Brittany: What does cervical cancer teach us about a “life course” approach to SRH?
Eva: I think that cervical cancer across its spectrum is a reminder that there are opportunities for action and intervention beyond cervical cancer and throughout a sexual and reproductive health life, and throughout a life course. We think of care in sexual and reproductive health from the perspective of the years when somebody might be pregnant or having their babies and that there’s nothing before and there’s nothing after, that there’s no need to seek care, no need to prioritize or fund care that might come outside of that. Whether or not somebody is reproducing and having children should in essence, be beside the point. Pregnancy is a great reason for people to seek care; people seek care during pregnancy, deliveries—not always, but often—and [these opportunities] bring people into care. Developing models that are integrated and facilitate adding the other pieces to that care—STI prevention and treatment and detection, cervical cancer screening, and preventive treatment—can all be integrated into those times of high health-seeking behavior.
But then there [are] the rest of our years. We are sexual beings beyond our fertile years! Sexuality does not end when fertility is no longer an issue. Let’s talk about post-fertility years. That doesn’t mean post-sexually active years, post-sexual being years. These are still years [where] people need attention in terms of their health care. Cervical cancer is a good reminder of that. We need to consider reproductive health cancers, we need to consider risk of STI infection, etc. well beyond one’s ability to get pregnant. These reproductive health issues don’t wrap up neatly into years where someone might be [fertile]. And they also don’t necessarily start then. There are all sorts of reasons to support health-seeking and encourage it, and raise awareness around education in the early life course also, around menstrual health, menstrual hygiene, [the] potential risk of sexual encounters or gender-based violence or intimate partner violence, and the potential risk around sexually transmitted infection around those encounters. Across the spectrum, we need to be thinking about the risk of GBV and intimate partner violence throughout the life course.
There are lots and lots of reasons to be paying attention to all these pieces, well beyond somebody’s years where they’re able to get pregnant. For some people, there are no fertile years, but it doesn’t mean that we’re not going to care for all of the other things that happen from a health perspective around somebody’s reproductive life, organs, experiences. We need to take care of people and not make assumptions. I think perhaps there is some gender bias here around women and sexuality and needs beyond pregnancy and reproduction. The providers’ and systems’ perspective is that women don’t need care outside of their ability and the years when they can reproduce—then we have an opportunity to shift this perspective. One of those ways is through prioritizing cervical cancer screening and prevention and then integrating it into other areas of care where women are likely to seek care during different parts of their life course.
Heather: As [Eva] alluded to, and I’ll just maybe emphasize the point, that to me, HPV/cervical cancer prevention is a really great model to look at through a life-course lens because there are multiple opportunities to intervene with safe, effective services across a young woman’s and an adult woman’s life stages. When you look at cervical cancer rates, when women reach 40–49 years, that is often when, because we’re not thinking of childbearing necessarily in those years, women often decide to no longer see their provider because they don’t realize that they still need these services, like cervical screening. Just when a woman is most vulnerable to this disease, she may disappear from the health system. This is why continued education reminders from health care providers are so important. Health communication and education—whether through a campaign, or one-to-one conversations with community health educators, or nurses, midwives, or other providers—is critical, especially for preventive services. Cervical cancer prevention gives us the opportunity—and in fact, the responsibility—to reach a girl or a woman at multiple points across her reproductive life and beyond, and should spur policymakers and program teams to develop holistic strategies that meet her needs at each of these points. This challenges us to be intentional and creative in designing communications, outreach, services, and follow-up with an eye to meet her along a continuum that spans her entire life.