Pap smear coverage among rural workers.

Despite the high incidence of cancer of the uterine cervix among black South African women, many do not have access to cytological screening services. Data describing Papanicolaou smear coverage and factors related to coverage are presented from 9 surveys of rural women workers in the food canning and processing industry in the Cape. Adequacy of Pap smear coverage was assessed according to whether the respondent had ever previously had a Pap smear, or had had one in the 3 years preceding the survey. From the 3 surveys with the greatest generalisability, only 49-65% of workers reported adequate Pap smear coverage. Knowledge about Pap smears was lacking. At the same time, of those women with adequate coverage, many appeared to be receiving unnecessary routine Pap smears. It appears that the policy which makes the availability of Pap smears dependent upon acceptance of contraceptive services is responsible for both the lack of Pap smear coverage and the over-provision of smears in this group of women. An urgent review of state Pap smear policy is required and a coherent community-based educational programme to facilitate the prevention of cervical cancer should be implemented as soon as possible.