Travellers' experiences of maternity and child health services in the Mid-Western Health Board area illustrate the need for more training for service-providers, a new report concludes.
The report, carried out by NUI Galway, on behalf of the board's Traveller Health Unit found dissatisfaction among Traveller women with their experience in the maternity hospital and, post-natally, from their GP.
The researchers point out that the health status of nomadic groups everywhere is poorer than among settled communities and that "patient satisfaction is an important indicator of quality healthcare".
Travellers have more than double the national rate of stillbirth, and the infant mortality rate is three times the national average. Traveller women's life expectancy is 12 years less than settled women.
Mr Stiofán de Burca, the health board's chief executive, said that against that background satisfaction with health services for Travellers was critical to their health.
"The provision of specialist services and innovative approaches to complement mainstream services is necessary," he said.
Travellers were trained as researchers as part of the project, and comparisons were made between the perceptions of 52 Traveller and 41 non-Traveller women.
Doctors, public health nurses and midwives were also interviewed.
The researchers concluded that training should be available for all personnel in contact with Travellers. Travellers should be encouraged to report discrimination in a constructive manner. The researchers also suggest the development of dedicated services. The provision of antenatal classes on an outreach or community basis and in Traveller-led situations should be considered. Service-providers should promote breastfeeding, they say.
Among Travellers, the average age for a first pregnancy is 20 compared to 24 for non-Travellers and they have four children on average. The settled community average is 1.44.
Travellers were less likely to attend ante-natal classes, and a majority of comments about antenatal clinical services were negative in tone.
The service was impersonal, language was complicated and insufficient information was forthcoming. "You get the feeling they think, 'Oh, there's another Traveller. Travellers are always pregnant.' Do you know that kind of way?" one interviewee said.
Travellers were also less likely to consult their GP about their babies following delivery. Negative comments about the GP service centred on the lack of explanation during consultation.
Positive comments about their GPs referred to the time and trouble taken by doctors to explain matters to them.
"My doctor actually listens to me . If I have something to say, he'll actually take his time and listen to me. With some doctors to Traveller people, there'd be a rush to get them out and another person in," was one comment made.
Maternity hospital experiences were mixed. The majority of Travellers and non-Travellers were satisfied with the service during delivery.
Negative experiences related to the perceived poor attitudes of staff. Some women said they had not received enough support when they inquired about breastfeeding.
Negative experiences of non-Travellers "referred to either specific instances of unsatisfactory clinical care, unhelpful nursing staff or contrasts between public and private care".
The researchers say that GPs' comments illustrate their belief that cultural differences reside in the Travellers themselves rather than the health system.
"Travellers have no interest in preventive healthcare," one doctor said. Another said Travellers' interest in vaccinating their children and in family planning was sporadic.
Only one GP, out of a total of 58 service-providers interviewed, referred to prejudice among the public being a barrier.
GPs also commented on poor appointment-keeping, the multiplicity of GPs used and Travellers' non-compliance as patients.
Other barriers were poor personal hygiene, the risk of litigation, lying, and the behaviour of adults and children, in waiting rooms.
"The main theme to emerge was that Travellers were seen to be 'demanding' patients.
"These comments demonstrate a tendency with the GPs surveyed to locate problems with service provision within Travellers themselves, rather than the service itself, or indeed the living conditions of Traveller families."