Professor Bev Lawton is one of those women who will simply refuse to take no for an answer – and because of her stubborn determination, women across Aotearoa now have a far greater chance of surviving cervical cancer. Bev’s tireless campaign for HPV self-testing, which was rolled out in 2023, has already saved lives and made accessing crucial healthcare easier for New Zealanders who need cervical screening, and was awarded Kiwibank’s lauded New Zealander of the Year this year in recognition of her incredible work (I mean she’s a bloody hero, let’s stick her on a bank note!). She is also the founder and director of Te Tātai Hauora o Hine – the National Centre for Women’s Health Research Aotearoa.
But while we’ve come leaps and bounds in women’s healthcare over the last few years, we still have a LONG way to go when it comes to addressing inequity, sexism and racism, as well as righting historical omissions and wrongs.
We caught up with Bev who offered some FASCINATING insights into her work, as well as what we need to do next to fully eliminate cervical cancer.
Kia ora Bev – first of all, a HUGE congratulations for a very well-deserved accolade. So, inequities in women’s health is an issue we have been passionately covering at Capsule for some time, and you have been one of, if not the, strongest voice championing wãhine health for some time. What have been the biggest wins in this space in the last decade or so?
We can now prevent cervical cancer with vaccination and screening. This is very exciting and now we need to push for elimination! We are the first high-income nation to start their human papillomavirus (HPV) cervical screening programme with HPV self-testing. The biggest win is its informed by community, by community and researchers, working alongside policymakers. That’s powerful – we get the right programme that way and it’s been a great success. With the offer of this more acceptable test (compared to the smear), women including those who have never had a cervical screen, or screen infrequently, are saying yes to this better test!Spoiler – the government needs urgently to commit to a fully resourced cervical cancer elimination strategy. They need to fund more colposcopy, reduce wait times, fund free screens for all and boost vaccination. It’s not good enough and without these commitments women will die of this preventable disease.
ACC cover now includes those who experience injuries as a result of pregnancy or childbirth. Whilst a good step, we would much prefer to be talking about a win in terms of women suffering less harm – less trauma, less injuries etcetera – as much is preventable! Our perinatal mortality rates (babies dying) have not changed for the last 11 years – ACTION and advocacy is needed
We have a women’s health strategy – now we need action. This is a distant third. There may be a strategy but where is the money, where is the ACTION?
There’s plenty more work to be done to address inequities in women’s health, but let’s hope that if you were to ask me again in another decade, I’d be excited to talk about changes to see an improved maternity care system, with whānau Māori more likely to have a positive experience and outcome, and reduced harm for everyone overall.
Where do you think the biggest challenges still lie?
Too many mamas and babies suffer preventable harm in Aotearoa New Zealand. Systems and attitudes need to change. There is an unacceptable SILENCE about the number of brown babies dying from preventable harm, and I mean preventable harm in our health system!
So, whether it’s addressing racism and biases embedded in a system, or factors with how care providers and hospital are delivering service, we need to research and urgently reduce these harms.
Systems are very very good at defending themselves. So, in partnership with communities – and importantly informed by whānau – that’s how we use research as a form of activism to introduce a system change, which we hope will then later inform necessary wider changes.
At the end of the day, systems are made up of people. And it is people who can make small but often significant steps to change or challenge the systems. So whether it’s providing care differently on an individual level, or trying different ways of working to be part of the solution, it all matters. That’s what informs and leads to necessary transformative change.
An overarching truth is that if we improve the system for Māori, we get it right for everyone as we improve system performances from beginning to end of whatever clinical pathway we look at. For example, looking at barriers and facilitators to care in the maternity pathway includes pre-pregnancy, pregnancy care, birth and post birth care. There are opportunities for change and for transformation.
It’s well-known that research into women’s health massively lags behind men’s – for example, the decision by the UK FDA to exclude women of childbearing potential from drug trials in 1977, and widely underrepresented in clinical trials due to concerns regarding hormones and pregnancy complications. How far have we caught up, and how much damage was done due to historical admission and bias?
We are way behind both in actions and investment. Much is happening around the world that is highlighting to the public globally, the role research has in informing policies, which is necessary to advance health and address bias.
Not all New Zealanders will be aware, but our country was part of a significant piece of health research history in the late 1980s, that led to significant reforms of medical and research ethics – not just here, but around the world. The ‘Cartwright Inquiry’ (named after the presiding judge Dame Silvia Cartwright) found women with cervical cancer – as part of ‘research’, were untreated or under-treated which was a crucial moment in time, in terms of highlighting patient (women patients) rights. This then led to the establishment of independent ethics committees which continue on today, and to the national cervical screening programme.
