Inaccurate Pap Smear Results Common in Colombia

Angela Castellanos

A majority of Colombian women get Pap smears, but new studies show that ten percent of such tests administered in Colombia yield inaccurate results.

Many Colombian women could be facing
risk of death as a result of undetected cervical cancer — despite having had Pap smears.  Why? Ten percent of such tests are not
accurate and therefore provide an incorrect diagnosis.  

The Pap smear is a method used for early cancer detection by
special staining of exfoliated cells. It can help reduce the death rate
by 60% in patients who usually go asymptomatic. 

The Instituto Nacional de Salud (INS), the public scientific authority for health, revealed that about 120,000 Pap tests per year — 10% of the
total — do not follow the scientific proceedings in taking the sample, its manipulation nor
its interpretation.

The 2005 National Population and Health
Survey (ENDS), the most rigorous research available on sexual and reproductive
health in Colombia, showed that the cervical cancer death rate had increased
from 54% in 1995 to 69% in 2000, among women aged 40 to 69. The survey
was conducted by Profamilia, a private, non-profit health provider. It also
revealed that among 20 to 49 year old women this rate had increased
from 34% to 37% in the same period. 

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Moreover, according to Pan American Health Organization, annually 2,300 Colombian women die as a result
of cervical cancer and about 5,000 are diagnosed with the cancer which
attacks the womb.  

Luis Eduardo Mejía, INS Director,
explained that this situation is partially a consequence of the operation
of bacteriological laboratories which do not meet the scientific standards. 
In fact, 70% of such laboratories have not been certified – that is to
say, 294 across Colombia, Mejía pointed out. 

In order to improve the
Pap tests, the INS, in conjunction with the Ministry of Social Protection,
developed a control guide of quality, which is a sort of protocol of
proceedings to follow in each step of the Pap process.  In addition,
the INS is training laboratory and medical staff on such proceedings
in order to ensure that the guide is implemented. So far, 800 gynecologists
and pathologists have been trained.  INS is also planning to train
indigenous people, whose women usually do not go for a test, because
of shame and fears about non-aboriginal healers. According to Mejia,
the prevalence of cervical cancer is increasing among indigenous communities. 

What is being done with the laboratories
which are operating without the INS certification? The Colombian authorities
have yet to make a declaration in this regard.  

How can a Colombian woman know if
her diagnosis is correct? Neither of the health authorities have disclosed
the laboratory’s names which are not certified by INS, nor have called
for a repetition of Pap tests.   

It is evident that health authorities did
not want to bring further public attention to this issue, maybe because such actions could have a negative impact in
the motivation of Colombian women to have a Pap test, which would jeopardize
its promotion.

In fact, local and national authorities
have long been campaigning for the annual Pap test. A Pap test promotion
campaign was launched two years ago in Bogotá, which included information,
testing and educational components. TV advertisements and brochures
were designed for public audiences. To provide sexual health education,
a number of promoters were trained to carry out social work with groups
of women who have never gone for the test. And the capital health authority
implemented mobile health teams which use vehicles equipped to perform
the Pap test in low income neighborhoods of Bogotá, as well as to start
conversations highlighting the importance of self-care.

In addition, new health regulations state
that both public and private healthcare providers are obliged to perform
free tests without previous appointment.

In 2005, ENDS revealed that 85% of Colombian
women have had Pap tests performed at some points in their lives, while
only 48% go for them once a year. However, 99% of women aged 18 to 69
are informed about the Pap test.

Nevertheless, 14% of those who have never
gone for the test said that cost is not what matters most. ENDS identified
the reasons behind such a behavior: carelessness (32%), fear (30%),
shame (17%), asymptomatic (15%), considering it unimportant or unnecessary
(7%) and lack of money (5%).

News Family Planning

Judge Thwarts Ohio GOP’s Attack on Planned Parenthood Funding

Michelle D. Anderson

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” said Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio.

An effort to defund Ohio Planned Parenthood affiliates by Gov. John Kasich (R) and the Republican-held legislature has come to an end.

Judge Michael R. Barrett of the U.S. District Court of the Southern District of Ohio on Friday ruled in Planned Parenthood’s favor, granting a permanent injunction on an anti-choice state law.

The court ruling will keep Richard Hodges, the Ohio Department of Health director, from enforcing HB 294.

The 2015 law, sponsored by Rep. Bill Patmon (D-Cleveland) and Rep. Margaret Conditt (R-Butler County), would have redirected $1.3 million in state and federal taxpayer funds from Planned Parenthood’s 28 clinics in Ohio.

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The law would have required the state department to keep federal funds and materials that the health department receives from being distributed to entities that perform or promote non-therapeutic abortions, or maintain affiliation with any entity that does.

