Paper short abstract:

Research on the Indonesian health system response to upscaling cervical cancer prevention, screening and treatment has identified a range of issues related to consent and equity, which impact adversely on the efficacy of the cervical cancer response and the rights of women and girls.

Paper long abstract:

Cervical cancer incidence and survival rates are dramatically shaped by economic inequality, with 90% of the women dying from this disease living in low- and middle-income countries. This paper draws on current four-year study in Indonesia, where cervical cancer is now causing the death of 50 women per day (Globocan 2019). One objective of this research is to map the Indonesian health system response to the urgent need for up-scaling cervical cancer prevention, screening and treatment. In mapping the health system response we have identified a quagmire of issues related to informed consent including: the rights of adolescent girls and parents in consenting to HPV vaccination; the consent processes occurring in the context of outreach screening (or screening safaris); and the contested need for husband consent to screening, cryotherapy and radical hysterectomy. The paper also discusses: the difficulties of ensuring equity of access to free HPV vaccination for girls, when school communities have the right to veto the implementation of school-based vaccination program; discrimination in access to screening and services for unmarried women; and differential access to prevention, screening and treatment for women living outside of major urban centres and for the urban poor. The Indonesian health professionals and cancer advocates we have interviewed express a diversity of opinions on consent, equity, efficacy and reproductive rights, yet there is a common thread running through their narratives, which is the explicit assertion that their position is in the best interests of women.