To Prevent Cervical Cancer, Health Workers Lean on Education and Trust

Cervical cancer is the fourth most common cancer in women in the world, according to the World Health Organization.

The disease, which develops from continuous human papillomavirus infections, is preventable through the HPV vaccine. However, access to the vaccine is limited or not available in some countries. Ongoing barriers like misinformation, limited geographic and economic mobility, and cultural beliefs have made it difficult to inform women and girls of health risks. Across many low- and middle-income countries, where access to care is expensive and constrained, health advocates and providers are creating pathways to health literacy and cancer prevention for hard-to-reach populations.

If successful, they could decrease rates of human papillomavirus, breast cancer, and cervical cancer.

But first, health providers have to work to overcome misinformation and educate caregivers, said Lawreen Sakini, social enterprise lead at Reproductive Health Network Kenya, or RPHK.

The organization provides comprehensive reproductive and sexual health information to communities across Kenya. In partnerships with 43 counties, RPHK has had community-focused initiatives across Kenya for the last 15 years. In 2023, they joined the Africa Action Network to dispel misinformation on HPV, provide the vaccine, and ultimately decrease rates of cervical cancer.

In some Kenyan communities, it's culturally inappropriate for young people to be sexually active and for anyone to discuss young people doing so, which can complicate conversations around receiving the vaccine.

According to Sakini, parents are often misinformed about the risk of cancer, but are willing to engage in conversation to ask questions.

"The first thing is to inform them on 'what is HPV?'," said Sakini. "'What does HPV mean and what can HPV lead to?'"

RPHK trains young people to become community health promoters to meet residents where they are and talk about the issue. Dozens of these young people have helped bridge the gap in health literacy among their Nairobi and Kakamega residents. They meet with young people one-on-one, in small group settings, and with their parents.

They've created an awareness of the issue and are de-stigmatizing HPV to encourage consent for the vaccine and ultimately prevent cervical cancer later in life.

"There was a lot of stigma around getting HPV information, let alone the vaccine," she said. "People would look at (the kids) like, 'you're so young, why are you having sex?'"

In Bangladesh, health providers face similar challenges and a need to raise health literacy around the issue of cervical cancer.

"[Bangladesh is] also a very conservative society," said Dr. Iftikhar Mahmood of HOPE Foundation for Women and Children of Bangladesh. "Even though they have the problem, they don't talk to their relatives or partners, and they don't come to the doctors."

HOPE operates a field hospital within the Kutupalong refugee camp in Cox's Bazar. While not the only medical site within the largest refugee camp in the world, they offer targeted women's health needs from mammograms, pap smears, colposcopy, and diagnosis of obstetric fistula, which refugees wouldn't be able to access elsewhere.

Bangladesh recently began to offer the HPV vaccine to girls aged 10 to 14 through a trial program, but it's not available to refugees. The stigma around HPV has also prevented refugees from going to the hospital for screenings. The language barriers, mobility restrictions, and limited trained personnel who can access and work within the field hospital, have made it increasingly difficult to effect positive change.

Dr. Mahmood said that since their patients don't have access to the vaccine, HOPE midwives and gynecologists try to encourage regular health screenings for preventative care. The health providers also meet with community leaders to share information and to grow a trusting relationship with the refugee community.

From 2021 to 2025, HOPE medical staff conducted 965 screenings, a low number given the national metric sits at over 5 million. However, in 2025, HOPE staff conducted 515 screenings, and staff credit the uptick in screenings to expanded provider trainings, community-led awareness, and targeted outreach.

"This vaccine can really save lives," Dr. Mahmood said. "If you think about it in terms of the cost, it's a very small cost for saving lives."

In other countries like India, vaccines are available, but far too costly for low-income workers.

In 2019, the Self-Employed Women's Association, or SEWA, surveyed its membership of 3.2 million people. They found consistent poor health outcomes from a lack of access to affordable, high-quality care across rural populations and those in urban areas.

Dr. Sahil Hebbar, senior coordinator at SEWA, said that members reported advanced diseases linked to failed access to managed care.

"It's a double-whammy of sorts because when they do fall sick, not only are there out-of-pocket expenditures, but they also lose their livelihoods when they are hospitalized," Hebbar said.

Like RPHK and HOPE Hospital, SEWA uses a community health worker model to reach patients where they are. For the last five years, SEWA health ambassadors have gone door-to-door to the association's membership to discuss noncommunicable diseases, routine immunizations, breastfeeding, mental health, waterborne diseases, and iron deficiency anemia.

"We realized there was a huge gap, especially in urban slums and in rural areas where access to care was very poor," Hebbar said.

The association began hosting health literacy events in public spaces to encourage members to get breast and cervical cancer prevention screenings, but just 25% of attendees participated. SEWA staff realized that the experience was too impersonal. Since 2023, the health ambassadors, who are well known in the community, have been conducting the screenings in private rooms. The screening participation rate has since gone up to 60%.

Now, nearly 12,000 SEWA members have received pap smears or mammograms, and almost 70 have been diagnosed with cancers in the stage one, two, or three phase.

"I think the numbers [of prevention and treatment] are promising as a start, but we have a long way to go," Hebbar said.

Direct Relief has provided funding to each of the organizations in this article to support cervical cancer education, prevention, and screening. Reproductive Health Network Kenya, through Africa Action Network, received a grant from Direct Relief for education and outreach efforts to support vaccination of young women in rural areas. SEWA received funding from Direct Relief via BD to support cervical cancer screening and outreach efforts, and HOPE Hospital has received ongoing support from Direct Relief to support women's health.