Unequal Access: Healthcare Disparities in Cervical Cancer Screening Among African Women

Using the structural intersectionality framework, world-system and the fundamental causes of diseases theories, and cross-sectional data of 61,543 women from the Population-Based HIV Impact Assessment Project conducted in Tanzania, Rwanda, Malawi, and Zimbabwe, this study examines the intersection of structural factors associated with inequalities in cervical cancer screening among women within the underdeveloped African countries. The findings suggest deeper-rooted intersecting structural factors that inhibit (or affect) the likelihood of being screened for cervical cancer in a lifetime among the marginalized (lower educated and poor) populations across the studied countries. There is also a significant rural-urban divide in the effect of socioeconomic status (SES) on cervical cancer screening, with rural women with lower education having a lower likelihood of being tested in Rwanda and Zimbabwe. Unexpectedly, rural-educated women in Tanzania and Malawi had a lower likelihood of being tested for cervical cancer in their lifetime compared to urban women. This research highlights the importance of implementing inclusive policy interventions that integrate new technologies in cervical cancer screening among marginalized women with multiple identities, as well as strengthening the roles of healthcare providers in reminding patients about the significance of regular screening in Africa. This is essential for Africa to keep pace with the advancements in cervical cancer screening strategies seen in the developed world.

Plain Language Summary

Although cervical cancer is preventable when diagnosed early, many women in underdeveloped or third-world countries still do not receive regular screenings for this disease. We analyzed data from 61,000 women across four African countries—Tanzania, Malawi, Rwanda, and Zimbabwe—to investigate the factors that inhibit women’s likelihood of being screened for cervical cancer in their lifetime. Our study revealed an overlapping social structure that affects individuals’ behaviors regarding cervical cancer screening, influenced by factors such as education, household wealth, and geographic location.

We found that rural women with lower levels of education in Rwanda and Zimbabwe were less likely to be screened for cervical cancer. Conversely, in Tanzania and Malawi, educated rural women also exhibited a lower likelihood of being screened for the disease. Based on these findings, we advocate for inclusive policies as well as technologies aimed at addressing the cervical cancer screening barriers faced by different groups with diverse backgrounds.