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Breast Cancer Awareness Month: what about black women?

23 October 2020 | Story Nombulelo Shange and Lesego Bertha Kgatitswe | Photo Pixabay

breast cancer awareness month_web read more — It is #BreastCancerAwarenessMonth, and women in rural areas struggle to receive and understand the life-saving messages, as much of the awareness is predominately in English, while cancer centres and health facilitates are mostly located in urban areas.

It is Breast Cancer Awareness Month, and questions around the reach of awareness are important to ponder. Who is the awareness really for? Much of the awareness is predominately in English, while cancer centres and health facilities are mostly located in urban areas. The result – women in rural areas struggle to receive and understand the life-saving messages. Accessibility remains a huge challenge when it comes to both diagnosis and treatment. Once diagnosed, black women must contend with many other socio-economic challenges that limit them from receiving treatment, even if it is free and provided by public healthcare institutions.

Overwhelming number of black women is poor and marginalised in SA

Women in the Northern Cape and parts of North West, for example, have to travel to Kimberley to access breast cancer treatment facilities. Kuruman has a satellite facility, but with limited resources and staff. Northern Cape is the largest province in South Africa when it comes to land mass, and most poor rural black women cannot afford the cost of travelling to Kimberley because of extreme poverty. A 2019 study conducted by the Pietermaritzburg Economic Justice and Dignity Group shows that 55,5% of the South African population survives on R40,90 per person per day. South Africa is also the most unequal society in the world, with those historically marginalised by colonisation and apartheid still being the most oppressed even today. Black women make up an overwhelming number of the poor and marginalised in SA. When black women are diagnosed with breast cancer, they have the burden of having to pit their bread and butter issues against their health concerns. Transport, food, and other travel costs have the ability to push these women and their families deeper into poverty when important healthcare institutions are far and inaccessible.

Breast cancer awareness and education needs to be scaled up in the black communities to also consider these socio-economic limitations. Greater focus on primary healthcare is also needed with regard to speedy referral for screening and diagnostic tests. These interventions are still largely lacking in black communities, partly because of the myths around who is affected by cancer. The misconception is often that cancer is a disease that only affects white people, and it still persists despite the growing incidences of cancer among black women. One of the reasons influencing this racialised idea of the illness might be the fact that there are seemingly higher incidences of breast cancer among white women than among black women.

In 2011, the National Cancer Registry reported that the overall risk for breast cancer in South Africa is 1 in 29 women, and further estimated that the lifetime risk is 1 in 12 among white women and 1 in 50 among black women. These figures, however, do not account for the black women who might never receive a proper diagnosis. Current and accurate research is not available on how these figures might have changed over the past 10 years. The 2017 Breast Cancer Prevention and Control Policy, however, attributes lower incidence of breast cancer among black women to multiple socio-cultural factors, such as universal and prolonged lactation, low use of hormone replacement therapy, late menarche, early age of first birth, and a diet low in fat and high in fibre. However, due to rapid urbanisation and lifestyle changes, there has been a significant decrease in these protective factors, making black women vulnerable to increased incidences of breast cancer and mortality.

Public healthcare system had to prioritise simultaneously

Historically, cancer, along with other non-communicable diseases, have been understood as diseases of affluence, as they are related to economic development, consumption, and lifestyle. In contrast, infectious or communicable diseases were understood as diseases of poverty and impoverishment. These crude categorisations were central in explaining global health inequalities, but the epidemiological transitions of the past few decades have forced us to think more critically about these issues. South Africa as a middle-income country is a case in point, with a disease burden of both communicable and non-communicable diseases, which the public healthcare system had to prioritise simultaneously. Breast cancer has thus been declared a national priority, as highlighted by the Breast Cancer Prevention and Control Policy of 2017.

The policy notes that women who live in rural areas are at a disadvantage regarding access to information and services; however, little is said about the intersections of race, class, and gender in understanding the structural barriers to breast cancer awareness and knowledge. The poor or inadequate breast cancer awareness and knowledge among black women should be a call for concern.

Poor knowledge and awareness of breast cancer leads to delayed detection, presentation, diagnosis, and treatment. This results in a late stage of cancer upon diagnosis, aggressive cancer treatment, severe side effects, poor quality of life, or worse – mortality. As public health specialists often say, ‘equity in healthcare begins with equity in health education’. Sociological analysis and theorising are thus important for us to understand these structural barriers, starting with how black women’s bodies are seen and treated. Researchers around the world have highlighted how the healthcare system treats black women differently as a result of implicit racial bias, discrimination, and racism.

American critical race theorist and feminist scholar, Patricia Hill Collins, attributes the discrimination experienced by black women to vectors of oppression that intersect in black women’s lives. Poverty, lack of representation in healthcare systems/leadership, discrimination along racial and gender lines – all these vectors come together and make access to healthcare a huge challenge for black women. Systems marginalise black women for economic gain or to maintain patriarchal dominance, making even the most basic rights and institutions inaccessible to black women.

The exclusion of black women

Beyond awareness, these challenges also speak to the exclusion of black women in public spaces, in senior positions within healthcare, in leadership, and in important decision-making that can impact how they navigate the world. The lack of representation affects even the personal aspects of black women’s lives, such as how they experience illness.

Feminists tackle this challenge by turning the personal into the political. Politicising the personal is forcing the challenges that women are faced with into the public space, compelling institutions and leaders to address these challenges. Breast cancer awareness does this in part, which is one of the things that makes the movement so important. But is it leaving black women behind?

While awareness might be lacking for black women with breast cancer, it is important to note that some women have exercised their agency to advance breast cancer awareness. Mama Lillian Dube, for example, used her public platform to talk about her experiences of breast cancer, demystifying the illness, and advocating for quality healthcare services for women. We also need to tap into existing structures and initiatives; community healthcare workers have done great work in the past to create awareness around HIV/AIDS. Similar strategies should be considered for breast cancer awareness to ensure that no woman is left behind.

