Prioritizing Women’s Health – Let’s Start With Elimination of Cervical Cancer

India desperately needs to ramp up efforts if it wants to meet the WHO's Global

It is unfortunate that even today, globally, over 800 women lose their lives every day to pregnancy and childbirth, one in three experience physical or sexual violence; and mental health challenges such as depression are twice as common in women.

These are just a few examples of gendered imbalances in health. Such preexisting inequalities have only been exacerbated during the COVID-19 pandemic.

For instance, the diversion of essential reproductive and sexual health services has led to devasting consequences for women, with an estimated additional 11,000 maternal deaths in 2020.

Nationwide lockdowns resulted in women shouldering increased unpaid care work, resulting in stress and mental health challenges. There remains much to do to ensure that women’s health is at the front and center, especially as we build back from the pandemic.

In India, lack of awareness and the reluctance to seek preventive healthcare are major roadblocks in ensuring healthcare to women and girls, in both rural and urban settings.

This results in many women and girls bearing the burden of diseases that are otherwise preventable. Cervical cancer is one such preventable and curable disease that disproportionately affects women in the country.

In fact, India is one of the developing countries in the world where the major cause of cancer mortality in women is cervical cancer with 67,477 women dying from the disease every year.

While we are armed with tools such as screening and a highly effective vaccine against HPV, awareness about the disease and uptake of these services remains appallingly low.

Even after being aware of pap smears and cervical cancer screenings, most women refuse to get them done because of the fear of results and stigma associated with the disease. As a result, less than 2 percent of the female population is screened for cervical cancer.

For India to meet the 90-70-90 targets set out by the WHO’s Global Strategy, there is an urgent need to ramp up initiatives geared toward cervical cancer elimination.

There is a dire need for women to get preventive healthcare. We need policy and community efforts to bring more women to the health centres for accessible and economically sound screenings and treatments.

The HPV vaccine has been piloted in three states (Sikkim, Delhi, and Punjab), with Sikkim introducing the HPV vaccine into its immunization schedule.

The state also launched a school-based vaccination program in 2018, making it the first one in the country to achieve >95 percent HPV vaccine coverage among targeted girls (aged 9-14).

Sikkim serves as a model for identifying best practices that can be further leveraged for scaling up HPV vaccination programs across the country and consequently zoom into the need for its inclusion in India’s national immunization schedule.

Along with vaccination, timely and regular screenings are essential to the prevention pillar.

During my tenure as the President of the Federation of Obstetric and Gynaecological Societies of India (FOGSI), we implemented a mother-daughter initiative where mothers were screened for cervical cancer and daughters were vaccinated against HPV.

This program was piloted in three villages, leading to 98 percent coverage. Scaling up such initiatives to the national level through concerted efforts from policy leaders, technical experts, civil society, and other public health partners can pave the way to the formation of a comprehensive national strategy for cervical cancer elimination.

The lack of health literacy concerning HPV and cervical cancer is also a deterrent to the uptake of preventive services and progress toward elimination.

Ramping up national campaigns and advocacy initiatives to build awareness, tackle myths, and provide evidence-based information around the safety and efficacy of the vaccine are the need of the hour.

To add to this, we must destigmatize conversations on adolescent sexual health and equip girls with accurate information to ensure responsible health-seeking behavior.

Only when women are empowered to make informed decisions about their health can we expect the incidence rate of cervical cancer to reduce. By committing to accelerate the availability of preventive services and scaling up advocacy initiatives to build awareness, we can ensure that no woman or girl is left behind.

(Dr Hema Divakar, Past President, Federation of Obstetric & Gynecological Societies of India (FOGSI) that looks at prioritising women’s health – specifically the lesser-known cervical cancer. She is also a Member of the Technical Advisory Group (TAG) for the Ministry of Health and Family Welfare.)