Meeting the challenge of caring for Hispanic women
Hispanic women access reproductive health care less often and need it more, national figures show. More than one in three Hispanic women polled in a 1999 survey said they had not received a routine gynecological or prenatal exam in the last year. Nearly a quarter had not gone for such checkups in at least two years. And more than one in 10 said they had never had such an exam.1
Such lack of care is troubling when given the following statistics:
• Cervical cancer rates among Hispanic women are nearly double those of the general population, according to a recent report by the National Cancer Institute in Bethesda, MD, and the American Can cer Society and Centers for Disease Control and Prevention (CDC), both in Atlanta.2
• In slightly more than a decade, the proportion of all AIDS cases reported among adult and adolescent women more than tripled, from 7% in 1985 to 23% in 1998. The epidemic has increased most dramatically among women of color: African-American and Hispanic women together represent less than one-fourth of all U.S. women, yet they account for more than three-fourths (77%) of AIDS cases reported to date among women in America.3
A number of factors come into play when looking at the need for increased use of reproductive health care among Hispanic women. According to the 1999 survey, 66% of the Hispanic women surveyed said they either delayed or did not get needed gynecological care because of one of these reasons:
• It cost too much or they did not have health insurance.
• They didn’t have a regular doctor or didn’t know where to go for care.
• It took too long to get an appointment or a needed referral.1
Social factors, such as lack of transportation, scarcity of after-hours clinics, and language and education barriers also hinder Hispanic women from accessing health care services, says Rodrigo Cardenas, MD, president of La Salud Hispana, a public health organization based in Englewood Cliffs, NJ.
When it comes to health, Hispanic women are more committed to their family’s well-being than their own, notes Cardenas. But unlike most other women, Hispanics tend to focus only on the health of their husbands and children, totally disregarding their own.
"When diagnosed with a disease, many accept it as a judgment or punishment for something they have done," Cardenas observes. "They also believe that as good wives and mothers, they must not complain but must accept the burden of illness."
This belief that destiny is out of one’s hands and events are inevitable is known as fatalism. Various factors, including immigration and educational level, are strongly associated with a fatalistic view among Hispanic women, especially those who are immigrants.4 Such beliefs can keep women from accessing such routine care as breast cancer screenings and Pap smears.5,6
Reaching women at risk
To reach Hispanic and other underserved women, the CDC offers breast and cervical cancer screening services through its National Breast and Cervical Cancer Early Detection Program. By October 1997, more than 1.5 million screening tests had been provided through the CDC-sponsored program.
One such CDC-funded program, the New Jersey Breast and Cervical Control Initiative in Trenton, works with a number of programs across the state to provide education and screening to women with limited health insurance or no health insurance who are at or below 250% of the poverty level, with a special emphasis on racial-ethnic minority populations and the disabled. Since the program began in 1996, 14,000 women — 31% Hispanic — have been screened for breast or cervical cancer.7
Having printed patient information in Spanish is not enough when it comes to providing prevention education materials, says Doreleena Sammons-Posey, state project director. One approach to delivering the prevention message is a play, "El Secreto de Marta" (Martha’s Secret), used by the Camden County Screening Project. The play focuses on Martha, a Hispanic woman who shares news of a lump in her breast with a friend, who then calls on a breast cancer survivor to talk with Martha about the importance of following through with screening and treatment. Humor and a light-hearted approach serve to dispel many fears and myths surrounding Hispanic women’s beliefs about the disease. Hispanic moderators are used to field questions and offer answers on women’s health issues following the production. (See resource listing, p. 143, to order a video of the production.)
Focus group participants have told program organizers they feel more comfortable when they see and hear people of their own culture, says Evelyn Robles-Rodriguez, RN, MSN, Camden County project coordinator. One facility in Elizabeth meets this request by offering special clinic days just for Hispanic women, using appropriate educational videos in the waiting rooms and scheduling a number of Hispanic translators and providers to staff the event, notes Sammons-Posey. The New Jersey initiative also has developed a resource directory to list agencies that provide services, including translators, to different racial/ethnic/minority populations to guide women to appropriate care.
It is becoming increasingly important to get the word out to Hispanic women about health risks, especially about those risks that have a greater impact on them, says Cardenas. One in four American women will be of Hispanic origin by the year 2030, according to U.S. Census data.
References
1. Kaiser Family Foundation. A National Survey of Women’s Reproductive Health Care. Menlo Park, CA: 1999.
2. Wingo PA, Ries LAG, Giovino GA, et al. Annual report to the nation on the status of cancer, 1973-1996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst 1999; 91:675-690.
3. Centers for Disease Control and Prevention. HIV/AIDS Among US Women: Minority and Young Women at Continuing Risk. Atlanta; August 1999.
4. Chavez LR, Hubbell FA, Mishra SI, et al. The influence of fatalism on self-reported use of Papanicolaou smears. Am J Prev Med 1997; 13:418-424.
5. Hubbell FA, Chavez LR, Mishra SI, et al. From ethnography to intervention: Developing a breast cancer control program for Latinas. J Natl Cancer Inst Monogr 1995; 18:109-115.
6. Hubbell FA, Chavez LR, Mishra SI, et al. Beliefs about sexual behavior and other predictors of Papanicolaou smear screening among Latinas and Anglo women. Arch Intern Med 1996; 156:2,353-2,358.
7. Alvarado M, Mestel R. Latino women neglect checkups. Bergen Record. Bergen, NJ; Aug. 23, 1999.
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