SKOPJE, the Former Yugoslav Republic of Macedonia — Here in the capital city, people enjoy the life of a modern Europe. But just an hour's drive away, on its outskirts lies Shutto Orizari, a derelict ghetto that is home to more than 30,000 Roma people.

This is where Bajramsha Salmani lives. Barely 30 years old, she has seven children. "I wasted my whole life caring for my children," she says with resignation. "My life is over."

It's just past 10 o'clock in the morning. Some of her children are still in bed in their single-room shack. Amid the clutter of soiled blankets and empty kitchen pots, they're in no hurry to get up. Today, like any other day, there is no breakfast waiting and no school to go to. For them, this morning marks the beginning of another long day, waiting to see if their father -- who occasionally gets work collecting recyclables at a nearby waste site -- can bring home enough money to feed them.

"On days when he gets paid," Bajramsha explains, "he buys sausages, four loaves of bread and some milk for the baby. We get one meal one day and eat nothing another day."

Her children are full of lice, wearing thread-bare clothes that haven’t been washed in weeks. Her youngest clutches a precious bottle of milk, his fingernails black with dirt.

"There is no place to wash them," she utters in desperation. "There is no shampoo, no clothes. My life is full of pain and suffering."

Limited access to education and basic healthcare

Too many Roma women in Eastern Europe and Central Asia share Bajramsha’s outlook on life, many lacking the social status and self-esteem to overcome adversity. Bound to tradition and restrictive gender norms, the women of this community are further limited by ethnic and cultural divides from the mainstream population. These factors are compounded further by poverty, as well as limited access to education and services such as basic healthcare.

Improved access to reproductive health services in particular contributes to women’s economic empowerment – when a woman has autonomy over her choices pertaining to her sexual and reproductive health and reproductive rights, and if she is able to decide who and when to marry, or how many children to have and when, she is in a better position to be economically empowered.

In conjunction with the 56th Session of the Commission on the Status of Women, UNFPA is highlighting the importance of economic empowerment and sexual and reproductive health services as key to reversing the low social and economic status of many women, especially those who live in rural areas. The overall theme of this year’s commission is “empowerment of rural women and their role in poverty and hunger eradication, development and current challenges”.

Roma: A community in need

Bajramsha and her family are far from alone, particularly in the Roma community, where a lack of opportunity applies to both men and women. Often regarded as outsiders, these people have long endured a life of prejudice and seclusion, leaving many Roma to live in abject poverty and increasing their risk of ill health, including the transmission of sexually transmitted infections such as HIV.

"This prejudice is wrong,” says Roma advocate, Ljatifa Sikovska. "The Roma are very loyal and hardworking people. Unfortunately, when most people hear the word 'Roma,' they immediately think of the stereotype of cheating and stealing."

A Roma herself, Ljatifa says the key to breaking this stereotype and the vicious cycle of poverty is to ensure they have the same rights and access to opportunity as everyone else.

"The integration process if very difficult," she continues, "and we must not leave that road."

Empowering Roma women and children to improve their quality of life

"Roma, wherever they are, have to understand one thing," explains Ljatifa. "They can't expect to stay home and wait for someone to come and sort out their problems. They need to be more active – raise their voice; fight for their rights. We need to change things."

As part of her work to improve the lives of Roma people, Ljatifa watches out for those in need. Not willing to take no for an answer, she brings Senada and her baby to the hospital to demand that she be treated. As a member of the Roma community with an education, she knows her rights, as well as those of Senada and her little girl.

Helping women make informed choices about family size is a critical step, says Latifa. "Families with many children are an issue in Roma communities. We try to explain through workshops with these women how to protect themselves and plan their families."

UNFPA is trying to work with the community in particular to raise their awareness. "Ignorance about existing services and about your rights is one of the worst things,” says Tatjana Sikoska, former Programme Coordinator for UNFPA. “And I think one of the key aspects of work is to tell them that there is a service, that there is a right and that they are entitled to fulfill that right."

Building a future for her community, starting at home

It is still a long road ahead, but by empowering the women and children of the Roma community, Ljatifa is paving the way to break the chain of poverty and social injustices that have beset her people for centuries.

“Mainstream society thinks that the Roma people do not want to be integrated,” she says. “That is not true. We do not have equal rights or equal status. That is why we are not able to express our values properly. I believe that every Roma person, girl or boy, deserves the opportunity to express themselves and to be a part of mainstream society.”

UNFPA advocates for the equal rights of Roma, and in particular for the health and empowerment of women and children. This year the Fund supported the international “Roma Health Conference – 2012 – Towards Better Health of Roma People”. Together with relevant stakeholders working to improve Roma health, UNFPA drafted the “Skopje Roma Health Declaration” to ensure joint ownership moving forward. The Skopje Declaration aims to catalyze the process of raising awareness and advocating for increased action on Roma health. The Declaration is supported in all countries that have signed on to the Decade for Roma Inclusion initiative, a political commitment by European governments to improve the socio-economic status and social inclusion of Roma.