Cervical Cancer in Rural India
Cervical cancer is considered among the most dreaded and common diseases of women in India. It accounts for approximately 16% of the entire cases of Cervical Cancer happening globally. The situation is found to be much more alarming in rural areas where most women are ignorant and illiterate regarding the hazards related to cervical cancer. Screening strategies such as HPV vaccination and screening policies are there. Other strategies for cervical cancer include rural cancer registries for detecting cancer (Bobdey et al., 2016). HPV DNA testing and Pap smear have been tried and suggested under the low resource setting of the country which are found to be effective. Along with this screening of cervical cytology has been found much effective in lowering the incidence of disease. Despite these strategies, there are lots of barriers with regard to feasibility and acceptability found in rural areas in India.
Determinants of cervical cancer and barriers in treatment
Cervical cancer in rural India is influenced by various determinants, including age, age at marriage, age of first childbirth, parity, family planning practices, and reproductive tract infections. Cervical cancer is a huge health issue experienced by women in India and every year nearly 120,000 women experience this disease. India accounts for nearly 15.2% of the entire death cases of cervical cancer in a global context. The incidence of cervical cancer has reduced in the urban population; high prevalence of cervical cancer is there in rural areas. Almost all cervical cancers are caused by HPV (human papillomavirus) which is a common virus that can be passed from one individual to another during sexual intercourse (CDC, 2023).
Cervical cancer has been found as the fourth most common type of cancer in women around the world with an estimation of 604,000 new cases as well as 342,000 deaths in the year 2020. Mostly the incidence has been found in the LMICs (low and middle income countries). This happens due to the obstacles experienced by women in rural areas of India. It has been reported in various studies that the health of women in rural areas and their access to the facility of health is compromised because of various factors like environmental economic and socio-cultural factors.
Within India, the health problems of cervical cancer contribute to nearly 6-29 percent of each and every cancer in women (Mehrotra & Yadav, 2021). The incidence rate of age-adjusted cervical cancer generally varies hugely among the registries. It has been found that the incidence of cervical cancer is highest in Mizoram which is 23.07/100,000 and lowest in Dibrugarh district which is 4.1/100,000. In developing countries due to a lack of essential quality control and infrastructure cytology screening of high quality might not be feasible for implementation on a wide scale in cervical cancer. Therefore, screening programs for cervical cancer on the basis of visual screening tests like VILI/VIA must be adopted as an important part of the primary setup of healthcare in countries like India where resources are not up to the mark in rural areas (Pimple & Mishra, 2022).
Influence of power dynamics in the context of cervical cancer
The screening and the reach of awareness of cervical cancer are not full-fledged in India, especially in the rural population which acts as a major drawback in combating the disease (Rajpal et al., 2018). In India, the disease of cervical cancer generally accounted for nearly 9.4 percent of all cancers and approximately 18.3 percent of the new cases in the year 2020. The International Agency for Research on Cancer mainly highlights that priority must be provided to cervical and breast Cancer prevention among women in a global context. Approximately 266,000 deaths are happening across the world every year because of this preventable disease. This disease is considered an important health issue for women in India and is the second largest cause of cancer death after breast cancer. Over 80% of the global burden of disease is happening in underdeveloped and developing countries where it is considered the most common cancer among women (Sankaranarayanan et al., 2009). This discrepancy is because of a lack of efficient control measures in those countries. Poverty along with the socio-cultural practices like high parity early manage and two specific extent polygamy has been recognised as the factors which increased practices like high parity early manage and two specific extent polygamy has been recognised as the factors which maximize the vulnerability of women to the cervical cancer.