I take inspiration from people such as Dame Silvia (who is a friend and a previous Chair of my centre’s Advisory Board), Professor Papaarangi Reid, Dame Areta Koopu, and the late Dame Tariana Turia. These wāhine toa have been formidable in demonstrating leadership, sometimes challenging and shaping system changes, whilst maintaining integrity and humility. Their ways of working are important.
And no matter what, women and Indigenous women must be at the decision-making table, whether it’s as clinicians, specialists, politicians, or academics. Workforce and representation are so very important.
Do you think health research today is fair and unbiased?
For the most part it is – health research is robustly assessed, and as part of that, factors such as fairness and bias are considered as part of the assessment, particularly in order to receive funding. The methodology – the ‘how’ it is done – is scrutinised, and then there’s the ethical considerations too. Often a research project, by the time it starts, has come into fruition close to three years after the initial planning. Health researchers work diligently to try and ensure aspects such as fairness and potential bias are well addressed, and the design is robust – research can’t be rushed, it takes time. And that means it requires good investment. We need more research investment in women’s health.
All of us who have endometriosis and PCOS always love to darkly joke that if those illnesses affected men in a majority, they’d be well cured by now. While simplistic, is it a sentiment that you broadly agree with?
Broadly, yes! We definitely encourage opportunities to keep shining a light on areas of women’s health which warrant urgent attention, research and investment.
If we had a test that reduced prostate cancer by 15% and a vaccine that was almost 100% effective and between the two we could eliminate prostate cancer – would we be waiting seven years for this test and even longer for an elimination plan? NO we wouldn’t. A sad fact.
I’m certain that the change to the cervical screening programme in 2023 came about, not just because of our and other research work, but because many across Aotearoa got behind the call to action – to change to HPV self-testing. There was a petition, there was media. Lots of people campaigned and in various ways for many years. We need to do something similar to address other important issues, such as uterine cancer, congenital syphilis, and preventable death in childbirth – there is a lot more work to done.
You’ve been dubbed a ‘true champion’ of women (my GOD, what an honour) and your leadership and mana while beginning the self-test cervical screening programme will no doubt save lives. How difficult was this to get off the ground, and do you consider it one of your biggest achievements?
It’s never just me as the champion – it’s all about the team. And my team know that when I refer to something as being ‘exciting,’ often it’s code for ‘hard!’ And they’re right. Much of our work isn’t easy – but we are guided by a wonderful Kāhui Kaumātua and the communities we are in partnership with. I have the easy job of being guided by them.
We fought to get this programme – we gathered evidence, advocated, researched and made a heap of noise. It shouldn’t have taken a cast of thousands to get this programme funded. Thanks to all the wāhine, organisations, clinicians etc who rolled up to support. I despair at times when I think of the years we should have had this HPV screening test and the lives that would have been saved. We were late, but we have the programme now.
We must continue to centre women’s health. I’ve been so energised by the wide and positive response to being named New Zealander of the Year. I keep hearing, “it’s a win for women!” I am very humbled by it all, but isn’t it fantastic that others take this as a celebration and something for women to be proud of, take ownership of, and continue to build from? That’s a fantastic achievement in my eyes.
As you told us last month, cervical cancer can, in fact, be eliminated in New Zealand, however it’s still not a priority for this government. On a level of 1-10, where’s your frustration sitting with that one?
My frustration is high. We and many others have been campaigning for many years, and to many different governments. But in a hui recently with Minister Brown, where I shared my thinking and whakaaro (and solutions – it’s important to share opportunities too!), he commented that it would be hard for anyone to walk away without knowing what I was asking ! And I think that’s fair. My message is simple – and I will continue to repeat it and to all political parties. Cervical cancer is now preventable and unlike with other screening programmes, potentially we can eliminate it! It’s such a great opportunity – but it does need a commitment from government which means funding and a plan. We are not talking a lot of putea – we can do this. So why aren’t we!
This is a big question, but broadly, how can women take control over their own health and be ‘healthier’, or, at least, as healthy as they can be?
I think as wāhine we want the best for our families, for our children. But we often put ourselves at the back of the queue. We are the house of the people – Te Whare Tangata – and we need the information and tools to keep healthy. So, information and prioritising and resourcing our health. That’s at all levels – personal, health system and government.
