It is Breast Cancer Awareness month and questions around the reach of the awareness are important to ponder.
Who is the awareness really for?
Much of the awareness is predominately in English, while cancer centres and health facilitates are mostly located in urban areas. The result; women in rural and peri-urban areas struggle to receive and understand the lifesaving messaging. Accessibility remains a huge challenge when it comes to both diagnosis and treatment. Once diagnosed, black women must contend with many other socio-economic challenges that limit them from receiving treatment, even if it is free and provided by public healthcare institutions.
Women in the Northern Cape and parts of North West for example have to travel to Kimberley to access breast cancer treatment facilities. Kuruman has a satellite facility but with limited resources and staff. The Northern Cape is the largest province in South Africa when it comes to land mass, the cost of travelling to Kimberley for most poor rural black women is one they cannot afford because of extreme poverty. A 2019 study conducted by Pietermaritzburg Economic & Dignity Group shows that 55.5% of the South African population survives on R40.90 per person per day. South Africa is also the most unequal society in the world, with those historically marginalised by colonisation and apartheid still being the most oppressed even today. Black women make up an overwhelming number of the poor and marginalised in SA. When black women are diagnosed with breast cancer, they have the burden of having to pit their bread and butter issues against their health concerns. Transport, food, and other travel costs have the ability to push these women and their families deeper into poverty when important healthcare institutions are far and inaccessible.
Breast cancer awareness and education needs to be scaled up in the black communities, to also consider these socio-economic limitations. Greater focus on primary healthcare is also needed with regards to speedy referral for screening and diagnostic tests. These interventions are still largely lacking in black communities partly because of the myths around who cancer affects. The misconception is often that cancer is a disease that only affects white people, and it still persists despite the growing incidences of cancer among black women. One of the reasons that influences this racialised idea of the illness might be the fact that there are seemingly higher incidences of breast cancer among white women than black women.
The National Cancer Registry reported in 2011 that the overall risk of breast cancer in South Africa is 1 in 29 women and further estimated that the lifetime risk is 1 in 12 among White women and 1 in 50 among black women. These figures however do not account for the black women who might never receive a proper diagnosis. Current and accurate research is not available on how these numbers might have changed over the last 10 years. The 2017 Breast Cancer Prevention and Control Policy attributes lower incidence of breast cancer among black women to multiple socio-cultural factors, such as; universal and prolonged lactation, low use of hormone replacement therapy, late menarche, early age of first birth, and a diet low in fat and high in fibre. However, due to rapid urbanisation and lifestyle changes there has been a significant decrease in these protective factors, making black women vulnerable to increased breast cancer incidences and mortality.
Historically cancer along with other non-communicable diseases were understood as diseases of affluence as they are related to economic development, consumption and lifestyle, in contrast infectious or communicable diseases were understood as diseases of poverty and impoverishment. These crude categorisations were central in explaining global health inequalities but the epidemiological transitions in the last few decades have forced us to think more critically about these issues. South Africa as a middle income country is a case in point, with a disease burden of both communicable and non-communicable diseases of which the public healthcare system has had to simultaneously prioritise. Breast cancer has thus been declared a national priority as highlighted by the Breast Cancer Prevention and Control Policy of 2017.
The policy notes that women who live in rural areas are at a disadvantage regarding access to information and services however little is said about the intersections of race, class and gender in understanding the structural barriers to breast cancer awareness and knowledge. The poor or inadequate breast cancer awareness and knowledge among black women should be a call for concern.
Poor knowledge and awareness of breast cancer leads to delayed detection, presentation, diagnosis and treatment. This results in late stage of the cancer upon diagnosis, aggressive cancer treatment, severe side effects, poor quality of life or worse, mortality. As public health specialists often say ‘equity in healthcare begins with equity in health education’. A sociological analysis and theorising is thus important for us to understand these structural barriers starting with how black women’s bodies are seen and treated. Researchers around the world have highlighted how the healthcare system treats black women differently as a result of implicit racial bias, discrimination and racism.
American Critical Race Theorist and Feminist scholar, Patricia Hill Collins attributes the discrimination black women experience to vectors of oppression that intersect in black women’s lives. Poverty, lack of representation in healthcare systems/ leadership, discrimination along racial and gender lines, all these vectors come together and make accessing healthcare a huge challenge for black women. Systems marginalise black women for economic gain or to maintain patriarchal dominance, making even the most basic rights and institutions inaccessible to black women.
Beyond awareness, these challenges also speak to the exclusion of black women in public spaces, in senior positions within healthcare, leadership and important decision making that can impact how they navigate the world. The lack of representation affects even the personal aspects of black women’s lives like how they experience illness. Feminists tackle this challenge by turning the personal into the political. Politicising the personal forces the challenges women are faced with to the public space, forcing institutions and leaders to address them. Breast Cancer awareness in part does this, which is one of the things that makes the movement so important. But is it leaving black women behind?
While awareness might be lacking for black women with breast cancer, it is important to note that some women have exercised their agency to advance breast cancer awareness. Mama Lillian Dube for example has used her public platform to talk about her experiences of breast cancer, demystify the illness and advocating for quality healthcare services for women. We also need to tap into existing structures and initiatives; community healthcare workers have done a lot of great work in the past to create awareness around HIV/AIDS. Similar strategies should be considered for breast cancer awareness to ensure that no woman is left behind.
By Lesego Bertha Kgatitswe (Lecturer at the Department of Sociology at Sol Plaatje University) and Nombulelo Shange (Lecturer at the Department of Sociology at University of the Free State)