Hesperian Health Guides
Every day 20,000 people visit the HealthWiki for lifesaving health information. Ifwe could translate 50 more chapters.
Make a gift to support this essential health information people depend on.
When Mira was a little girl, she dreamed of living in a big house, with electricity and a tile floor. Her husband would be handsome and kind, and she would be able to do whatever she wished. But Mira’s family was poor, and she was the youngest of four daughters. Sometimes, when her father was drinking, he would beat her mother, and weep at his misfortune of having so many girls.
When Mira was 14, and old enough to be married, she cried when she learned her dreams would never come true. It was already arranged: Mira would marry a man whom her father had chosen. He had some land, and Mira’s father thought the family would benefit from their marriage. Mira had no choice in the matter.
With the birth of Mira’s second child — a son—her husband stopped insisting on sex so often. Mira was very glad for that. Although he did not hurt her, he had warts all over his penis that disgusted her. Over the next 20 years, she had 6 more children, including a little girl who died at age 3, and a boy who died at birth.
One day, Mira was using the latrine and she noticed a bloody discharge coming from her vagina when it wasn’t time for her monthly bleeding. She had never had a health exam, but now Mira asked her husband if she might see a health worker. He replied that he didn’t trust doctors, and besides, he didn’t have the money to spend every time she felt worried about something.
Mira was 40 when she began to suffer constant pain low in her belly. The pain worried her, but she didn’t know who to talk to about it. Some months later, Mira finally decided she had to go against her husband’s wishes and get medical help. She was frightened for her life, and borrowed some money from a friend.
At the health center, Mira got some medicine for the vaginal discharge, although the health worker did not examine her first. Mira returned home that night, exhausted and upset that she had defied her husband and spent her friend’s savings. As weeks passed, Mira’s health continued to worsen, and she became discouraged, realizing that something was still wrong.
Finally, Mira became so weak that her husband believed she really was ill, and they begged a ride to a hospital in the big city far away. After waiting several days, Mira was seen at the hospital. Finally, she was told that she had advanced cancer of the cervix. The doctor said they could remove her womb, but that the cancer had already spread. The one treatment that might save her life was available only in another part of the country, and was very expensive. The doctor asked, “Why didn’t you get regular Pap tests? If we had found this earlier, we could have treated it easily.” But it was too late for that. Mira went home, and in less than 2 months, she died.
Why did Mira die?
Here are some common answers to this question:
|A doctor may say...||
Mira died of advanced cervical cancer because she did not get treatment earlier.
|Or a teacher...
Mira died because she didn't know she should have a visual inspection of the cervix or a Pap test done.
|Or a health worker...
Mira died because her husband exposed her to genital warts and other STIs. These put her at high risk for developing cancer of the cervix.
All these answers are correct. Women who start having sex at a young age and are exposed to genital warts are at a greater risk for cancer of the cervix. And if the cancer is found early (by having a visual inspection of the cervix or a Pap test), it can almost always be cured.
Yet these answers show a very limited understanding of the problem. Each of them blames one person—either Mira or her husband—and goes no further. Mira was at greater risk of dying of cervical cancer because she was a poor woman, living in a poor country.
|These are some of the links in the chain of causes that led to Mira’s death. They are the same links that cause many of women’s health problems.|
How poverty and the low status of women worked together to cause Mira’s death
You can explore the root causes of Mira’s death or other health problems by using the exercise called But Why?
Mira and her family were poor, so she was forced to marry and start having sex when she was very young. As a woman, she lacked power in her relationship with her husband. She had no control over when and how many children to have, or over her husband’s relationships with other women. Her family’s poverty meant that she suffered from poor nutrition her whole life, which weakened her body and left her more at risk for disease.
Although Mira’s community lacked health services, the nearest health center did have some women’s health services, like family planning and information about preventing HIV. But the health workers had no information or training about other women’s health problems, even such serious ones as cancer of the cervix. They did not know how to do a pelvic exam (to look at the vagina, cervix and other reproductive parts) or a Pap test. So even if Mira had gone for medical care sooner, the health worker would not have been able to help her.
As a result, Mira had to travel a long distance at great cost to see a doctor who could tell her what was wrong. By that time it was too late.
Finally, Mira’s country was poor, with little money to spend on health care. Like the governments of many poor countries, her government chose to focus on other important health services, but not on women's health. What money her government did spend on women’s health went to expensive hospitals in the big city instead of community health programs that women like Mira can get to. This meant that the services to find and treat cervical cancer—and many other women’s health problems—early were not available. Poverty and the low status of women worked against Mira at all 3 levels—in her family, in her community, and in her country—to create the health problem that caused her death.