Opinion article by Nombulelo Shange, Lecturer in the Department of Sociology, University of the Free State, and Lesego Bertha Kgatitswe (Lecturer in the Department of Sociology at Sol Plaatje University)

News Archive

UV vestig hom afgelope eeu as leier op verskeie terreine

2004-05-11

Michelle O'Connor - Volksblad - 11 Mei 2004

Ondank terugslae nou 'n 'gesonde volwassene'

HOEWEL die Universiteit van die Vrystaat (UV) vanjaar sy eeufees vier en met 23 000 studente die grootste universiteit in die sentrale deel van die land is, was dié instelling se geboorte glad nie maklik nie. MICHELÉ O'CONNOR het met prof. Frederick Fourie, rektor, oor die nederige begin van dié instelling gesels.

DIE behoefte aan 'n eie universiteit in die Vrystaat het reeds in 1855, kort ná die stigting van Grey-kollege, kop uitgesteek.

Grey se manne het hulleself teen 1890 begin voorberei om die intermediêre B.A.-eksamens af te lê. Dié eksamen het hulle toegang gegee tot die tweede jaar van 'n B.A.-graad aan die destydse University of the Cape Good Hope, nou die Universiteit van Kaapstad.

"Presidente F.W. Reitz en M.T. Steyn het destyds albei die stigting van 'n universiteit hier bepleit. Die grootste rede was sodat die seuns van die Vrystaat nie weggestuur word nie.

"Dié twee se droom is op 28 Januarie 1904 bewaarheid toe ses studente hulle onder dr. Johannes Bril, as hoof/rektor van Grey-kollege, vir die graad B.A. ingeskryf het. Dié graad is aanvanklik deur die Kaapse universiteit toegeken.

"Net die klassieke tale soos Latyns en Grieks, die moderne tale, Nederlands, Duits en Engels, filosofie, geskiedenis, wiskunde, fisika, chemie, plant- en dierkunde is aanvanklik aangebied.

"Die UV se geboue het gegroei van 'n klein tweevertrek-geboutjie wat nou naby Huis Abraham Fischer staan, en verblyf in die Grey-kollege se seunskoshuis," sê Fourie.

Volgens hom is die universiteit se eerste raad en senaat tussen 1904 en 1920 saamgestel. Die eerste dosente is aangestel en die eerste geboue opgerig. "Dié tyd was egter baie moeilik.

"Die instelling het teen 1920 net 100 studente gehad en was geldelik in die knyp. Daar was geen vaste rektor nie en geen vooruitgang nie. Vrystaatse kinders is steeds na ander universiteite gestuur.

"Ds. J.D. Kestell, rektor van 1920 tot 1927, het egter dié instelling finaal gevestig.

"Hy het self studente van oor die hele Vrystaat gewerf en geld by onder meer kerke en banke ingesamel. Kestell het selfs Engelse ouers oortuig om hul kinders na die Greyuniversiteitskollege (GUK) te stuur en teen 1927 het dié instelling met 400 studente gespog.

"In die tydperk tussen 1927 en 1950 het die GUK weer verskeie terugslae beleef.

"In dié tyd was dit onder meer die Groot Depressie en die Tweede Wêreldoorlog. Die armblanke-vraagstuk het regstreeks op studente en dosente ingewerk en die politieke onderstrominge van dié tyd het die instelling ontwrig.

"Die GUK het egter oorleef en die Universiteitskollege van die Oranje-Vrystaat (UKOVS) is in 1935 gebore," sê Fourie.

Hy sê in dié tyd is verskeie fakulteite gevestig en teen 1950 het die UKOVS met 1 000 studente gespog.

Teen 1950 het dit 'n onafhanklike universiteit geword en die naam is verander na die Universiteit van die OranjeVrystaat (UOVS).

Dié tydperk is gekenmerk deur Afrikaner- en blanke selfvertroue en heerskappy. Studentegetalle het tot 7 000 in 1975 gegroei en heelwat vooruitgang het in dié tyd plaasgevind.

"Tussen 1976 en 1989 sukkel dieuniversiteit weer met onder meer ekonomiese krisisse, die land se politieke onstabiliteit en word die UOVS geï soleer.

"Een ligpunt in dié tyd is die toelating van die eerste swart studente, die nuwe Sasol-biblioteek en die fakulteit teologie wat die lig sien.

"Tussen 1990 en vanjaar het die UOVS verskeie op- en afdraandes beleef. Die universiteit doen nie net die eerste stappe van transformasie nie, maar begin ook aan 'n beleid van multikulturaliteit werk.

"Die UOVS se naam verander in 1996 na die Universiteit van die Vrystaat/University of the Free State en in 2001 word die Sotho-vertaling bygevoeg.

"Geldelike druk en probleme neem drasties toe en personeel word gerasionaliseer.

"Teen 2000 begin die UV met 'n draaistrategie en studentegetalle neem tot meer as 23 000 toe," sê Fourie.

Hy sê die UV het die afgelope eeu nie net verskeie terugslae oorleef nie, maar homself ook op verskeie gebiede as 'n leier gevestig.

Die universiteit behaal sy eie geldelike mikpunte, neem 'n nuwe taalbeleid van veeltaligheid aan en herbelê in personeel.

Die instelling inkorporeer die kampusse van die Vista- en Qwaqwa-universiteit en groei internasionaal.

Die UV vestig ook fondamente van 'n institusionele kultuur van verdraagsaamheid, geregtigheid en diversiteit.

"Die baba het in die afgelope eeu 'n gesonde volwassene geword."

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