Academic journal article Human Organization

On the Periphery of Midwifery: A Critical Analysis of a Community-Based Cancer Screening Program in Mexico

Academic journal article Human Organization

On the Periphery of Midwifery: A Critical Analysis of a Community-Based Cancer Screening Program in Mexico

Article excerpt

The incidence of invasive cervical cancer in Mexico is believed to be among the highest in the world even though a national screening program has been in effect for over 30 years. As the Mexican government struggles to overcome obstacles in delivering cancer screening services, civil society groups are working towards increasing the acceptability and accessibility of Pap exams among marginal populations. This paper examines a community-based program initiated by the Morelos Women's Center (CMM), which trains traditional midwives to conduct Pap exams in rural communities. The study considers how the CMM seeks to address the cultural and structural obstacles that women face in public clinics as the national government retracts health services under neoliberal reforms. Drawing attention to the disjunctures that emerge as traditional midwives with little formal education are trained to carry out a biomedical program, the paper raises questions regarding how effectively community organizations can fill in the gaps left by a declining health system. The case suggests that micro-analyses of community health efforts are essential for identifying the potentials and limitations of civil society organizations as they increasingly take on responsibilities in health care planning, promotion, and distribution.

Key words: Cervical cancer, Pap screening, Midwifery, Civil Society Organizations, Neoliberal Health Reform

Introduction

Cervical cancer is a "disease of poverty" that principally affects low socioeconomic level population groups (Palacio-Mejía, et al. 2003). Over 80 percent of deaths resulting from cervical cancer occur among women in developing countries (Dailard 2003). Whereas cervical cancer mortality rates in Canada and the United States have decreased steadily over the last 40 years, similar trends have not been observed in developing countries where rates have remained constant or have increased over time (PAHO 2005). Research suggests that women's lack of access to cervical cancer screening contributes significantly to high mortality rates, particularly since 90 percent of cases can be detected by the Papanicolaou (Pap) test (Flores et al. 2003).

The incidence of invasive cervical cancer in Mexico is believed to be among the highest in the world, and mortality rates have changed little since the 1980s (Flores et al. 2003). Although a national screening program has been in effect for over 30 years, recent estimates suggest that only 40 to 47 percent of Mexican women receive a Pap exam every three years (Flores et al. 2003; Gómez-Jauregui 2001). The Ministry of Health contends that two key factors limit the program's efficacy-the lack of cultural acceptability of the exam and the limited health services accessible to marginal populations (Secretaría de Salud 2004). Despite ongoing efforts to improve its program, the government remains unable to significantly increase cervical cancer screening rates, particularly among rural and economically marginal communities.

As the government struggles to overcome these obstacles in delivering cancer screening, civil society organizations (CSOs) are working towards increasing the acceptability and accessibility of Pap exams among marginal populations. This response is occurring as neoliberal state reforms reduce the state's direct responsibility for implementing appropriate and sufficient social assistance programs for the poor (Laurell 2001). Mexico's health care sector is one of many areas influenced by the systematic application of neoliberal policies driven by international bodies since the 1980s. In its 1987 publication, Financing Health Services in Developing Countries, the World Bank proposed that patients pay more for their health care and encouraged the development of private health insurance schemes, the expansion of the private sector's participation in health care, and the decentralization of government health services (Isaacs and Solimano 1999). …

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