Breast cancer care-seeking behavior in rural Bangladesh: the role of stigma, gender identity, and violence against women
While women in higher income countries can expect to survive a diagnosis of breast cancer, women in lower- and middle-income countries such as Bangladesh have mortality rates near 50%, suggesting that there are significant barriers to care seeking for breast problems. Given limited literature on barriers to care among native, rural South Asian populations, this study thus sought to understand 1) the impacts of breast problems on women and their families, including the extent of abuse among women with breast problems, and 2) the barriers and facilitators of care for women with breast problems in rural Bangladesh.
Sixty-three study participants (43 women and 20 men) were interviewed about their experiences. Interviewers elicited barriers to care, facilitators of care, and questions about the attitudes and behaviors of family and community members were in structured interviews.
The study found that breast problems and their treatment put significant resource and emotional strains on the family. Furthermore, over a third of women in this study reported abuse of some kind, with emotional abuse, neglect, and abandonment being the most frequently reported.
The study reinforced barriers to care identified in the literature for South Asian populations, but only a quarter of participants reported stigma of any kind. Lack of knowledge about breast cancer and inability to pay for care were the most frequently reported barriers, followed by access to care and fear of treatment. Facilitators of care among women who received a biopsy point to the importance of support by the husband and husband’s family, as well as the ability to identify economic support for and knowledge about care.
This study contributes to the understanding of two overarching themes: structural violence and the value of women, as well as how these themes influence poor outcomes for women with breast cancer in rural Bangladesh. Suggestions for future studies and short and long-term interventions to address study findings are offered.