By Nyasha Chingore-Munazvo and Priti Patel
Around the world a woman dies of cervical cancer every two minutes. This is even worse in southern Africa, where cervical cancer is the leading cause of cancer death among women — more women in southern Africa die of cervical cancer than breast cancer.
Deaths due to cervical cancer in southern Africa are further increased by the link between cervical cancer and HIV. Research has shown that women infected with HIV are more likely to develop cervical lesions that can become cancerous. Furthermore, cervical lesions occur at a younger average age in women living with HIV, and progress more quickly if left untreated. Cervical cancer in the region thus afflicts women at a time when they are most productive.
But deaths from cervical cancer are completely preventable. Of the women who die worldwide from cervical cancer, only 14% of such deaths take place in developed countries. The overwhelming majority take place in developing countries.
Compelling evidence shows that with comprehensive management programmes, cervical cancer is easily manageable in any resource setting. Scientific, medical and public health advances have identified methods which can be used in low-resource settings to effectively address pre-cursors to cervical cancer. Yet very few countries in southern Africa have utilised these tools.
In 2011, the Southern Africa Litigation Centre embarked on research to determine the barriers to accessing and making available cervical cancer services in the region in order to identify how governments could overcome such barriers. What we found was troubling. In Zambia and Namibia, where we met with almost 200 women to discuss their experiences accessing cervical cancer services, we found that very few countries in the region have comprehensive policies on cervical cancer. Prevention services such as screening and vaccinations were not widely available in the public sector and treatment for both pre-cancerous lesions and invasive cancer remained a challenge.
One woman we spoke to in Zambia, who was in her mid-thirties and living with HIV, recounted being told by her local hospital that they did not have adequate facilities to assess how advanced the cervical cancer was. She had to travel 45km to access the necessary medical services. Even then she was told that her exact results would take too long and thus she should undergo a hysterectomy in case she had advanced cervical cancer. She learned months after the hysterectomy that she did not in fact have advanced cervical cancer and would not have needed a hysterectomy.
Unfortunately her story was not unique. We continuously heard about how the unavailability and inaccessibility of screening services often resulted in women only accessing medical assistance when they had advanced cervical cancer, resulting in significant physical pain, psychological distress and in many cases death. Some women recounted how inadequate access to services resulted in their undergoing unnecessary procedures, which had significant social and cultural ramifications for them.
The good news we found was that the issues identified by the research can be addressed by governments in southern Africa with very little effort. As a first critical step, countries need to implement comprehensive policies on cervical cancer. At present very few countries in southern Africa have comprehensive policies on cervical cancer management. The issuing of such policies can send a strong signal of government’s commitment to addressing cervical cancer and can provide a much needed roadmap for how to address cervical cancer. The lack of such policies sends a disturbing signal that the medical needs of women are not a priority for government.
The low level of prioritisation of cervical cancer in the region is unfortunately just another example of the lack of political will to provide for the sexual and reproductive health needs of women. Women in southern Africa bear the greatest burden of the HIV pandemic. The region continues to face excessively high maternal mortality and gender based violence rates and women’s rights are continuously impugned with little response from government. Child marriage is rampant. A significant percentage of maternal deaths in the region are reported to be due to complications from unsafe abortions but this has resulted in little government action to relax laws and ensure access to safe services. Violations such as the forced and coerced sterilisation of women living with HIV continue uncurbed in some countries.
Failure on the part of southern African governments to address women’s health challenges constitutes a gross violation of women’s rights. It is the duty of governments to ensure that the rights of all people including the rights of women are respected.
The prevalence of cervical cancer among women in the region represents one of the greatest health failures of our time. The premature death of thousands of women from a preventable disease carries untold social and economic consequences. It is time for southern Africa to make the decision that women’s lives are worth saving.
Nyasha Chingore-Munazvo is a project lawyer with the Southern Africa Litigation Centre and the author of a recently-published report on cervical cancer.
Priti Patel is the deputy director of the Southern Africa Litigation Centre.