Programa de Salud Global

Abstract Background: Despite efforts to increase cervical cancer screening access in rural Bolivia, uptake remains low. Bolivia has one of the highest cervical cancer mortality rates in the Americas. As it redoubles efforts to deliver universal health care, the Bolivian government needs information on the factors constraining cervical cancer screening access, and utilization, especially in rural areas. Methods: Our qualitative study explored cervical cancer screening barriers and described community and provider perceptions and experiences of care. Bolivian and US researchers analyzed data collected from eight focus groups with male and female community members (n=80) and interviews with healthcare providers (n=6) in four purposively selected rural communities in Monteagudo, Bolivia. Deductive and inductive codes were used to thematically analyze data using MaxQDA software. Results: Four themes emerged from the data: lack of knowledge/misconceptions, health system inadequacy, lack of confidence in providers, and opportunities for improvement. Both men and women displayed misconceptions about the causes of cervical cancer, its consequences, the recommended screening frequency, and the means of accessing care. Providers noted community members’ lack of knowledge and low risk-perception as utilization barriers but also highlighted poor health service quality and inconsistent health education as factors. Poor healthcare quality was a significant barrier; this included poor patient-provider communication, lack of transportation to screening facilities, and severe delays in receiving test results. Providers also noted problems with provider training and physical space for screening. Community members reported low confidence in nurses to perform screening, preferring doctors and specialists. They also expressed discomfort in having male healthcare providers conduct screening. Providers reported low confidence in government officials to support cervical cancer screening improvements. Suggestions for improvements included more intensive cervical cancer outreach to rural areas, mobile screening, and having specialists train lower-level providers to perform screening. Conclusions: Our findings suggest that poor healthcare quality has affected screening uptake in addition to physical barriers to care. They indicate a need for initiatives to reduce reporting time for Pap test results, the incorporation of community-based HPV self-testing into screening protocols, and the implementation of programs to improve community confidence in providers’ ability to perform screening.

El 11 de junio de 2010 en El Colegio de México se llevó a cabo el taller de reflexión Enfoques teóricos y perspectivas metodológicas en los estudios de las familias y las movilidades. Este taller, impulsado por el esfuerzo intelectual de varios investigadores e investigadoras adscritos a diversas instituciones académicas, tuvo como interés primordial la reflexión en torno a la migración –interna, internacional, urbana y rural–, la movilidad intraurbana y los arreglos familiares –composición, relaciones intergeneracionales, cambios de roles, redes de apoyo, arreglos para el cuidado de niños y ancianos, y relaciones de género.En este documento se sintetizan las ponencias de los estudiosos e investigadores que colaboraron en el taller, y se resumen las discusiones que suscitaron dichas presentaciones entre los participantes del encuentro. Además de concentrar estas reflexiones teóricas, críticas y metodológicas, y mostrarlas al público interesado, esta relatoría tiene la finalidad de plantear la necesidad de constituir un grupo de reflexión teórico-metodológica que se encargue de profundizar en las relaciones entre familias y migración como campos de estudio interrelacionados. AbstractOn June 11, 2010 at El Colegio de México, a workshop for reflection was conducted on Theoretical and Methodological Perspectives in Studies on Families and Mobilities. This workshop, motivated by the intellectual effort of several researchers affiliated to various academic institutions, focused on reflections on migration, both internal and international, urban and rural, intra-urban mobility and family arrangements: composition and intergenerational relations, changing roles, support networks, child and elder care arrangements and gender relations.This paper summarizes the presentations by the scholars and researchers who contributedto the workshop, in conjunction with the discussions raised by these presentationsamong the attendees. In addition to concentrating these theoretical, critical and methodologicalreflections and sharing them with the interested public, the report aims to raisethe need to form a group of theoretical-methodological reflection to study relations betweenfamilies and migration as interrelated fields of study.

Medical education in Mexico has significant deficiencies in the area of sexual and reproductive health and does not offer students the information needed for dealing with abortion as a relevant problem in the professional practice of medicine. Medical education does not offer options for the clinical training of future physicians in integrated models for abortion care, which include the use of safe and effective technologies as well as a range of services to respond to women's needs. These limitations are especially relevant in countries such as Mexico where unsafe abortion continues to be a significant public health problem. In addition, the legal context for abortion has begun to change during the current decade; therefore, the search for alternatives to incorporate a broad approach to abortion in medical school programs is a task that cannot be postponed.