Centering ‘Care’ in Reproductive Healthcare: The Lily Project

Cervical cancer is the fourth most common cause of cancer incidence and death among women worldwide. Despite the availability of preventive measures, barriers to access to the vaccine and the obstacles to implementing routine cancer screening programs pose significant challenges in prevention and detection. Historically, stakeholders have invested in detection programs, such as screen-and-treat, self-swabbing, and patient navigation (Pourette et al. 2022). While such interventions showed the effectiveness of patient-centered methods, they also underscored continuing obstacles with access to rural women, the inaccuracy of self-sampling, and the effectiveness of community education (Daniel et al. 2023).

Building on the evidence regarding continued barriers to access to vulnerable communities, this paper introduces a case study of the women-centered approach of a sexual and reproductive health NGO operated in Nicaragua between 2016 -2019, The Lily Project (TLP). Recognizing the challenges in access to reproductive health for vulnerable populations, TLP aimed to bring empowering cervical cancer provision to the most vulnerable. Their method significantly included utilizing mobile clinics and bringing the exam room to women. TLP prioritized the needs of women by curating a ‘women’s space’ in the exam room to ensure the exam's privacy and provide a space for women to learn about reproductive healthcare and talk about their problems before, during, and after the exam.

Additionally, while working with multiple stakeholders, TLP held itself accountable primarily to women and the community. They ensured active communication, listened to women’s experiences, and modified their process with feedback. TLP’s emphasis on accountability is reflected in their commitment to follow-ups, which is the most crucial barrier to preventing deaths. Currently, due to political and pandemic conditions; TLP shifted to health strategies, which they continue to use today to provide Nicaraguan women with support and education to empower them to protect their sexual and reproductive health.