Perceptions of Infertility as a Barrier to Cervical Cancer Screening in Rural Botswana: A Qualitative Study

Background: Cervical cancer screening in Botswana and in particular the use of visual screening in rural areas has been on the rise in the past several years. Despite increased awareness and the introduction of less invasive methods of screening, qualitative data indicate that socio-cultural factors such as infertility related stigma, and beliefs about impaired fecundity affect overall efficacy of screening campaigns. Objective: This study sought to explore barriers to the utilization of cervical cancer screening in rural communities in northern Botswana. Methods: In-depth interviews were conducted in this qualitative research study. All interviews were transcribed and coded both manually as well as with the use of MAXQDA software to elicit themes. Results: The respondents all had high awareness of the current visual screening with acetic acid (VIA) and the Pap smear tests but reported non-utilization of these tests when available due to concerns over potential fertility impairment. While awareness of cervical cancer was high, a relatively high lack of understanding and education about cervical cancer and its relation (or not) to fertility outcomes was reported. The major factors identified by women in this qualitative study included lack of desire to screen prior to childbearing, beliefs and fears about inevitability of cervical cancer and lack of treatment options, financial burdens, lack of familial support, geographic burdens and stigma/emotional barriers to results of screening. Conclusion: This study provides new data on the myriad reasons for women’s lack of participation in cervical cancer screening programs. These data suggest potential cultural barriers and fears of fertility related stigma that may impact the efficacy of ongoing cancer prevention strategies. Interventions that take social and gendered beliefs about fertility into account are needed to better implement future strategies for success.