Funding that would’ve been cut off from the state health department went to the Violence Against Women and Breast and Cervical Cancer Mortality Prevention acts, the Infertility Prevention Project, Minority HIV/AIDS and Infant Mortality Reduction initiatives, and the Personal Responsibility Education Program.

Planned Parenthood in a lawsuit argued that the Republican legislation violated the First Amendment and the Due Process Clause and Equal Protection Clause of the 14th Amendment.

Barrett had temporarily blocked the law after Planned Parenthood affiliates filed the lawsuit and requested a preliminary injunction. The judge had issued an opinion contending that some legislators passed the law to make it difficult for people to access abortion care, as Rewire reported.

Iris E. Harvey, president and CEO of Planned Parenthood of Greater Ohio, praised the judge’s temporary order.

“This law would have been especially burdensome to communities of color and people with low income who already often have the least access to care—this law would have made a bad situation worse,” Harvey said in a statement.

Kellie Copeland, NARAL Pro Choice Ohio’s executive director, said in a statement that the Ohio legislature passed the anti-choice measure in an effort to appeal to conservative voters in early primary states during Kasich’s presidential campaign.

Copeland said that while the legislation made no effort to reduce the number of abortions performed, “it actively blocked critical health care for low-income women and families.”

Planned Parenthood said those services included 70,000 free STD screenings, thousands of HIV tests for at-risk community residents, and the largest infant mortality prevention program in the state.

In the 23-page court order and opinion, Barrett, an appointee of President George W. Bush, acknowledged that the law would have deterred “patients from seeking these potentially life-saving services.”

Planned Parenthood noted that the recent ruling in Ohio makes it among the ten states where courts have blocked anti-choice laws following June’s landmark Whole Woman’s Health v. Hellerstedt U.S. Supreme Court ruling.

Investigations Media

The ‘HUSH’ Documentary: Another Secret Recording Inside an Abortion Clinic

Sharona Coutts

HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited. They trot out many of the worn theories that have been rejected by medical and public health experts. The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

Another day, another secret recording made in an abortion clinic.

At least, that’s the very strong impression given by some of the scenes contained within the documentary film HUSH, which premiered late last year and is currently making the rounds of film festivals and anti-choice conferences in the United States and internationally, including the National Right to Life Convention that took place in Virginia last month.

The film is the creation of Mighty Motion Pictures and Canadian reporter Punam Kumar Gill, who says in the film that she is pro-choice, a “product of feminism.” It purports to tell the story of “one woman,” Gill, who “investigates the untold effects of abortion on women’s health.”

HUSH—which claims in the film’s credits to have received support from the Canadian government—attempts to cast itself as neither pro-choice nor “pro-life,” but simply “pro-information.” The producers insist throughout the film, in their publicity materials, and in private emails seen by Rewire that their film is objective and balanced.

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That’s how they pitched it to Dr. David Grimes, a highly respected OB-GYN and a clinical professor in the Department of Obstetrics and Gynecology at the University of North Carolina School of Medicine, who agreed to do on-camera interviews for the film. Grimes now says the producers and reporter misled him about their intentions.

“There was no balance,” Grimes told Rewire. “It’s a hatchet job. It’s obvious.”

Indeed, HUSH relies almost exclusively on interviews with renowned anti-choice “experts” whose work has been discredited, many of whom are featured in Rewire‘s gallery of False Witnesses. They trot out many of the worn theories that have been rejected by medical and public health experts—namely, that abortion is linked to a host of grave physical and mental health threats, “like breast cancer, premature birth, and psychological damage.”

The innovation of HUSH, however, is that it has reframed these discredited ideas within the construct of a conspiracy theory.

When Anti-Choice “Science” Goes Conspiracy Theory

As a piece of propaganda, the use of the conspiracy theory has the advantage of removing the debate over abortion’s safety from the realm of logic. In HUSH‘s topsy-turvy world, the medical establishment becomes the scare-quoted “Medical Establishment,” and the more distinguished or authoritative a person or organization, the more suspect they become.

For reasons that remain murky, the film’s thesis is that the world’s leading reproductive and health organizations—including the National Cancer Institute, the American Cancer Society, the American Congress of Obstetricians and Gynecologists, and the World Health Organization, along with all of their staff, contractors, and affiliated experts—have been hiding information about the risks of abortion.

This is most apparent when the reporter, Gill, tells the viewers that “if women have the right to abortion, they should also have the right to know” about the risks she believes she has identified.

