Rights not about numbers

United Nations Office on Drugs and Crime (UNODC) supports screening prisoners for cervical cancer, writes UNODC communications officer for Southern Africa MOSES MAGADZA.

Women in prisons are silently left behind when it comes to screening for silent killers, including cervical cancer.

UNODC is working with the Ministry of Health in Malawi to support prisons conduct cervical cancer screening for all female prisoners nationwide.

In 2017, Malawi Medical Journal reported that Malawi had the highest rate of cervical cancer in the world—accounting for over 40 percent of cancers affecting women.

Although cervical cancer can be prevented through cervical screening and the use of Human Papilloma Virus (HPV) vaccines, experts say knowledge and uptake of these measures are low, particularly in prison settings.

For the first time in the country, cervical cancer screening among female prisoners began last Tuesday, according to Henry Ndindi, a medical doctor who is UNODC Malawi country coordinator.

The country has 30 prisons with nearly 14 300 inmates. The population is more than double the carrying capacity of the country’s correctional facilities.

Also being screened for cervical cancer are female prison officers and spouses of male officers.

Malawi Prison Service (MPS) has a work force of 3 620 officers, including 700 female employees.

UNODC works to strengthen governments’ capacity to adopt and implement legal and policy frameworks as well as strategies that adhere to UN minimum standards for Sexual and Reproductive Health Rights (SRHR), HIV and AIDS for prison populations, including women and adolescent prisoners.

The international standards, including the Nelson Mandela Rules, support the provision of the same standards of health care in prisons as are available in communities.

The Nelson Mandela Rules encourage UN member States to offer prisoners health care services free of charge and without discrimination.

Similarly, the United Nations Rules for the Treatment of Women Prisoners and Non-custodial Measures for Women Offenders— popularly known as the Bangkok Rules of 2010—encourage screening of all female prisoners for reproductive health-related issues.

Additionally, Sustainable Development Goal three (SDG 3) requires countries to ensure healthy lives and promote wellbeing for all at all ages.

However, in many countries that include Malawi, prisons still experience challenges in providing appropriate and adequate health services to prisoners who form part of key populations who bear a disproportionate burden of most diseases.

A study commissioned in 2011 revealed that 42 in every 100 female prisoners in prisons located in the Central Region had an HIV prevalence of 42 percent. This was also associated with high levels of syphilis.

This screening forms part of UNODC’s efforts to take health services closer to hard-to-reach and often underserved populations.

The National Cervical Cancer Control Strategy recommends cervical cancer screening for every woman aged between 30 and 49 years at least once in their lifetime.

It UNODC is supporting the Ministry of Health to increase access to diagnosis of all pre-cancerous lesions or cancer for appropriate management and referral for confirmed cancer cases among female prisoners, female prison officers and spouses of male officers in Malawi Prison Service.

Apart from bankrolling the exercise, UNODC provided logistical support to service providers who are from the Ministry of Health. 

More broadly, the UN agency is supporting efforts to integrate prison and public health given severe human resources-related challenges that the prison service is grappling with.

The screening was completed on Sunday. Approximately 1000 women were expected to benefit from this unprecedented intervention.

Ministry of Health chief reproductive health officer Twambilire Phiri said although there were only about 250 female inmates in the country, they deserved the best possible healthcare services “like everyone else”.

She described the nationwide cervical cancer screening specifically targeting female inmates as proof that human rights are not about numbers.

“Some people might say that female prisoners are very few in Malawi. Even if there was only one female prisoner, this screening would be necessary. We do not wish women to be prisoners because they are the hubs of families. Putting them in prison leads to so much suffering of all those who depend on them,” Phiri said.

The country’s cervical cancer programme remains highly donor-driven, she explained.

“We rely on partners. Our mission is to provide strategic leadership for the delivery of a comprehensive range of quality, equitable and efficient health services to all people in Malawi. UNODC has released funds which made it possible for us to offer these services,” she stated.

From neighbouring Zambia, Dr Christopher Kalila, a member of Parliament, medical practitioner and advocate for prison health, was effusive in his praise for this screening.

He said: “This is a major milestone in prison health. It’s a perfect example of not leaving anyone behind as espoused by Sustainable Development Goals and recognising the rights of marginalized groups in our society.

 “We only wish other African governments could take similar steps in scaling up SRHR interventions like cervical cancer screening to all population groups.”