She had asked to be tested for cervical cancer, but doctors told her she was too young to worry. “I insisted for the test and finally they agreed,” says Amela. “Ten days later I got a phone call with the results of my test, which confirmed my worst fears.” Thankfully, she was diagnosed early enough to be treated and is now free of the potentially deadly disease.
The Balkan country of Bosnia and Herzegovina is facing a relatively high prevalence of cervical cancer. With an incidence rate of about 13.2 cases per 100,000 women, cervical cancer is one of the leading causes of mortality for women in the country, say health officials.
“It is the second most common cancer among women in the country and fourth most common overall in the country,” says Faris Hadrovic, Assistant Representative at UNFPA. “Unfortunately, Bosnia also ranks quite high in the region in terms of cervical cancer, and treatment of cervical cancer is very limited.”
Public awareness of cervical cancer is low
He explained that there are few regular screening programmes that would detect the virus early, and little or no public information campaigns educating women about the disease. Many women do not even visit a gynaecologist regularly.
Despite the ease of testing for the human papilloma virus or HPV—the virus that causes cervical cancer—the number of women being tested in the country is relatively low. But in trying to raise awareness, activists encounter resistance in a society where sexually transmitted infections remain a taboo subject. Aside from the cultural obstacles, in this post-conflict country, social and economic concerns often take priority over health.
“People seem more concerned with things like jobs, money and apartments,” explains Dr. Mirsada Hukic, Director at the Nalaz Lab, a testing centre for women.
UNFPA is working with a number of NGO and Government partners to overcome obstacles in raising awareness and to increase early detection through greater access to testing. In many cases, front line professionals are the best way to help get the message across. “Nurses and midwives are the first point of contact with women and girls who come for a check-up,” says Sejda Dzindo, Chief Nurse at the Institute for Healthy Maternity. “It is important for them to emphasize clients need a check-up at least once a year.”
Raising awareness with a song
Supported by UNFPA, the NGO Renesansa has found effective and innovative ways of improving awareness, overcoming resistance from a skeptical public.
“At the start it was really hard,” explains Renesansa Director, Spomenka Hadzic, “Even today it is a taboo topic. It has always been our goal to raise awareness through different activities, especially in schools and colleges, to reach people at a younger age.”
One such initiative from Renesansa targeted younger women through the use of pop culture. The well-received music campaign, “My Life is My Song,” featured the local singer MayaSar, and included a song about cervical cancer that she wrote in response to a friend’s treatment for the condition. UNFPA supported recording of a video clip by four singers, famous regional divas. The singers used Bosnian, Croatian, Serbian, and Macedonian languages respectively in the song, with lyrics expressing the feeling of hope, the possibility to fight and prevent cancer.
Campaign spreads a message of hope
“As part of the ‘My Life is my Song’ campaign, we organized an auction where UNFPA materials about cervical cancer were distributed,” explains Ms. Hadzic, flanked by posters and photos of previous events. “I knew this event was a success when my son’s girlfriend came to me afterwards with more questions about the issue. So if just half the people from that event pass on the brochure to someone else, it could have a huge impact.”
In addition to large posters, pamphlets on HPV and cervical have been produced, with the key message: ‘HPV is preventable – mission possible’. One pamphlet specifically for girls and women explains susceptibility to HPV infection and cancer. A companion pamphlet, for boys and men, outlines the key role of men in preventing transmission of HPV.
The campaign generated close to 100 media opportunities and generated increased traffic to gynaecologists. The Government has expressed an interest in the program as well, as echoed in the sentiments of Dr. Drazenka Malicbegovic, Ministry of Civil Affairs of Bosnia & Herzegovina. “It is important to introduce this problem to a wider audience, because through prevention, we can reduce the prevalence of this type of cancer.”
A message for the public
“We should spread the message that no woman should die from cervical cancer,” proclaims Ms. Dzindo at the Institute for Healthy Maternity. This message supports one of the campaign’s goals: to generate optimism for those with cancer.
But cervical cancer survivor, Amela Dzafovic, has a slightly more personal take on the approach. “My message is, ‘I am the message.’ The reason I am here is that if I can make one woman or one girl get tested, then I will be happy. I am asking you, please go and get tested.”
With continued support from Government and UNFPA programming, service providers and NGOs such as Renesansa hope to get their message through to women, young and old, one at a time.
A comprehensive approach to cervical cancer prevention
Prevention of cervical cancer is core to UNFPA’s mandate to ensure universal access to reproductive health as defined by the International Conference on Population and Development.
UNFPA is supporting several countries as they develop and strengthen their cervical cancer prevention programmes. As in the case of Bosnia and Herzegovina, awareness raising is a key component of any cervical prevention programme aiming to ensure that individuals can make informed decisions about their health. Once awareness is raised, the services required to respond to the demand created also need to be in place.
In this sense, UNFPA’s support to cervical cancer prevention programmes emphasizes the need for national strategies to be part of a comprehensive approach that includes HPV vaccination for young girls (which can serve as an entry point to other reproductive health needs of young and adolescent girls), screening and treatment for women diagnosed with precancerous lesions, and treatment and palliative care for women with invasive cervical cancer.
