Bugarie Santé sexuelle et reproductive



Roma live in the Nadezhda ghetto


Roma are estimated to live in Bulgaria, making up 10% of the population


Sexual and reproductive health

In Bulgaria the rates of abortion and of mortality among women giving birth are twice as high as in the rest of Europe : almost a third of pregnancies are terminated. The most marginalised groups are the most at risk. 

Roma people are subject to discrimination in several ways, particularly regarding access to healthcare. Among the Roma 57% of men and 59% of women have no social security cover, compared to 20% for the rest of the Bulgarian population. These figures are higher than anywhere else in the European Union. The attitude of healthcare staff tends to be mistrustful and negative and maternity units have separate wards for Roma women.

Sliden has the highest rate of early pregnancy in Bulgaria

In the Nadezhda ghetto, in the town of Sliven, access to healthcare is particularly difficult for the marginalised Roma who live in conditions of extreme hardship. Ambulances refuse to go into the ghetto. Sliven has the highest rate of early pregnancy in Bulgaria: in 2017, 9.5% of live births were to mothers under the age of 17 (compared to 2.9% for Bulgaria as a whole). The most vulnerable families can’t afford contraception and/or safe abortions.


Migration, rights and health


Although Bulgaria was affected by the migrant crisis in 2015 and received large numbers of asylum seekers (20,000 asylum claims in 2015), the number of refugees has since fallen considerably. In 2019 there were 2,000 asylum claims and the reception and registration centres saw fewer than 400 people, taking up less than 8% of their capacity. The State Agency for Refugees is therefore now able to respond to the refugees’ healthcare needs itself and so Médecins du Monde has ended its work in the centres, although it continues to support the organisations working in the camps.

However, civil society views the presence of the refugees in Bulgaria very negatively and they face violent backlashes. Moreover, the registration system for accessing the healthcare system and the limited numbers of doctors in the country significantly impedes access to healthcare.

Our activities in Bulgaria

Rights and health

Having worked in the Nadezhda ghetto since 2003, Médecins du Monde ended its programme on preventing unwanted pregnancies in April 2019. Since then, a new programme to increase ‘access to services and rights for the vulnerable communities living in Nadezhda’ was launched in September 2019.

The goal of this new project is to support the empowerment of the Roma population, especially young people, to enable them to exercise their rights and obtain effective access to sexual and reproductive health services in Nadezhda.


A woman and her three children in Nadezhda ghetto, Sliven, Bulgaria © Gaelle Girbes

In total, the project is aimed at 20,000 people.

The new programme comprises three elements:

  • The residents of Nadezhda gain a better awareness of their rights (health and social rights), particularly in relation to sexual and reproductive health.
  • Médecins du Monde encourages community mobilisation and supports the advocacy work undertaken by Nadezhda residents.
  • The residents have better access to health and social care services in Sliven.



In 2019


  • reached 4,800 people with our awareness-raising message through information sessions and visits to Nadezhda

  • held 49 sessions where ghetto residents could come and talk to someone in confidence

  • supported the establishment of community groups and advocacy for better access to services and rights

  • carried out a mapping exercise of services available to the residents of Nadezhda


Addressing and preventing gender-based violence

Launched in September 2018, the WE ACT project involves five European countries in which Médecins du Monde France and Médecins du Monde Belgium operate, including Bulgaria. The aim of this Médecins du Monde project is to address and prevent the gender-based violence which is commonly experienced along the routes taken by migrants. The project seeks to help women and children who are migrants and refugees. We support capacity-building for healthcare staff so that migrants who have experienced violence can be more effectively identified and integrated into the national healthcare system.




In 2019


  • produced a leaflet and posters on ‘The right to live without violence’ in different languages (English, Bulgarian, Farsi and Arabic), to be made available at healthcare centres
  • organised several workshops to improve coordination between the police, healthcare staff and social workers in contact with migrants and refugees




our institutional support

Open Society Foundations soutient Médecins du Monde
Beginning of intervention in Nadejda ghetto to improve the living conditions of inhabitants.
Action centred on hygiene, vaccination and sexuality.
Opening of information and advice centre (CIO).
The town hall commits to financing medical family planning consultations for women.
Launch of programme to support migrants in the reception and registration centres.
Launch of programme to support care and treatment for women and children who experience violence as migrants.

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