The political economy of global health and decolonization of global health
Cervical cancers higher burden around elderly cohort as well as within states which are demographically advanced signifies greater tertiary care units’ necessities within these areas. The incidence of cancer among cohort of reproductive age is found to be highly increased within females. This requires an urgent call by giving major policy focus on greater uterine cancer burden among female people. Additionally, a powerful gradient of income within prevalence of cancer highlights greater cancer incidence among several richer households (Rajpal et al., 2018). The average pocket spending on inpatient care within the public facilities is approximately 3 times of the public facilities. It is thereafter necessary to know well the procedure of seeking treatment can be greater among various richer households; hence cases of cervical cancer usually remain underreported (Rajpal et al., 2018). Moreover, treatment for nearly 40% of the cases of hospitalization is final mainly through contributions from relatives and friends, sales of acid, and borrowings (Singh et al., 2022). Also more than 60% of households who want care from the private sector incur pocket expenditure more than 20% of their annual per capita expenditure. The entire incidence as well as mortality of cervical incidence has shown an important decreasing trend within India between the years 1990 and 2019. The largest decline in incidence and the rate of mortality has been reported in the time period between 1998 and 2005. The largest mortality and incidence of cervical cancer has been reported in Tamil Nadu and is lowest in Ladakh and Jammu & Kashmir (Srivastava et al., 2018).
Global health actors and forces shaping this problem further
Advocates of public health and cervical cancer need to take active participation in the review and analysis like identification of lessons where these people can utilize them for promoting treatment or prevention of cervical cancer on universal agendas. It can be identified as the most difficult thing for these global actors to identify that the appeals do not take a part in establishing agendas of policies for health distribution or health burden alone. These actors basically understand the making of health policy as a social change procedure instead of a health needs’ rational evaluation (Parkhurst & Vulimiri, 2013). Within the agenda of health policies, it is observed in the current research that various social movements take an essential part in bringing changes in health policies and the ultimate success is dependent upon a socially potential threat’s articulation to the health of the public, the capability for mobilizing a diversified constituency of an organization and political opportunities’ convergence obtaining vulnerabilities of a target. A potential initiative towards operating from this viewpoint can be making expansion to the structure of cervical cancer from technical terms to aspects of social justice and human rights. More resonance can be showcased through these messages with various policymakers as well as the public when statistical disease burden-oriented data presentation is unconvincing (Wang, 2016).
The evidence base and interventions applied to address this health issue
Within cervical cancer grounds, there seems to be a moderate human networks and resources level that is dedicated globally to the problem. More cohesion is produced by global actors through the adoption of a collaborative policy or program within the community while creating partnerships such as alliances for action related to cervical cancer and the prevention of cervical cancer. These amalgamations make items for maximizing attention globally as well as operating to share potential resources. There are certain strategic actions that need to be taken for attaining coverage of ninety percent in relation to HPV vaccination and that can be carried out by securing affordable and appropriate HPV vacations (WHO, 2023). The second step would be maximizing vaccinations’ coverage and quality through sustainable delivery platforms which are multisectoral in characteristics along with using innovative community-oriented initiatives for reaching vulnerable groups of people like adolescent girls not being able to go to school. There should be registers or monitoring systems in place that would efficiently enhance and track quality and coverage. Due to the fact that vaccination programs for HPV are expanded and introduced, this shall require evidence-oriented and nationwide attempts at social mobilization and communication (Kumar & Kumar, 2021).
Evidence gaps and suggestions for research, practice, or policy in addressing cervical cancer
There are certain limitations and gaps related to barriers and health policies oriented research with regards to cervical cancer around India. Mainly, pilot work and further resources are required to be carried out in these areas as much of the research and evaluation carried out is operational or practical in nature. This will include evaluating the process to structure cervical cancer and its impact provided when providing assistance within various healthcare settings (WHO, 2023). There is a necessity to produce negotiations based on minimizing vaccination costs for several poorer countries. In addition, conducting feasibility research and evaluation with regards to pilot programs and policies for treatment and screening purposes within sub-Saharan regions of Africa. There is less research and evidence regarding safe motherhood and more evidence needs to be developed further concerning this aspect.
Overall, it can be concluded that there is a great necessity to improve cytological screening policies' sensitivity, and efficacy for cervical cancer within rural India. This will be followed up by maximizing the workforce of training within this field. Health managers operating within health care settings around India are required to implement this strategy, particularly for the National Programme of Cancer Control. Besides this, there is an immediate necessity for awareness programs and educational interventions to carry out the screening purpose for cervical cancer's primary control and prevention. Additionally, to resolve and overcome different region-specific problems related to cervical cancer, the second-generation vaccine should be utilized which brings cost-effectiveness to the treatment process.
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