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South African Family Practice

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The influence of gender roles and traditional healing

on cervical screening adherence amongst women in
a Cape Town peri-urban settlement
a a a
Despina Learmonth , Anica Jansen van Vuuren & Chantelle De Abreu
a
Department of Psychology, University of Cape Town, Cape Town, South Africa
Published online: 18 Feb 2015.

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To cite this article: Despina Learmonth, Anica Jansen van Vuuren & Chantelle De Abreu (2015): The influence of gender
roles and traditional healing on cervical screening adherence amongst women in a Cape Town peri-urban settlement,
South African Family Practice, DOI: 10.1080/20786190.2014.978096

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 South African Family Practice 2015; 1(1):1–2
http://dx.doi.org/10.1080/20786190.2014.978096 S Afr Fam Pract
ISSN 2078-6190  EISSN 2078-6204
Open Access article distributed under the terms of the © 2015 The Author(s)
Creative Commons License [CC BY-NC-ND 4.0]
http://creativecommons.org/licenses/by-nc-nd/4.0 RESEARCH

The influence of gender roles and traditional healing on cervical screening

adherence amongst women in a Cape Town peri-urban settlement
Despina Learmontha*, Anica Jansen van Vuurena and Chantelle De Abreua

a
Department of Psychology, University of Cape Town, Cape Town, South Africa
*Corresponding author, email: despina@drlearmonth.com

Background: Cervical cancer is the third most common gynaecologic malignancy worldwide and is the second most
common cancer among South African women. Although entirely preventable, cervical cancer is responsible for the death of
approximately 3 027, 53% of those diagnosed, South Africa women annually. A variety of factors influence women’s cervical
screening adherence.
Methods: A focus group discussion was conducted with female residents in Khayelitsha. Data from the focus group discussion
Downloaded by [University of Cape Town Libraries] at 23:34 05 March 2015

was analysed using thematic analysis whereby emergent themes and subthemes were identified and reported.
Results: The study confirmed previous findings around screening barriers amongst women residing in other Cape Town
peri-urban settlements. New information regarding the influence of gender inequalities and traditional healers on screening
adherence also emerged.
Conclusion: The incorporation of men into cervical screening intervention programmes and the integration of traditional healers
meaningfully into the health care system appear to be vital in improving adherence to screening.

Keywords: adherence, barriers, behaviour change, cervical cancer, cervical screening, Pap smears, South Africa, traditional healing

Invasive cervical carcinoma is the third most common
gynaecologic malignancy and is the fourth leading cause of
death in women worldwide.1 Despite its high prevalence, the
slow growing nature of the cancer renders it almost entirely
preventable if detected at an early stage.2,3 An extreme disparity
of annual mortality and new diagnoses exists between
developed and developing countries (comprising 85% of global
cases).1 This dichotomy is caused by differences in the
implementation of, and adherence to, cervical screening
programmes, as well as other psychosocial factors such as
poverty, HIV/AIDS, and gender inequality.1 In South Africa,
epidemiological studies demonstrate significant screening,
diagnostic and mortality biases among different ethnic groups.
Black women are most likely to die of this disease.2
Currently disadvantaged black South African women face a
multitude of the known barriers to screening including, poor
knowledge, low socio-economic status (SES), unemployment,
poor health care accessibility, lack of health insurance, language
barriers, and opposing cultural beliefs (Figure 1).3 This myriad of
complications is often reflected in fatalistic attitudes and beliefs
regarding cervical screening with consequent low adherence to
treatment on receipt of an abnormal Pap smear result.2,4
Khayelitsha†-based NGO assisted the researchers in recruiting
black low SES Xhosa women residing in Khayelitsha as
participants. Fifteen women, aged 25–51 years old, took part in
the study.
A focus group discussion, co-facilitated by two researchers and
an established isiXhosa-speaking community health trainer, was
held at a Khayelitsha community health centre. In recognition
of previous methodological limitations,3 emphasis was placed
on pre-focus group rapport building and the inclusion of
an isiXhosa  -speaking facilitator. Consent was obtained and the
discussion was recorded. To ensure privacy, names and identifying
details were omitted from transcriptions and notes; and
participants were requested to respect confidentiality. The data
generated was analysed using thematic analysis with an emphasis
on researcher collaboration and agreement. Throughout the study,
the authors were mindful of their subjective social and cultural
positions, distinguishing their potential impact on the study.
Seven themes emerged from the data. Five, namely: Stigma, Fear,
Time, Age, and Health Education re-emphasised those identified
in the previous research study.3 Two further sub-themes, Gender
and Traditional Healing, also emerged.

