Abstract
Background
Major health inequalities exist surrounding the utilisation of cervical cancer screening services globally. Jordan, a low- and middle-income country, has poor screening rates (15.8%), with barriers to accessing services, including lack of education. Emerging studies demonstrate that intimate partner violence (IPV) impacts reproductive health decisions. As a large proportion of Jordanian women have reported experiencing IPV, this study examines the association between IPV and cervical cancer screening in Jordan, the first of its kind using national-level data.
Methods
Using Jordan’s Demographic Health Survey 2017–18, cervical cancer screening awareness and self-reported screening were estimated in participants who answered questions on IPV (n = 6679). After applying sample weights, Heckman’s two-stage probit model determined the association of awareness and utilisation of cervical cancer screening with experience of IPV, adjusting for the socio-economic factors.
Results
Of the women with privacy to answer the IPV module, 180 (3.4%) were found to be victims of sexual violence, 691 of physical violence (12.6%) and 935 (16.2%) of emotional violence. Women subjected to sexual violence were less likely to admit to having awareness of a Pap smear test; however, this did not impact screening rates. Victims of emotional violence were more likely to be screened than non-victims. No association between physical violence and cervical cancer screening was found.
Conclusions
A significant association between cervical screening awareness and IPV demonstrates that cancer screening policies must consider IPV among women to improve screening awareness. The paper further sheds light on the paradoxical association between emotional violence and screening. It is acknowledged this situation may be far worse than reported, as women without autonomy were unlikely to answer IPV questions that may endanger them—targeted surveys on cervical cancer screening warrant further investigation.
Major health inequalities exist surrounding the utilisation of cervical cancer screening services globally. Jordan, a low- and middle-income country, has poor screening rates (15.8%), with barriers to accessing services, including lack of education. Emerging studies demonstrate that intimate partner violence (IPV) impacts reproductive health decisions. As a large proportion of Jordanian women have reported experiencing IPV, this study examines the association between IPV and cervical cancer screening in Jordan, the first of its kind using national-level data.
Methods
Using Jordan’s Demographic Health Survey 2017–18, cervical cancer screening awareness and self-reported screening were estimated in participants who answered questions on IPV (n = 6679). After applying sample weights, Heckman’s two-stage probit model determined the association of awareness and utilisation of cervical cancer screening with experience of IPV, adjusting for the socio-economic factors.
Results
Of the women with privacy to answer the IPV module, 180 (3.4%) were found to be victims of sexual violence, 691 of physical violence (12.6%) and 935 (16.2%) of emotional violence. Women subjected to sexual violence were less likely to admit to having awareness of a Pap smear test; however, this did not impact screening rates. Victims of emotional violence were more likely to be screened than non-victims. No association between physical violence and cervical cancer screening was found.
Conclusions
A significant association between cervical screening awareness and IPV demonstrates that cancer screening policies must consider IPV among women to improve screening awareness. The paper further sheds light on the paradoxical association between emotional violence and screening. It is acknowledged this situation may be far worse than reported, as women without autonomy were unlikely to answer IPV questions that may endanger them—targeted surveys on cervical cancer screening warrant further investigation.
| Original language | English |
|---|---|
| Article number | e0290678 |
| Number of pages | 21 |
| Journal | PloS ONE |
| Volume | 18 |
| Issue number | 8 |
| Early online date | 31 Aug 2023 |
| DOIs | |
| Publication status | Published - 31 Aug 2023 |
Bibliographical note
Open Access via the PLOS AgreementAcknowledgments
The authors thank the MEASURE DHS for granting access to the DHS data.
Data Availability Statement
Data Availability: This study has used publicly available, secondary data. The datasets can be accessed on request at measuredhs.com. The data are available for download free of charge once the registration is complete and the data request is approved. The data was accessed via the official DHS website’ with a reference provided: Department of Health and Statistics. The 2017-18 Jordan Population and Family Health Survey 2017/18. [internet] Jordan [cited: 18 May 22] Available from: https://dhsprogram.com/pubs/pdf/FR346/FR346.pdf.
Access to Document
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© 2023 Urquhart et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. https://creativecommons.org/licenses/by/4.0/