In September, 2015, I participated in a Global Health Hackathon, and worked with a team on creating a pilot program to improve maternal health in Malawi, a very poor country in southeastern Africa. Many villages in rural Malawi are miles away from the nearest regional health clinic. Without paved roads, women who need emergency help during labor have to be carried in a litter, perch on the back of a bicycle, or if they are lucky and can pay, may be driven to the clinic by a local farmer in an oxcart. A major innovation is a special “ambulance trailer” that can attach to a bicycle or motorcycle, allowing the patient to lie down and be shielded from sun or rain by a canopy and zipper bag.
It reminded me of the general plight of women’s health across much of the world. As Western cancer survivors, we have many concerns about our quality of life, including preserving our sexual health and fertility. Yet our worries seem insignificant compared to cancer “survivorship” for women in sub-Saharan Africa. Breast cancer is increasingly common, especially among younger women in rural villages. Cervical cancer is a major killer of women, particularly women infected with HIV. Yet cancer screening is rare in poor countries and most women are diagnosed after their tumors have spread. Those who do survive their treatment are often abandoned by their husbands and by their families of origin, since cancer is seen as a shameful, contaminating disease. A young woman with a mastectomy, infertility, a vagina too tight for intercourse, or a fistula that leaks urine or stool may be left in a barren hut with no income for herself or her children. Even opiate drugs for pain relief are rarely available to women dying of cancer.
Women in the world need two things to have a chance at a decent life: literacy and contraception. If you look at statistics on the number of women versus men expected in the world, every year, about 4 million women and girls go “missing,” especially in China, India, and sub—Saharan Africa. About 40% are never born because a fetus is identified as female and the pregnancy is terminated, or because an infant girl is killed at birth. During childhood, boys get more resources than girls, including food, education, and medical care, so another 20% of girls die before age 15. The other 40% of missing women die prematurely between the ages of 15 and 59. Death in pregnancy or childbirth remains a major problem in the poorest countries. Parents also want sons who can work to feed the family, care for aging parents, and keep the family name alive. Daughters are a liability. They may need a dowry to get married and usually live with the husband’s family after marriage. Some girls are sold into physical or sexual slavery by their own parents as a way to support the rest of the family. Ironically, with ultrasound being used to identify and discard female fetuses, a growing excess of young men in some of these countries actually increases rates of sexual violence against women, although this trend is still being debated.
So we need to have perspective as women cancer survivors even though the United States still has far too many health disparities.
This educational material is intended for informational purposes only and is not intended to replace, or substitute for, professional advice, counseling, diagnosis, or treatment. Always seek the advice of a qualified health provider with any questions you may have regarding a condition. Never disregard professional advice or delay in seeking treatment because of something you have read in this educational material.