Gender norms and systemic barriers are fuelling cancer-related deaths among women in West Africa, despite the availability of preventive tools

Survival rates for breast and cervical cancers have increased significantly in the past few decades in high-income settings, where women have access to HPV vaccination and routine screening to prevent or detect and treat cancers early. 

In low-resource settings such as West Africa, however, they remain the leading causes of cancer-related death among women. Many are diagnosed at advanced stages, face prolonged delays in receiving treatment, and are unable to access basic supportive care. 

This is in part due to economic hardship, under-resourced health systems, or geographic barriers to care. Yet there are other significant though often less recognised factors that can severely hinder effective access to prevention, treatment, and supportive care, notably social and gender norms that can discourage or delay women from seeking timely medical help.  

In contexts where health systems are under strain and out-of-pocket costs are high, supportive care – including pain management, psychosocial services, and social reintegration – is often absent or inaccessible. Women are especially impacted, as they are more likely to be economically vulnerable, primary caregivers, and constrained by cultural expectations. These barriers affect not only survival rates but also quality of life for those who do survive. 

To explore these challenges, Dr Samiratou Ouedraogo, UICC Young Leader 2023–2024 and researcher at the Groupe d’action contre le cancer, a UICC member organisation in Burkina Faso, led an analysis of national cancer control strategic plans in West African countries.  

In an interview with UICC, she speaks to the results of the analysis and the importance of embedding gender equity in cancer policy and the need for a rights-based approach to supportive care. 

When and in what context did you first notice the impact of gender roles on access to cancer care? 

My initial plan was not to focus on gender or cancer, but when I came back to Burkina Faso in 2020, I realised that public health aspects of cancer were largely ignored. It is important to stress that I have already worked in the past on health equity and access – first through research on informal medicine, then on cancer screening in France. However, it became a personal matter when I learned more about my grandmother’s breast cancer, which was diagnosed when I was a child. Looking back, I saw how little we knew and how much social and gender norms shaped her care. That realisation pushed me to focus my interest on prevention and equity in cancer control here. 

What are the specific gender issues that affect cancer control in West Africa? 

There is a young population across the region, but we are also seeing an increase in cancer cases. Women are dying from preventable cancers, including breast and cervical cancers, even though the tools for early detection and treatment exist. 

One reason is that many women don't have access to services – or even to basic information. Gender roles and inequalities play a big part in this. A woman might need her husband’s permission or financial support to go to the doctor. Or she might be too busy caring for others to prioritise her own health. So gender equity is fundamental to improving cancer outcomes. 

Your analysis of national cancer strategies found that gender equity is often only implicitly addressed. What stood out to you most in reviewing these plans?  

What stood out is that while all the strategies mention breast and cervical cancer – because of how widespread and deadly they are – they focus mostly on the biological aspect. They rarely go further to ask why women aren’t accessing care in time, even when the tools for prevention and treatment exist. 

There’s this idea that if something is free, then people will just go and use it. But that’s not how it works. Free doesn’t mean people know about it. It doesn’t mean they understand what it is or why it matters. A woman might not know what screening even means – especially if she feels healthy. Or she might know, but does not know where to go, or when. Or maybe she does know, but she can’t go – because her husband says no, or because she has no one to take care of her children. 

Sometimes we say a service is there, so the problem is solved. However, in reality, many women don’t get that information at all. The public health campaigns don’t always reach them. Or if they do, it’s not in a way they can understand – maybe the language isn’t right, or it’s just not clear. So the service is there, yes, but it’s not really accessible for everyone. 

There are more obvious barriers, such as cost or distance from a care centre, but lack of information is a less visible one. Perhaps you can detail some of the other less obvious barriers that prevent women from accessing supportive care and treatment, which you’ve hinted at? 

There are a lot of things that limit women from getting care – and they’re all connected. First, like I said, there’s the issue of information. Even when services exist, many women don’t know they’re there, or they don’t understand why screening is important, especially if they’re not feeling sick. 

Then, there’s the economic side. It’s not just about the price of treatment. Most women here work in the informal sector– they sell things at the market, clean houses, or do day labour. If they don’t work, they don’t earn. There’s no job security, no sick leave. So if a woman decides to go to the hospital, that means losing some income. And if she’s the only one bringing in money, or she has small children at home, how does she manage that? Sometimes, just the thought of what it would cost her to take time off makes her give up on going at all. 

And then you have the social and cultural barriers, which are sometimes even harder. In some places, if a woman has a gynaecological cancer, people might think she did something wrong. There’s a lot of stigma around cancer in general but particularly around gynaecological cancers. Her family or her husband might push her away. Or they might not – but the woman herself might still feel ashamed, like she brought it on herself. This feeds into not even seeking care in the first place – some women fear being judged or rejected if they speak up about symptoms or go for testing. That kind of stigma can really isolate someone. 

And then there’s the cultural issue of autonomy. In many cases, women don’t really have the power to decide for themselves. Maybe they know where to go, maybe they even have the money. But still, they need permission; have to ask their husbands, their in-laws, or their father. And sometimes, the answer can be no. That’s why it’s not just a question of building services, of what services exist – but whether women are in a position to actually use them. 

How does this affect the quality of care and the experience of people living with cancer? 

Supportive care is almost inaccessible. I’m talking about pain management, psychological support, help with daily life after treatment. Health workers aren’t always trained to announce a diagnosis or explain what comes next. And even the word 'cancer' doesn’t exist in many local languages, so people might think that it’s a curse, something mystical. In many cultures, women, especially, are expected to bear pain without complaint. They often won’t even say anything. So they go through all this alone, without support, and that really changes how they experience the disease – and even whether they survive or recover from the experience if they do. 

Can you expand on that? What happens to women who survive cancer? Are there systems in place to support them? 

Very little. A woman might survive the illness, but she could lose everything – her job, her income, even her position in the community. There’s almost no follow-up care. Reconstruction surgery is rarely available, and there’s no real guidance for how to go back to work, or just back to life. Women who’ve had a mastectomy are often left to figure things out alone. There’s no system to help them feel like themselves again, to support their mental health or even just reintegrate socially. So they survive – but they’re left with nothing. 

What would it mean to make cancer control plans and policies truly gender-responsive? 

When we talk about gender-transformative strategies, we mean plans that go beyond simply recognising these barriers. We mean policies that actively work to change them – by tackling stigma, engaging men, building trust in communities, and including women themselves in the design and delivery of their care. It’s about transforming the norms and power dynamics that keep women from seeking help in the first place. Not just offering services, but making sure they’re truly reachable and usable for all women, in all their diversity. 

So it’s not just about listing services, it’s about making sure people can really use them. That means thinking about things like transport, how far someone has to travel, how much time it takes, how stigma plays a role, and whether they even feel safe coming forward. It also means education, and bringing in women themselves to help shape these strategies. If you don’t involve the people most affected, you’re missing the point. The plan might look good on paper – but it won’t work on the ground. 

How can communities be engaged in this transformation? 

We’ve been working on programmes that bring in men – spaces where men can talk, learn, and support women’s access to care. This has worked in maternal health, and I believe it can work for cancer too. Sometimes it just takes someone who has lived it to open people’s eyes. 

Do you see any signs of progress? 

A little. In some countries, we’re seeing more awareness and stronger political commitment. But often, it only happens when someone in power is personally affected – and that shouldn’t be the reason we act. Health is a right. If policies don’t include vulnerable people – those who are hardest to reach – they’re being denied that right.