Few published studies have explored factors relating to cervical

Gender (Figure 1) highlighted the construction of gender and the
screening adherence amongst South African women. An urgent
subordinate position of poor black women in the family and
need to comprehensively determine screening barriers specific
society.4 Men’s lack of acceptance of cervical screening, the
to currently disadvantaged South African women exists in order
association of cervical cancer, hysterectomy and the potential loss
to end continued unnecessary suffering and death.
of womanhood and female sexuality,2,4,5 and suspicion of
promiscuity negatively impacts on screening adherence.5
This study aimed to: further explore factors affecting currently
Promiscuity relates to the sub-themes of stigma and health
disadvantaged women’s cervical screening adherence, add to
education, but emerged with the sub-theme of gender as it links to
the existing qualitative data, and expand upon a previous study
the frequent stigmatisation of black South African women as the
by two of the authors.3
carriers of sexually transmitted diseases (STIs) (particularly HIV).5
Although the biggest STI risk factor for some women is sexual
The University of Cape Town’s Psychology Ethics Committee intercourse with their partners, STIs (particularly HIV) are associated
approved the study. Community health trainers working with a

South African Family Practice is co-published by Medpharm Publications, NISC (Pty) Ltd and Cogent, Taylor & Francis Group
 2
Downloaded by [University of Cape Town Libraries] at 23:34 05 March 2015
Figure 1: Barriers to cervical screening
with promiscuity and are stigmatised.4,5 Emotional and financial
support from a partner is a key factor in adherence.5,6 Therefore,
involvement of sexual partners is crucial for cervical screening and
treatment adherence.6
Traditional Healing (Figure 1) as a theme denoted a preference for
seeking treatment from traditional healers. Marginalised and
underserved populations tend to connect more powerfully with
social institutions that provide them with a sense of belonging.6 Up
to 80% of South Africa’s population consult traditional healers prior
to primary health care consultations,7 as cervical cancer is often
framed in terms of sociocultural beliefs rather than biomedically.2
Allopathic health care, often fraught with economic, practical and
other issues (Figure 1), is only sought out when traditional or
home-based methods fail.4,5 Traditional healers’ explanations and
treatments of medical complaints also tend to resonate more
powerfully with individuals’ belief systems.4,7 Consequently, stronger
links need to be created with traditional healers in order to truly
build a working relationship which maximises all patients’ health
care outcomes. Although, traditional healers are recognised via the
Traditional Health Practitioners Act, Act 35 of 2004 as registered
members of the South African medical fraternity, the integration of
alternative practitioners in the health care system is still fragmented.
Facilitation of regular adherence to cervical screening demands
careful consideration of all the barriers to the implementation
and maintenance of this health behaviour. Such information is
vital for enhancing the development of effective screening
programmes for urbanised, resource-poor communities.
Authors’ contributions
DL (University of Cape Town) was the project supervisor and
leader, responsible for project design, data collection, data
analysis, write up of the initial draft and critical review of final draft
S Afr Fam Pract 2015; 1(1):1–2
for important intellectual content, and preparation of the paper
for submission for publication. AJvV (University of Cape Town)
was responsible for write-up of the initial draft and preparation of
the paper for submission for publication. CDA (University of Cape
Town) was responsible for data collection, data analysis and
contributed to the write-up of the initial draft.
Note
† Khayelitsha is a large peri-urban settlement on Cape Town’s
outskirts.
References
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— a Cape Town community responds on World Cancer Day. J Cancer
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36342003000900015
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Received: 09-04-2014 Accepted: 11-09-2014