Groundbreaking initiative gets over 90% of female prisoners to have smear test

A groundbreaking cervical screening programme which helps women with a history of trauma and abuse has succeeded in getting more than 90 per cent of female prisoners to attend a smear test.

Cervical screening, commonly referred to as a smear test, helps to pick up early signs of cell changes in the cervix that can turn into cancer.

But the prospect of having a smear test can be profoundly distressing and traumatic for survivors of rape or any kind of sexual violence.

Many of the inmates at HMP Styal, a women’s jail for adults and young offenders in Cheshire, had never had a smear test in their lives or were overdue one for a range of reasons, which includes having a history of trauma and abuse.

Many male and female prisoners are vulnerable, with high rates of trauma, abuse and mental health issues among the UK’s prison population.

A previous report by the Prison Reform Trust found 80 per cent of women in jail were serving sentences for non-violent offences. Other studies have found high numbers of female prisoners have suffered domestic abuse and sexual violence, while many suffer from mental health issues – with campaigners frequently warning women in prison are often victims of much more serious offences than the ones they have been convicted of.

“I felt frightened and apprehensive when I received a letter inviting me for a smear test at Styal,” a prisoner from HMP Styal said. “I ignored it and the letters that followed, but after the nurse came to see me for a chat and showed me all the equipment, I felt more in control of the situation.”

She added: “I am very proud to say I had it done and now I even encourage other women to attend when they say they are scared.”

Some 19 prisoners were referred directly to colposcopy after an abnormal smear result and have managed to get treatment since the new cervical screening system was rolled out. While an additional 29 have had a positive test result for human papillomavirus (HPV) which means they require a yearly follow-up smear test.

The vast majority of cases of cervical cancer are caused by HPV – an infection that is very common, and which about eight in 10 people in the UK will contract at some point in their lives.

While it is rare for women to be diagnosed with cervical cancer, with only 3,200 diagnoses in the UK every year, HPV is almost as common as the cold virus. The body generally clears HPV without it causing damage, but a deep-seated stigma about the infection remains.

The new screening programme, which started in April last year, is the brainchild of the prison’s specialist nurse and health lead and works by looking at inmates’ history and providing specialist support to encourage women to have smear tests. Women who are fearful are able to voice their anxiety in one-to-one sessions as well as being shown the equipment which will be used so they feel more at ease.

There are also sessions held which “debunk any myths about smear tests” women have encountered over the years. Inmates can also write about their experience of having a smear test on a butterfly for others to read and get encouragement from colposcopy with this scheme called “The Butterfly Model”.

Nicola Shufflebotham, a specialist nurse at HMP Styal who helped develop the screening programme, said: “It really has been wonderful seeing patients grow in confidence to attend their smear test appointments. Our clinics are a huge success and patients actually come forward and ask for a test now.”

Jo’s Cervical Cancer Trust says many sexual violence survivors outside the prison population have told them they had not been to cervical screenings due to their experiences.

“Cervical screening can feel both intrusive and intimate because of the physical position the test is done in and the medical equipment used,” the UK’s leading cervical cancer charity adds. “This means it can trigger flashbacks of the things you have been through, or evoke physical and psychological responses, like a panic attack, dissociation, or freezing. Many survivors are anxious about having to disclose their experience to a healthcare professional.”

But the charity notes there are a number of things survivors can ask the healthcare professional do to make the situation easier to handle.

Dr Kate Paradine, chief executive of Women in Prison, said they welcome more prisoners taking smear tests and the overall initiative but warned prison environments “pose significant barriers” to getting healthcare.

She added: “Such as women needing to be accompanied by staff to appointments both within the prison grounds and outside, which can cause delays in accessing support.

“Women in contact with the criminal justice system have significantly poorer health outcomes compared to both men and the general population. Prison both compounds pre-existing health inequalities and creates additional ill health, for example rates of self-harm for women in prison are at a record high.

“There is another way – by ensuring that women are supported in the community, women can better address their needs and root causes of being swept into crime, which often include poverty, domestic violence and mental ill health.”

Previous research by Nuffield Trust discovered almost 40 per cent of outpatient appointments were cancelled or missed by women in jail, which is double the number of appointments missed by the non-prison population.

Michelle Quirke, HMP Styal’s governor, noted the initiative at the prison was “already making a huge difference”. She added: “The screening could save lives so I’m proud we’ve found a way to encourage more women to come forward to be tested.”