Barriers to cervical cancer screening in rural Mexico

Cervical cancer is a major health problem in Mexico. The national mortality rate due to cervical cancer was estimated at 21.8 per 100,000 among women over 15 years of age in 1994. Reasons for this high prevalence have not been defined, although it may be influenced by lack of access to health care, lack of knowledge about the Pap procedure, or cultural beliefs. While some studies have examined barriers to Pap screening, most have focused on urban samples. We conducted a pilot study using direct interviews to learn about factors that may influence cervical cancer screening among rural Mexican women. We interviewed 97 rural women between the ages of 16 and 66 and found that 52% had not received a Pap smear within the last 2 years (of that group, 62% had never received a Pap smear). In our sample, the most frequent reason for not obtaining a Pap smear was anxiety regarding physical privacy (50%). Less frequent reasons were lack of knowledge (18%) and difficulty accessing health care (14%). Women who had delivered children were significantly more likely to have received a Pap smear (71%) than women who had no children (10%), P < 0.05. The responses of many women suggest that compliance with cervical cancer screening would be enhanced by addressing cultural beliefs, encouraging conversations about women's health issues, and increasing the number of female health care providers.