“I believe that women need to visit gynaecologists only when they are in the family way. The other probable reason why one would visit the specialist is when they are hoping to conceive. This apart, irregular menstrual cycles is what would draw me to a gynaecologist’s clinic,” says 22-year-old Madhura*.
The idea of having a screening done for other sexually transmitted diseases or for cervical cancer is not something that occurs to her as a possible necessity to visit a gynaecologist.
“I have not been told by my family that it is necessary to have my cervix screened. For as long as I have no symptoms of an underlying health condition, why would I need to visit one?” she questions.
She is not alone. A majority of women in India either find no need to visit a gynaecologist for routine checks or do not have access to gynaecologists at all.
NHFS-4 shows dismal numbers
Only 25 out of 100 women in urban areas and 20 out of 100 women in rural India, in the age group between 15 and 49, had their cervix screened at least once in their lifetime. This is as per the National Health and Family Survey-4 (NHFS-4).
According to statistics available with the department of health and family welfare, cervical cancer accounts for 26% of female cancers in India.
Going by the numbers, Karnataka has the least number of women who have their cervix screened even once in south India. While only 13.7% of urban women surveyed for NHFS-4 said they underwent screening, the numbers were unexpectedly higher at a 17% in rural areas.
Other states, however, fare better than Karnataka. In Kerala, 61.7% in urban and 61% in rural areas had undergone the screening. In Andhra Pradesh and Telangana regions, over 30% were reportedly screened in both urban and rural areas. In Tamil Nadu, 21.7% in urban and 24.4% in rural areas were screened.
Dr C Ramesh, head, department of epidemiology at Bengaluru’s Kidwai Memorial Institute of Oncology explains that in Karnataka cervical cancer accounts for 13% of the total cases of cancer.
“In Bengaluru alone, we see 600 new cases of cervical cancer every year. The prevalent cases per year range anywhere between 1,500 to 1,800,” he adds. “The prevalence of cervical cancer is less in urban areas when compared to rural areas.”
Risk of HPV
A nation-wide study, conducted by SRL Diagnostics, in a retrospective analysis of HPV (Human Papillomavirus) testing in cervical cancer screening found that over 3,000 women were tested for High-Risk HPV infection between 2013 and 2017.
The highest percentage of positive cases of high-Risk HPV was found in the 16-30 age group. About 8.04% women showed high-risk HPV infection among those tested. The study also found that more women from western India (about 10.23%) had high-risk HPV infection than those from any other zone. This was followed by south India at 9.78 %.
Stigma and lack of awareness
A Delhi-based group of volunteers under the banner Haiyya have been working towards making women feel at ease while visiting gynaecologists. From breaking taboos to educating young women, Haiyya is involved in several activities.
Mrinalini Dayal, Campaign Manager, Haiyya believes that the stigma associated with having to see a gynaecologist could be a primary reason why women choose to stay away from cervical screening.
Unlike a usual visit to a dentist or an ophthalmologist, it does not occur to many that there is a need to pay a routine visit to a gynaecologist as well. Mrinalini believes this is due to lack of awareness.
“There is no information in schools or colleges either. We do not read anywhere that it is essential to get cervical screening done. Nor does anyone in the family tell you about it,” she says.
What more? A fear of being asked “uncomfortable” questions could be another reason why women stay away from the visits, she says.
“There is still so much stigma about pre-marital sex. Many a time, women we interact with tell us that they have gynaecologists advising them not to indulge in sex before marriage and ask them why they need to. ‘Why are you here? Are you married? Why did you engage in sex before getting married?’ These are a few questions that women were being asked at a clinic,” Mrinalini says.
Rohini* visited a gynaecologist when she was in college and recollects the traumatic experience she had which stopped her from visiting another again.
“It was a bitter experience. It happened when I was in college. I paid a visit to the specialist. I was 21 back then. She asked me if I was sexually active. When I told her I was, what followed was a change in her behaviour. She became judgemental. She asked me why I needed it? I felt taunted,” she recollects.
Rohini has never had a screening ever since.
Mrinalini says that for many it is also a sense of stigma of having the test conducted by another person that keeps them away from the screening.