Sofiya Ivanova, one of the health mediators who lives in Nadejda herself.

Stefka Nikolova, DotW Community Health Worker


“I got married at 15 and became a mother when I was 17. I saw that the women around me had many children and did not know how to cope. It made me want to help. I asked Doctors of the World for training to become a community health worker. It’s easier to talk about sex when you’re close to people. We take women and girls to information sessions on hygiene, puberty, contraception and sexually transmitted diseases. Today, my 15-year-old daughter is pursuing her language studies. I am so proud of her.”