Reproductive and Maternal Health in the Post-2015 Era: Cervical Cancer Must Be a Priority

Ruby Singhrao mail,
Megan Huchko,
Gavin Yamey

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Citation: Singhrao R, Huchko M, Yamey G (2013) Reproductive and Maternal Health in the Post-2015 Era: Cervical Cancer Must Be a Priority. PLoS Med 10(8): e1001499. doi:10.1371/journal.pmed.1001499
Published: August 13, 2013
Copyright: © 2013 Singhrao et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funding: No specific funding was received for writing this article.
Competing interests: GY declared that he is a former Senior Editor of PLOS Medicine and current Freelance Editor, but he played no role in editorial decisions about this essay. GY also declared that the Evidence to Policy initiative has received support from the Bill & Melinda Gates Foundation, which has funded trials of integrated reproductive health services. All other authors have declared that no competing interests exist.
Abbreviations: DALY, disability-adjusted life year; HPV, human papillomavirus; LMICs, low- and middle-income countries; VIA, visual inspection with acetic acid
Provenance: Not commissioned; externally peer reviewed.

Summary Points

Over the last two decades, there has been unprecedented global action on tackling high maternal mortality rates in low- and middle-income countries (LMICs) and on expanding access in these countries to reproductive health interventions, including family planning.
The attention has paid enormous dividends: from 1990 to 2010, the annual number of maternal deaths worldwide fell from 546,000 to 287,000. While this positive trend is cause for celebration, we also believe that the global health community is failing women in a crucial way: it has neglected prevention, screening, and treatment for cervical cancer in LMICs.
Such neglect is difficult to understand. Unlike some other cancers, including selected reproductive cancers, cervical cancer is detectable, highly preventable, and curable if detected early.
There is an enormous international disparity in the incidence of, and survival from, cervical cancer, which are both also closely aligned with country income.
The incidence of cervical cancer is 52.8 per 100,000 women in sub-Saharan Africa compared to 6.8 per 100,000 women in Western countries. Women are more likely to die in low-resource settings due to lack of infrastructure for screening.
In this Essay, we propose four arguments for why cervical cancer screening and treatment should be included when it comes to operationalizing these two goals and thus to improving reproductive and maternal health outcomes. Each of the four arguments is illustrative of a larger framework that has equity and socioeconomic, gender, public health, and health services dimensions.