5th International Conference on Gynecology and Obstetrics

Schmeer is a Professor of Sociology at Ohio State University, USA. Her research focuses on social inequalities, family and community contexts and women’s health across settings. She has lived and worked in various parts of Latin America for the past 30 years. She has conducted research on women and children’s health in Nicaragua since 2012 and worked with The Lily Project since 2018.

Background: Despite being preventable, cervical cancer is the fourth most common cancer among women worldwide. Barriers such as lack of quality care, social stigma, loss to follow‑up, and limited knowledge of sexual health hinder access to cervical cancer screening and treatment, particularly among rural and low‑income women.

Objectives: In this case study, we describe the Lily Project, a Nicaraguan‑based cervical cancer prevention non-governmental organization working in a politically, socially and economically restrictive context. With no national HPV testing or vaccination program, and low quality, underfunded public health services, The Lily Project (TLP) aimed to bolster cervical cancer screening and education for marginalized women in rural areas.

Methods: The methods for this case study included extensive fieldwork conducted by the first author with authors 3 and 4. Informal interviews and discussions with TLP leaders, and on-the-ground observations, provided more detailed information about TLP process. The intake forms also contributed to the quantitative data analyzed here using Excel and R.

Results: Through descriptive analyses of qualitative and quantitative data we highlight TLP attention to meeting multiple aspects of women’s needs in designing their Pap and VIA screening process. While the technical aspects of the screenings, such as Pap and VIA may be less ideal than HPV testing, the goal of TLP was to provide the necessary cervical screenings (which are needed even if HPV testing is done) in a way that is women-centered and provides attention to quality of care issues such as: privacy, respect, female providers, education and informed, reliable delivery of results. The stakeholder collaboration approach is worth noting as a way of bringing multiple sources of health care and support to women for the prevention of cervical cancer.

Conclusion: The Lily Project provides evidence that it is possible to provide women-centered, high-quality care and culturally acceptable cervical exams in challenging conditions and among hard-to-reach populations. The future of cervical cancer screening should combine lessons learned from this and other innovative approaches to prioritize women-centered approaches to screening care and follow-up, in addition to promoting HPV vaccine uptake, to reduce cervical cancer in low-income settings.