Waking up to cervical cancer
Mother-of-three Afroza Begum, 23, of Chandar Char village on an island in Lalmonirhat's Teesta basin has tested positive for cervical cancer. She doesn't know what to do. “My husband wants to take a second wife,” she says.
Her neighbour Sahera Begum, 33, is suffering a similar fate. “Day by day I am losing interest in intimate relations with my husband,” says the mother-of-four.
While cervical cancer is often symptom free in its early stages, when symptoms do develop they include irregular bleeding and pain during sexual intercourse.
“I have cervical cancer,” says Nurjahan Begum 24, of Char Narsingh, a village on another island. “I no longer feel able to satisfy my husband and he's threatening me with divorce.”
What the three women have in common is they were all child brides, married at age 11 or 12. While the main cause of cervical cancer is exposure to particular strains of the sexually transmitted human papilloma virus (HPV), secondary causes include smoking, multiple pregnancies and having sexual relations at a young age.
Last year the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) estimated 12,000 Bangladeshi women are diagnosed with cervical cancer per annum, and each year 6,500 women die of the disease.
Worldwide it is the fourth most common cause of cancer deaths among women, with most cases occurring in developing nations.
Yet the Papincolaou or pap smear test if completed every three to five years can identify changes early, which has enabled developed countries to dramatically reduce the incidence of cervical cancer. In addition two vaccines against HPV are available, one of which can reduce the risk of cancerous and precancerous changes in the cervix by about 93%.
“I wouldn't dare to tell my family about the cancer,” says Nurjahan Begum. Social stigma and lack of awareness make it hard for many women of Lalmonirhat's river islands to seek timely and effective prevention, detection and treatment.
Khandaker Reaz Ahmed, technical officer of the Char Integrated Project of NGO Own Village Advancement identifies child marriage as an important contributing factor locally. “Girls are often married at a young age,” he says, “and they often suffer from malnutrition and cervical cancer. The incidence of cancer in turn gives rise to a prevalence of men marrying multiple wives.”
Day labourer of Sholmari village on Teesta Char in Kaliganj upazila Akhlas Uddin, 30, says on the islands the men have little distraction from difficult lives. “If wives deny us intimate relations,” he says, “obviously we become upset and may wish to take a second wife.”
Ignorance of the disease is widespread. Guardians Nabiul Islam, Mansur Ali and Shamser Ali of Char Narsingh village say they have not heard that cervical cancer is affecting the island's women. Yet all have observed the incidence of multiple marriages to be on the rise.
Recently Dr. SR Begum, a consultant to Square Hospital, visited the area and tested 74 islander women for cervical cancer. Of them, 20 proved positive. “The 20 sufferers are victims of underage marriage,” says Dr. Begum. “They also became mothers to multiple children in a very short space of time. These are risk factors for cervical cancer.”
Yet marriage for girls at a young age is a well-established social practice with its own justifications. “We do it for our daughter's safety,” says Mansur Ali. “Families can face problems if adolescent daughters are kept at home.”
Dr. Nuruzzaman Ahmed, the superintendent of Lalmonirhat District Sadar Hospital, says many cases of cervical cancer in village women are long kept secret. “We have testing facilities for the disease,” he says, “and if detected in its early stages cure is much cheaper.” Along with cervical cancer, Dr. Ahmed says breast cancer and malnutrition are health issues associated with underage marriage.
A strong education campaign in Lalmonirhat's river island communities would go a long way to encourage testing, treatment and understanding for sufferers of cervical cancer and give those communities the opportunity to better appreciate a major disadvantage of underage marriage.
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