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  • br The current U S Preventive


    The current U.S. Preventive Services Task Force (USPSTF) Pap test recommendations include screening women ages 21–30 every three years with the opportunity to lengthen screening intervals to 5 years at age 30 with HPV co-testing. Current recommendations caution against the potential harms of overscreening, such as the risk of false positives, invasive diagnostic procedures, overtreatment, and elevated levels of anxiety and stress due to abnormal results (Moyer, 2012). False positive Pap test results, misdiagnosis, and unnecessary treatment cause sig-nificant harms, including distress and clinically detectable levels of anxiety, which impacts women's mental health and future screening decisions (Cooper, 2011; Drolet et al., 2012). Recent research suggests that Thapsigargin screening for HPV alone may provide more accurate results than Pap test alone or co-testing and may lead to decreased false positive screening results (Huh et al., 2015). Furthermore, false positive (and false negative) Pap test results may be related to the skill of the health care provider or laboratory. Research demonstrates the need for stan-dardization of quality assurance (QA), monitoring and evaluation of cervical cancer screening programs (Elfström et al., 2015).
    2.2. A reproductive justice approach
    A reproductive justice approach argues that women maintain the right to decide if, when, and how to become a parent (Solinger, 2016). This conceptual framework incorporates the social, environmental, and economic contexts that determine women's ability to raise children in a healthy environment (Kluchin, 2016). According to Ross (2016), a re-productive justice approach considers political and economic factors, including equal pay, access to health care, and freedom from violence by individual and institutional actors (Ross, 2016). The reproductive justice movement acknowledges the complicated intersections of gender, race/ethnicity, and SEP as sources of reproductive oppression and systems of social inequality, including sexism, racism, and classism (bell hooks, 1984; Berger and Guidroz, 2010; Roberts, 1997). The reproductive justice framework highlights the intersection of race/ethnicity, immigration status, age, SEP, gender, sexual orienta-tion, and ability. These dimensions of social inequality lead to op-pression based on racism, xenophobia, ageism, classism, sexism, het-erosexism, and ableism. This approach acknowledges the complex ways that biological, political, social, and economic contexts influence health
    B. Sundstrom, et al.
    inequities and limit reproductive justice. Reproductive decision making is explored within the social, cultural, political, legal, and economic contexts of women's lived experiences (Macleod et al., 2018). Scholars have argued in favor of employing a reparative or reproductive justice approach without appropriating electron in movements that have historically valued cisgender, educated, able, and white individuals by addressing marginalized issues and considering biological, social, and economic inequities (Macleod et al., 2017; Pirotte, 2016). Price (2011) calls for reproductive justice research to investigate why African-American, Latina, and Asian-American women maintain low rates of cervical cancer screening. Limited extant research has applied the reproductive justice framework to investigate women's experiences with sexually transmitted infections (STIs), including HPV (Stephens et al., 2012). The reproductive justice framework fills a gap in the literature by il-luminating the interaction between intersectional identities and sys-tems of social inequality. This improved understanding offers an op-portunity to empower women's reproductive decision making and address health disparities.