Cervical Cancer Screening in India. In: Schroeder D, Cook J, Hirsch F, Fenet S, Muthuswamy V, editors. Ethics Dumping. Cham: Springer International Publishing; 2018. pp. 33-48. [DOI: 10.1007/978-3-319-64731-9_5]

Awareness on cancer cervix, willingness, and barriers for screening of cancer cervix among women: A community-based cross-sectional study from urban Pondicherry

Background

Early detection of cervical cancer can significantly reduce the associated morbidities and mortality. However, uptake of screening for cervical cancer in India is not encouraging.

Objectives

To assess the awareness about cervical cancer, willingness, and barriers for undergoing screening of cervical cancer among women in urban Pondicherry.

Methods

This cross-sectional study was conducted among women of 30-65 years in urban Pondicherry during January - July 2019. A total of 219 women, selected using two-stage random sampling, were interviewed using a pretested semi-structured questionnaire. Multistep multivariable logistic regression was done to identify the independent correlates of willingness to undergo screening for cervical cancers.

Results

About one-third women were aware of cervical cancer. Awareness was more among women who were young, had higher education, had family history of cancer, and currently working. Awareness of risk factors, signs and symptoms of cancer cervix was low. Although 60% of the women, who have been aware of cervical cancer, were aware of possibility of early detection, <15% were aware of the various methods. 32% of the women were willing to undergo screening for cervical cancer, and occupation, family history of cancer, and knowledge about risk factors were found to be independent correlates. Fear and "not having signs and symptoms" were the major reasons for unwillingness.

Conclusion

Level of awareness and willingness for undergoing screening of cervical cancer was low in study area. Targeted interventions for awareness and health system efforts for addressing the reasons behind unwillingness are required.

Avoiding Gender Exploitation and Ethics Dumping in Research with Women

There is a long history of women being underrepresented in biomedical and health research. Specific women’s health needs have been, and in some cases still are, comparatively neglected areas of study. Concerns about the health and social impacts of such bias and exclusion have resulted in inclusion policies from governments, research funders, and the scientific establishment since the 1990s. Contemporary understandings of foregrounding sex and gender issues within biomedical research range from women’s rights to inclusion, to links between human rights, women’s health and sustainable development, and the increasing scientific and funding expectation for studies to consider the sex (biological) and gender (cultural) implications of research design, results and impact. However, there are also exploitation issues to consider when foregrounding the inclusion of women as research participants, especially for research ethics committees and institutional review boards. A hidden risk is that exploitative research designs and practices may be missed, particularly by reviewers who may not have a nuanced understanding of gender-based harm. Utilizing contemporary case studies of ethics dumping, this paper highlights some of the concerns, and makes recommendations for IRBs/research ethics reviewers to help ensure that essential research is undertaken to the highest ethical standards.

Preventing ethics dumping: the challenges for Kenyan research ethics committees

Ethics dumping is the practice of undertaking research in a low- or middle-income setting which would not be permitted, or would be severely restricted, in a high-income setting. Whilst Kenya operates a sophisticated research governance system, resource constraints and the relatively low number of accredited research ethics committees limit the capacity for ensuring ethical compliance. As a result, Kenya has been experiencing cases of ethics dumping. This article presents 11 challenges in the context of preventing ethics dumping in Kenya, namely variations in governance standards, resistance to double ethics review, resource constraints, unresolved issues in the management of biological samples, unresolved issues in the management of primary data, unsuitable informed consent procedures, cultural insensitivity, differing standards of care, reluctance to provide feedback to research communities, power differentials which facilitate the exploitation of local researchers and lack of local relevance and/or affordability of the resultant products. A reflective approach for researchers, built around the values of fairness, respect, care and honesty, is presented as a means of taking shared responsibility for preventing ethics dumping.