Across the United States, Black women have a significantly higher chance than white women of dying from cervical cancer. A new report from Human Rights Watch, an advocacy organization, zooms in on Georgia to investigate some of the reasons why and finds that “neglect and exclusion” from the nation’s broken healthcare system are to blame.
If caught early, cervical cancer is highly treatable, with a 93% five-year survival rate. Still, more than 4,000 women in the US die from it each year. The mortality rate is more than twice as high for Black women as that of white women, a rate similar to women living in developing countries with poor healthcare access, according to an American Cancer Society study. The gap is similar to disparities in cancer outcomes more widely across the United States.
Gynecologists can screen for the disease with an annual exam, called a Pap test. It’s a quick, if slightly uncomfortable, procedure: The doctor inserts a small brush into the vagina to collect cells from the cervix to later analyze under a microscope.
But Black women in Georgia, particularly in rural areas, are less likely to get those screenings, or to be diagnosed, the Human Rights Watch report found. Cervical cancer diagnoses have decreased in the state in recent decades, but disparities remain. Even after diagnosis, the five-year survival rate for Black women who were diagnosed with cervical cancer in Georgia was 57% in 2018, compared to 65% for white women, according to data from the National Cancer Institute.
“This pattern of neglect and exclusion from the healthcare system should be front and center,” said Annerieke Daniel, a researcher for Human Rights Watch, which produced the report in partnership with the Southern Rural Black Women’s Initiative. “No one should be dying from this disease, and Black women should not be dying at disproportionate rates.”
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The report, which partnered with community researchers to interview 148 Black women in rural southwest Georgia, found statewide challenges for women’s healthcare are partly to blame.
Nearly half of the state’s counties lack an OB-GYN, according to the report. Seven rural hospitals have closed since 2010, and 38 labor and delivery units since 1994. More than 250,000 Georgians are uninsured because they can’t find an affordable option, according to the Kaiser Family Foundation. Georgia is one of 12 states that haven’t expanded Medicaid, which would mean more residents with low incomes would have healthcare coverage.
One woman told the researchers: “I did not have a habit of going to the doctor because I had to pay.”
Another remembered a conversation with a nurse about follow-up testing after a routine exam showed abnormal results. “She said I would have to pay for it to get the information and get the test done over again,” the woman said. “I couldn't afford it, so I just didn't go back.”
Lack of information, stigma, discrimination, and distrust of the medical system also played a role, the report found. The human papillomavirus (HPV) vaccine can substantially reduce the risk of cervical cancer — but in 2019, only about half of teenagers in Georgia were fully vaccinated for it. About a third of the women interviewed for the report had never heard of it, and some parents associated it with sexual activity, Daniel said. Many of the women also recalled feeling their healthcare concerns were dismissed by medical professionals because of their race.
The state has services meant to help uninsured Georgians with low incomes get access to cervical cancer screenings, through healthcare navigators and medical transport systems; the report recommended these resources be expanded to reach more people.
“We see this as a human rights failure,” Daniel said. “When you have Black women dying at such high rates from a disease that is highly treatable and highly preventable, it’s clear whose rights and health the government is investing in and protecting.”