3 de Abril: Mejor que un huevito de chocolate
This week, the La Paz daily, La Razón, reported on an upcoming campaign to vaccinate 30,000 Bolivian girls between the ages of 9-13 against the Human Papillomavirus (HPV), one of the leading causes of cervical cancer. The campaign, which will vaccinate girls in five cities and one rural community in Bolivia between April 6-10, is being carried out by the Centro de Información, Educación, y Servicios en Salud Sexual y Reproductiva (CIES) in cooperation with the Ministry of Health. The vaccinations will be provided without cost, and will be distributed at schools and in public health centers in the areas of highest cervical cancer incidence in the country–El Alto, Oruro, Potosí, Trinidad, Sucre, and in rural areas outside of the city of Sucre. According to Wilma Pérez, the author of the article, “Bolivia has one of the highest rates of mortality due to uterine cancer in the world,” with “five women dying daily from the disease.” The World Health Organization reports that cervical cancer is the leading cancer affecting women in Bolivia.
According to EhealthMD, poverty and failing to get regular pap test screenings are among the leading risk factors for cervical cancer. Since women who suffer from cervical cancer generally show few symptoms until the disease is quite advanced, a yearly pap test–which detects changes in the cells of the cervix that can be related to cervical cancer–is the best way to catch the disease early on. Women who are poor generally know less about the causes of cervical cancer and the importance of yearly screenings, have less access to sexual and reproductive health services, and are frequently malnourished–a condition which also increases the risk of cervical cancer. Since Bolivia is the poorest country in Latin America apart from Haiti, it is not surprising that it also displays one of the highest rates of death from uterine cancer in the world–according to the WHO study cited above, only 28% of women in Bolivia report ever having had a pap exam.
Although I am as yet unable to provide concrete statistical data on these themes, my own research seems to support the conclusions of the articles cited above. Since beginning research in Bolivia, I have examined thousands of gynecological and obstetrical records from prominent La Paz and El Alto hospitals stretching from the mid-1950s to 2009. Anecdotally, I can attest to the fact that the majority of women seen at these facilities across these years report never having had a pap test. A smaller majority report having had perhaps one or two pap tests across their entire reproductive lives, rather than the yearly test that is recommended. The number of patients that report to hospitals with advanced cervical cancer seems astounding; many of these women die during their hospital stays.
Another fact that I have noticed in these records, which you can interpret how you like, is this: those women who report having had more than three pap smears in their lives are also more likely to report having used some method of birth control (including the rhythm method), and are more likely to report having had an abortion.
It seems very unlikely that any one of these factors–birth control use, pap tests, or abortions–causes in any direct way any of the other two factors. Instead, it seems to me that each one of these factors corresponds to a degree of control that women are exercising over their own sexual and reproductive lives. Women who get yearly pap tests or who use birth control to limit or to space their births are, through these actions, declaring a sense of autonomy over their bodies, sex lives, and reproductive choices. And women who have abortions, I would argue, are also exercising this autonomy. Although few women actually want to experience an unwanted pregnancy or to have an abortion, many women who do choose abortion–particularly young women–report that the experience made them more mature, responsible adults, since for many, it was the first time they were forced to make a truly autonomous decision about their lives. So, perhaps it should not surprise us that women who have had abortions in Bolivia also get pap tests and use birth control. The conditions of these women’s lives have allowed them access to information and services in sexual and reproductive health, which have given them the tools to exercise control over their own bodies–something that many Bolivian women lack.
A final note: it seems sort of ironic to me that the HPV vaccination campaign has been timed so close to Easter, a holiday that is widely celebrated in the largely Catholic country of Bolivia. The HPV vaccine has drawn criticism from right-wing and religious elements in other countries due to the belief that girls who are vaccinated–like girls who have access to birth control–will have sex earlier than girls who are not (or do not). Instead, opponents of the vaccine believe that young people should not be taught about sex, have access to birth control, or be protected from HPV, and that this will simply prevent adolescents from having sex. This profoundly sex-negative message–which was institutionalized in the U.S. through abstinence-only education in many schools during the Bush years–has proven to only increase rates of adolescent pregnancy and STI infection. Fortunately, right-wing forces have not derailed the HPV vaccination campaign in Bolivia. So, during the week following Easter, 30,000 Bolivian girls will receive something much more valuable, though perhaps less tasty, than chocolate eggs.