The Kenyan woman confronting cancer stigma with knitted breast prostheses – Al Jazeera

Report on a Social Enterprise Advancing Sustainable Development Goals for Cancer Survivors in Kenya

Executive Summary

This report details the initiative led by Mary Mwangi, a cancer survivor in Thika, Kenya, who established a social enterprise producing knitted breast prostheses. The project directly addresses the health, economic, and social challenges faced by breast cancer survivors post-mastectomy. By providing an affordable alternative to expensive silicone prosthetics and creating a supportive community, the initiative makes significant contributions to several United Nations Sustainable Development Goals (SDGs), including SDG 3 (Good Health and Well-being), SDG 1 (No Poverty), SDG 8 (Decent Work and Economic Growth), SDG 5 (Gender Equality), and SDG 10 (Reduced Inequalities).

Alignment with Sustainable Development Goals

SDG 3: Good Health and Well-being

The enterprise directly promotes physical and mental well-being for breast cancer survivors, a demographic often lacking adequate post-treatment support within the public health system.

• Physical Health: The knitted prostheses offer a practical and affordable solution for women who have undergone mastectomies, addressing a key aspect of physical recovery.
• Mental Health: The initiative restores self-confidence and dignity, combating the psychological distress associated with cancer treatment and body image changes. Psychologist Joy Kulet affirms that losing a breast is a psychological issue, and solutions like these are crucial for recovery.
• Community Support: The “New Dawn Cancer Warriors” support group, led by Mwangi, provides a safe space for survivors to share experiences, which is identified as an essential part of the healing process.

SDG 1 (No Poverty) & SDG 8 (Decent Work and Economic Growth)

The project provides a clear pathway to economic resilience for women whose savings were depleted by extensive medical costs, a common barrier to escaping poverty.

1. Financial Accessibility: By pricing knitted prostheses at 1,500 Kenyan shillings ($11.60) compared to silicone versions costing 22,000 shillings ($170), the initiative makes essential post-operative care accessible to women living below the poverty line.
2. Income Generation: The enterprise serves as a source of sustainable income. Mwangi has rebuilt her own business and created employment opportunities for other survivors. Hannah Nungari Mugo, a former vegetable trader, now earns an income to support her family by knitting prostheses.
3. Skills Development: Mwangi has trained over 200 women, equipping them with knitting skills that enable them to establish independent businesses and achieve economic self-sufficiency, contributing to decent work and local economic growth.

SDG 5 (Gender Equality) & SDG 10 (Reduced Inequalities)

The initiative empowers women and tackles the social and economic inequalities they face as cancer survivors.

• Combating Stigma: The project actively works to dismantle the social stigma and discrimination faced by women post-mastectomy. By providing prostheses and a support network, it helps women regain their confidence and participate fully in community life.
• Empowerment: Women in the program, like Mary Patricia Karobia, report that creating the prostheses provides not only an income but also a sense of purpose and joy in helping other survivors.
• Reducing Health Inequality: The enterprise ensures that access to restorative products is not limited to the wealthy, thereby reducing a significant health and social inequality faced by low-income breast cancer survivors in Kenya.

Operational Model and Impact

Production and Distribution

• Output: Mary Mwangi produces approximately 50 prostheses per week and has sold over 600 to date.
• Product Line: The enterprise offers prostheses in various sizes and colors, along with specially adapted bras.
• Distribution Channels: Products are sold directly and in bulk to partner organizations, including Kenyatta National Hospital and Milele Health, for donation to survivors.

Challenges and Future Outlook

The initiative faces operational constraints that limit its potential for expansion.

• Financial Limitations: A lack of funds prevents registration as a formal training school and limits the ability to absorb fluctuating yarn prices.
• Infrastructural Constraints: The current workshop space can only accommodate four trainees at a time.
• Vision for Growth: Mwangi’s long-term goal is to train a larger number of cancer survivors across Kenya, enabling them to achieve financial independence through their own knitting enterprises, further scaling the project’s contribution to the SDGs.

1. Which SDGs are addressed or connected to the issues highlighted in thearticle?

The article addresses and connects to the following Sustainable Development Goals (SDGs):