Later, the film shows graphics highlighting the states that have various informed consent laws—some of which are literally called “A Woman’s Right to Know” acts—that force providers to give patients false information about the safety of abortion. Rather than concluding that the authority of the state has been used to mandate that doctors provide medically unsound “counseling” using the very junk science that Gill presents throughout the film, she hews to the back-to-front logic of all conspiracy theories. In her view, the existence of these laws shows that the risks are real, but that the faceless, nameless “they” still won’t let women in on the their deadly secrets.

In Gill’s world, the unwillingness of organizations to speak with her becomes evidence that they are hiding something.

The American Congress of Obstetricians and Gynecologists tells Gill that it won’t fulfill her requests by giving her an interview because the science is settled; Gill sees this as a sign of conspiracy.

“This is where I started to feel equally suspicious of those denying any link,” Gill tells the viewer, her voice floating over inky footage of the U.S. Capitol at night. Lights from the Capitol dance on the velvety surface of the Lincoln Memorial Reflecting Pool, and Gill confides: “I felt like I was digging into something much deeper and darker.”

A comical scene ensues where Gill is astonished to find that turning up with a film crew on the grounds of the National Cancer Institute does not suddenly persuade it to grant her an interview with one of its experts.

“What was going on here?” says Gill in her voiceover. “It was like they really didn’t want any questions being asked.”

In fact, the National Cancer Institute had replied to Gill’s multiple requests with links to its website, which contains the conclusive studies that have long since dispelled the notion that any link exists between abortion and breast cancer. The film shows footage of those emails.

Furthermore, Grimes provided Rewire with copies of emails he had exchanged with the film’s producers during its production, in which he gave them citations to relevant studies and warned them that the work of the anti-choice “experts” they had approached had been thoroughly debunked.

After seeing the film, Grimes emailed the producers inquiring why they hadn’t simply asked him to connect them with additional experts.

“Had you truly wanted more pro-choice researchers to speak to these issues, I could have named scores of colleagues from the membership of the Society for Family Planning and Physicians for Reproductive Health who would have been happy to help,” Grimes wrote in a note he shared with Rewire. “You did not ask. That some organizations like the National Cancer Institute did not want to take part in your film in no way implies a reluctance on the part of the broader medical community to speak about abortion research.”

It seems that Gill—whose online biographies give no indication that she is a scientist—would not have been satisfied in hearing about existing research. She tells the viewers that, in her view, “more study is needed to determine the extent of the abortion-breast cancer link,” and concludes that “to entirely deny the connection is ludicrous.”

In an interview with Rewire, Grimes noted that doing such research would be viewed as unethical by reputable scientists.

“That issue is settled, and we should not waste limited resources that should be directed to urgent, unanswered questions, such as the cause of endometriosis and racial disparities in gynecologic cancers,” he said.

Grimes made his dissatisfaction clear to the producers. He wrote to them: “My inference after viewing the film is that you are suggesting a large international conspiracy of silence on the part of major medical and public health organizations, the motivation for which is not specified.”

The corollary to the suspicion cast over the most reputable research and representative bodies is that the film transforms the marginal status of the anti-choice “experts” into a boon.

Seen through HUSH‘s conspiracy theory lens, the fact that the work of people like Priscilla Coleman, David Reardon, and Angela Lanfranchi is rejected by the medical establishment becomes proof not of the unsoundness of their ideas, but rather that a conspiracy is afoot to silence them.

Instead of presenting this small but vociferous group of discredited activists as outliers—shunned because their theories have no scientific basis, or because they lack any credentials relevant to reproductive or mental health, or because they have repeatedly mischaracterized data—HUSH paints them as whistle-blowing renegades determined to set the truth free.

A tearful Lanfranchi recounts the story of patients who came to her with aggressive breast cancer in their 30s. Lanfranchi says she strove to understand “why this was happening,” and realized that each of these young women had had abortions, which she then concluded had caused their cancer. Lanfranchi said her hopes that the public would learn of this risk were dashed over time.

“Over the years I’ve realized that, no, it didn’t matter how many studies there were,” she tells viewers. “That information was not going to get out.”

Joel Brind says that he has worked with a colleague whom he says he later discovered was pro-choice, but that their views on abortion never came up. “This is about science,” he tells Gill. “This is about the effect on women and whether or not abortion increases the risk of breast cancer. Period.”

Gill asks both Lanfranchi and Brind whether they are trying to “stop abortion,” or whether they “want abortion to go away.” Both answer that all they want is for women to be informed when they exercise their choice.

The film makes no mention of the fact that both have been anti-choice activists for decades; they have each testified in support of anti-choice laws in both legislative and judicial proceedings, and both have participated in the extreme right-wing, anti-choice, anti-LGBTQ World Congress of Families.

