The Shifting Politics of Health in Canada: Papanicolaou (Pap) Screening, Human Papillomavirus (HPV) Vaccination, and Cervical Cancer Prevention (original) (raw)
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Engaging Canadian First Nations women in cervical screening through education
Recognition of the need to decrease cervical cancer rates in Indigenous populations has been ongoing – yet few successful interventions have been reported. In addition, the literature addressing the challenges and barriers associated with designing screening programs aimed to specifically reach Indigenous women is limited. Here, we report findings from a mixed methods cervical cancer research project conducted in partner-ship with 10 First Nations communities in Northwest Ontario, Canada. Individual inter-views with community health professionals (the majority of whom identified as First Nation) stressed that awareness of cervical screening benefits is lacking. In contrast, focus group participants (women with no formal health education) emphasized the desire to learn more about the science of human papillomavirus (HPV) and that a posi-tive HPV or abnormal Papanicolaou test need not mean a woman will develop cervical cancer. Both the health professionals and the focus group participants highlighted that sexual health education must start early, in schools, preferably before girls are sexually active and that it has to continue throughout life to create a screening culture with a focus on women’s well-being. Health professionals elaborated mainly on special events for community women, whereas focus group participants also recognized the need to include community men in health education particularly for destigmatizing the sexually transmitted HPV infection.
BMC International Health and Human Rights, 2020
Background Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between...
Gynecologic oncology, 2018
In Canada, Indigenous people have higher human papillomavirus (HPV) infection rates, lower screening rates for cervical cancer, and higher rates of invasive cancer, leading to worse cervical cancer-related outcomes than observed in non-Indigenous Canadian women. Lingering harms from European colonization drive these health inequities and create public health challenges. Policy guidance is needed to optimize HPV vaccination rates and, thereby, decrease the burden of HPV-related illness, including high-morbidity surgical procedures and chemo-radiotherapy. The Enhancing HPV Vaccination In First Nations Populations in Alberta (EHVINA) project focuses on First Nations, a diverse subset of recognized Indigenous people in Canada, and seeks to increase HPV vaccination among girls and boys living in First Nation communities. Developing an effective strategy requires partnership with affected communities to better understand knowledge and perceptions about cancer, healthcare, and the HPV vacc...
The marketing of Gardasil1 and CervarixTM vaccines for the prevention of human papillomavirus (HPV) targeted pre-sexual girls and cervical cancer, representing young women as practicing ‘decision autonomy’ in acquiring the ‘facts‘ about HPV and cancer. We challenge this overly simple explanatory model of vaccine choice. Through interviews with vaccine scientists and public health nurses in Canada, we illustrate the clinical, political and practical complexities of introducing a new and controversial vaccine. The omission of provocative sexual themes in the marketing of the vaccine strategically created an object marked for ‘women only’. The public acceptability of the vaccine was promoted by neglecting the clinical and sexual facts of the spread and prevalence of HPV infection and related cancers across genders and sexual orientations. This strategic omission generated a blockbuster vaccine embedded in a discourse of individualised risk and pharmaceutical control centred on female bodies.
Women's Health Issues, 2013
Objective-In Canada, opportunistic screening programs have successfully reduced mortality from cervical cancer; however, minority or disadvantaged groups, as well as women in northern and rural areas, are inadequately recruited by this approach. Hence, we set out to examine the structural barriers that prevent First Nations women's participation in cervical cancer screening. Methods-Using a participatory action research approach and semistructured interview guides, we conducted in-depth interviews with 18 experienced health care professionals, 12 of whom were also community members. These individuals included nurses, nurse practitioners, community health representatives, social workers and physicians who provide care to women in our First *
Making the case for cervical cancer prevention: what about equity?
Reproductive Health Matters, 2008
Cervical cancer is a major cause of suffering and premature death among women in the developing world, yet it is largely prevented in most higher-income countries. From an equity perspective, cervical cancer is unequally distributed globally in ways that are unnecessary, avoidable and unjust. Although cost-effectiveness analyses demonstrate that prevention measures are justified in low-resource countries, affordability and lack of prioritisation have contributed to a lack of progress. This paper describes the inequities in cervical cancer disease burden, barriers in access to and utilisation of services, and the underlying conditions of poverty and low socio-economic status that put women in a disadvantaged position. These social disadvantages are aggravated by the disease itself, with serious consequences for women, their families and communities. Remedies are available in the form of new prevention and treatment approaches, including vaccines against human papillomavirus (HPV), rapid HPV testing, visual inspection of the cervix with acetic acid (VIA) and cryotherapy. These technologies could help to overcome the social, economic, and political disadvantages that contribute to disparities in cervical cancer incidence and mortality through an optimal combination of vaccination, screening and treatment. In the long run, however, increasing women's access to care will also require societies to address structural barriers related to health systems and poverty.
2010
This article presents a critical feminist perspective on New Zealand's HPV immunisation programme. The programme, delivering the HPV vaccine to young women, has been progressively rolled out since September 2008 and heralded as a major development in cervical cancer prevention and women's health more generally. However, the programme has also been the subject of fierce debate, for both its context and the strategies used in its implementation. Women's health advocacy groups have been highly critical of aspects of the programme's implementation. Concerns have included the gendering of sexual health responsibility by targeting the vaccine only at young women; the disregard of consumer rights to informed choice and consent in the marketing of the programme; and the failure to integrate the programme with the National Cervical Screening Programme which risks undermining the life saving success of cervical screening in New Zealand.
Canadian journal of public health = Revue canadienne de santé publique
To describe the similarities and differences among multiple groups of immigrant women and Canadian-born women of low socio-economic status regarding barriers and enablers associated with cervical cancer screening, in order to inform core elements of a strategy that would be acceptable across multiple underscreened groups. Within a health behaviour framework, we used a qualitative explanatory multiple-case study approach consisting of focus group interviews (n = 11) in Hamilton, Canada. Participants were newly immigrated (1-5 years) women and a group of Canadian-born women of low socio-economic status; all participants were in the age range 35-69 years and married. Language groups were Arabic, Cantonese, Somali, Dari (Afghanistan) and Spanish (Latin America). Two separate focus groups for each ethnolinguistic group were conducted; one in English and one in the native language. A template approach to analysis was used. All groups indicated a strong need for information on necessity of...