• SDG 1: No Poverty. The article highlights the catastrophic financial impact of cancer treatment, which “swept away” Mary Mwangi’s business loan and savings, and forced another survivor’s family to take out a significant loan. Mwangi’s initiative provides an income-generating opportunity for survivors, directly addressing poverty alleviation.
• SDG 3: Good Health and Well-being. The core of the article revolves around breast cancer, a non-communicable disease. It discusses the physical treatment (mastectomy), the lack of adequate follow-up care in the public health system, and the profound psychological impact on survivors. The provision of affordable prostheses and the creation of support groups directly contribute to the mental and physical well-being of these women.
• SDG 5: Gender Equality. The story focuses on women’s health and the specific social challenges they face. It details the “social discrimination” and “stigma” women experience after a mastectomy, which affects their dignity. The initiative empowers women economically and socially, helping them regain confidence and challenge societal prejudice.
• SDG 8: Decent Work and Economic Growth. Mary Mwangi’s enterprise is a clear example of entrepreneurship and micro-enterprise growth. By training over 200 women and hiring some to help with production, she is creating jobs and promoting productive activities, enabling survivors to “earn a living through knitting.”
• SDG 10: Reduced Inequalities. The initiative specifically targets a vulnerable and marginalized group: female cancer survivors facing health, economic, and social inequalities. By providing affordable health-related products, income opportunities, and a support system, the project works to reduce these inequalities and promote social and economic inclusion.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 1: No Poverty

   • Target 1.2: By 2030, reduce at least by half the proportion of men, women and children of all ages living in poverty. The article illustrates how high healthcare costs for cancer can push families into poverty, mentioning Mwangi’s $10,000 loss and another family’s $3,800 loan. The knitting initiative provides a direct income source to counteract this.
   • Target 1.4: By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources. The project empowers vulnerable women (cancer survivors) by teaching them a skill that allows them to earn an income and gain economic independence.

2. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being. The article focuses on cancer, a non-communicable disease, and emphasizes the psychological toll (“Losing a breast for a woman is more than physical; it is psychological”). The support group and prostheses are direct interventions to promote mental health and well-being for survivors.
   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential… products. The article highlights the lack of financial risk protection and the unaffordability of essential products like silicone prosthetics ($170). Mwangi’s knitted prostheses ($11.60) provide an affordable alternative, increasing access for women living in poverty.

3. SDG 5: Gender Equality

   • Target 5.1: End all forms of discrimination against all women and girls everywhere. The article explicitly describes the “social discrimination” and “stigma” faced by women post-mastectomy, such as being called “the woman whose breasts were cut.” The support group provides a safe space to counter this discrimination.
   • Target 5.5: Ensure women’s full and effective participation and equal opportunities for leadership in… economic and public life. Mwangi acts as an entrepreneur and a community leader, creating economic opportunities for other women and enabling their participation in economic life.

4. SDG 8: Decent Work and Economic Growth

   • Target 8.3: Promote development-oriented policies that support productive activities, entrepreneurship, creativity and innovation, and encourage the formalization and growth of micro-, small- and medium-sized enterprises. Mwangi’s business, born from her knitting hobby, is a micro-enterprise that supports productive activities and innovation (creating an affordable prosthesis).
   • Target 8.5: By 2030, achieve full and productive employment and decent work for all women and men… and equal pay for work of equal value. The initiative creates income-generating opportunities for women survivors, allowing them to support their families and engage in decent work.

5. SDG 10: Reduced Inequalities

   • Target 10.2: By 2030, empower and promote the social, economic and political inclusion of all, irrespective of… sex, disability… or other status. The project empowers and promotes the social and economic inclusion of women marginalized due to their health status (cancer survivors), helping them regain confidence and participate in community and economic life.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For SDG 1 (No Poverty)

   • Financial Impact of Illness: The amount of debt or savings lost due to treatment (e.g., $10,000 loan for Mwangi, $3,800 loan for Mugo).
   • Income Generation: The income earned by women making prostheses (e.g., Hannah Mugo makes seven prostheses a week to sell).

2. For SDG 3 (Good Health and Well-being)

   • Cost of Health Products: The price difference between standard silicone prosthetics ($170) and the knitted alternative ($11.60).
   • Access to Products: The number of prostheses sold or donated (about 600 prostheses and 450 hats sold by Mwangi).
   • Mental Health Improvement: Qualitative evidence of improved self-esteem and confidence among survivors, as described in Jane’s story and by the psychologist Joy Kulet.

3. For SDG 5 (Gender Equality)

   • Prevalence of Stigma: Anecdotal reports of discrimination and social exclusion mentioned by Mwangi, Mugo, and Karobia.
   • Women’s Economic Empowerment: The number of women trained in knitting (over 200) and earning an income from it.

4. For SDG 8 (Decent Work and Economic Growth)

   • Job Creation: The number of women trained and hired by Mwangi to fulfill large orders.
   • Business Productivity: The number of prostheses produced per week (Mwangi produces about 50).
   • Entrepreneurship: The existence of Mwangi’s business and her dream for other survivors to start their own independent businesses.

5. For SDG 10 (Reduced Inequalities)

   • Inclusion of Vulnerable Groups: The number of cancer survivors and individuals with other health conditions participating in the support group and workshops.
   • Affordability for Low-Income Populations: The low price of the knitted prostheses makes them accessible to the more than 40% of Kenyans living below the poverty line.

4. Table of SDGs, Targets, and Indicators

Source: aljazeera.com