To the extent that HUSH acknowledges these activists’ bias, it is couched in a softer light that is linked, implicitly, to their religious views—a reality raised by Grimes in his on-camera interview, in which he notes, accurately, that the anti-choice “intellectuals” often lack the relevant medical or scientific qualifications to do the type of work they purport to do, but that they do tend to share religious convictions that lead them to oppose abortion and contraception.

That allows the producers to imply that the False Witnesses are perhaps victims of discrimination; to suggest that their work is being discounted because of the activists’ religious beliefs, and not because the work itself has been thoroughly debunked. Play the ball, not the man, appears to be the producers’ plea.

It’s a conspiracy theory twilight zone: where medical groups withhold information for reasons so cloudy that they cannot be articulated, but where people who have for years worn their beliefs on their sleeves cannot be evaluated with those political views in mind.

After asserting that she is, herself, pro-choice, Gill says she “finds validity” in the claims of the anti-choice advocates, and that she finds it “sickening” that the “media and health organizations have spent their energies closing the case and vilifying those who advocate in favor of the link, instead of investigating any and all reasons why breast cancer rates among young women have increased and women are dying.”

The producer, Joses Martin, did not answer Rewire’s questions about the experts he and his team had selected, other than to say, “We are very proud of the balanced approach that we’ve taken in this documentary that is neither anti-abortion nor pro-abortion.”

Another Instance of Secret Recordings Made in Abortion Clinics

What troubles Grimes most about the film is not so much that he was cast as the face of an international conspiracy by virtue of being the sole pro-choice physician to appear on camera, but that he may be associated with people who appear to have made secret recordings in at least one abortion clinic.

The footage and audio in question have been heavily edited, and it is difficult to discern what is real from what has been staged or spliced to give certain effects.

Early in the film, Gill is shown standing in the entry path to what the producers identify as a “Seattle abortion clinic.” As she makes her way inside, the footage swaps to guerilla-style, hidden camera shots, which capture wall artwork that appears in some Planned Parenthood clinics. Viewers see Gill’s face in the waiting room, as well as blurs of other people there. The film then swaps to audio recordings without any video footage. Gill can be heard posing as a patient, receiving counseling from a woman who is identified as a “health center manager.” This audio is used twice more during the film.

In Washington state, it is a crime to make audio or video recordings of people without their consent. Similar laws are in place in California, Florida, and Maryland, states where David Daleiden and his co-defendants from the Center for Medical Progress made their surreptitious videos of Planned Parenthood employees and members of the National Abortion Federation.

Grimes asked the producers whether they had obtained permission to make any of those recordings; Rewire asked the producers whether the recordings were in fact made in Seattle.

The producer, Joses Martin, replied to Grimes that he would “not be disclosing the name or location of the clinic or the name of the individual recorded to yourself or anyone else.”

“We have kept this information undisclosed and private both in the film and out of the film to not bring any undue burden on them. We’re certainly not implicating anyone involved of wrong doings, as was the goal in the Center For Medical Progress case,” Martin wrote in an email shared with Rewire.

In an email to Rewire, Martin did not answer our specific questions about the recordings, but asserted, “We did not break any laws in the gathering of our footage.”

Planned Parenthood had no comment on whether the crew had obtained consent to film inside its clinics, or whether Gill had misrepresented herself throughout her conversation with the counselor. Nor did the organization comment on the increasing use of secret recordings by anti-choice activists within its clinics. In a federal suit, Planned Parenthood has sued Daleiden for breaches of similar laws in California, Florida, and Maryland.

The branch of the Canadian government that the producers credited with supporting the film was less sanguine when informed about the apparent use of secret recordings made in American abortion clinics.

The film’s credits say that it was produced “with the assistance of the Government of Alberta, Alberta Media Fund,” but when Rewire contacted that Canadian province to learn why it had funded a piece of anti-choice propaganda, a spokesperson distanced the fund from the film.

“We have entered into conversations with the production company but we do not at this point have a formal agreement in place, and we were not aware that the production had been completed,” the spokesperson said. “We’re not able to comment on any funding because to date we have not funded the project. Thank you for bringing the use of our logo to our attention and we’ll be in touch with the producers to discuss.” The producers did not reply to Rewire’s question about their use of the logo.

Ironically, while the producer, Martin, did reply to emails from both Grimes and Rewire (albeit without answering specific questions), the reporter, Gill, remained silent. She never answered questions about what she knew about the backgrounds of the False Witnesses to whose work she lent such credence. She didn’t respond to our questions about whether she obtained permission to record video or audio within abortion clinics, or where those clinics were located. And she didn’t reply to our questions about the nature of her relationship with the extreme anti-choice group Live Action, who also received a credit at the end of the film.

To a reporter such as Gill, such silence would surely have been deeply suspicious.

Rewire Investigative Reporter, Amy Littlefield, contributed to this report. 

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