Ethnic Disparities in the Reproductive and Sexual Health Screening Practices of Ecuadorian Women

Background: Evidence suggests that reproductive and other health disparities disproportionately affect Indigenous and Afro-Hispanic ethnic minority groups throughout the Latin American and Caribbean (LAC) region. Factors associated with reproductive health disparities in LAC countries include low social economic status (SES), poor health care access, racial and gender discrimination, machismo, health beliefs and low perceived risk for breast cancer, cervical cancer, sexual transmitted infections (STIs) and other conditions. Preventive measures such as health education and early screening is vital for disease prevention and detection. However, screening rates for breast cancer, cervical cancer, and STIs are lower in most LAC countries compared to the United States (USA), Canada, and other high-income countries. Likewise, the low prevalence of modern contraceptive use (e.g., condom, intrauterine device (IUD), contraceptive pills, Norplant, etc.) is another important public health challenge facing many LAC countries. Ecuador is a middle-income Andean country that displays high rates of fertility and reproductive cancers as well an increasing population burden of human immunodeficiency virus (HIV) and other STIs. The country also has one of the largest ethnic minority populations in the LAC region. Persons of indigenous and African descent constitute an estimated 7-25% and 3-10% of the population of 14 million inhabitants. Ethnic disparities in poverty-linked indicators and some chronic and infectious health outcomes have been reported for indigenous and Afro-Ecuadorian groups but little is known those related to reproductive health. A better understanding of reproductive health disparities and the factors that influence them including health-seeking is useful for improving programs and policies that serve ethnic minority groups in Ecuador. Aims: This study aimed to compare ethnic differences in reported sexual and reproductive health knowledge and practices including health-seeking of reproductive-aged Ecuadorian women. The main objectives were to describe the prevalence of reproductive and sexual health screening behaviors among reproductive-aged Ecuadorian women with respect to cervical cancer, breast cancer, contraception use and sexually transmitted infections and to identify ethnic differences in knowledge and screening practices prevalence of contraceptive use, breast cancer, cervical cancer, HIV and STIs among the three major Ecuadorian ethnic groups. Methods: The ENDEMAIN 2004 national survey was carried out by the Centro de Estudios de Poblacion y Desarrollo Social (CEPAR) with technical assistance from the U.S. Centers for Disease Control and Prevention (CDC). The nationally-representative survey used a multistage clustering design. One reproductive aged woman (15-49 years) per household selected from 10, 814 Ecuadorian households completed a questionnaire on her sexual and reproductive health. The data was analyzed with IBM-SPSS Version 21 database management and analysis software. Univariate analysis was conducted for continuous variables (mean and standard deviation) and categorical variables (frequencies and percentages). Unadjusted bivariate analysis were conducted using Pearson Chi-Square test for categorical variables and ANOVA for continuous variables for majority Mestizo versus minority Indigenous and Afro-Ecuadorian women. Logistic regression was used to compare the prevalence ratio among the three groups (Mestizo versus Indigenous and Afro-Ecuadorian) while adjusting for other covariates. Results: The results from this study demonstrate the health knowledge disparity between Mestizo, and Indigenous women. Indigenous women reported the lowest knowledge percentage for most of contraceptive methods and were less likely than Mestizo women to use a contraceptive method. No statistically significant difference was found between Afro-Ecuadorian and Mestizo women in regards to any lifetime contraceptive method use. As expected, Indigenous and Afro-Ecuadorian women were less likely than Mestizo women to ever hear about breast and cervical cancer and sexual transmitted infections. Discussion: The study results suggest a high need for tailored interventions for reproductive health to include breast and cervical cancer screening and HIV and STIs screening for the most neglected ethnic groups, Indigenous and Afro-Ecuadorians. Although higher HIV screening rates and knowledge rates are reported for Afro-Ecuadorian women in comparison to Indigenous women still the rates are not as high as the majority Mestizo women. Policy development for Ecuador must focus on making health education available to those groups in rural areas in order to reduce the health disparity existing between Mestizo women and Indigenous and Afro-Ecuadorian women. The study findings have implications for reproductive health promotion and intervention design in rural, low income settings and for minority populations