Accelerating cervical cancer elimination: healthcare decision-making and cervical cancer screening uptake in sub-Saharan Africa.
This study examined the association between healthcare decision-making and cervical cancer screening among ever-partnered women in SSA and assessed whether this relationship varies across countries.
This cross-sectional study pooled Demographic and Health Survey data (2019-2024) from 114,764 ever-partnered women aged 25-49 years across fourteen SSA countries. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Country-by-healthcare decision-making interaction terms and adjusted predicted probabilities assessed contextual variation.
Overall, 13.00% of women reported ever being screened for cervical cancer. Compared with women making healthcare decisions independently, women whose partners made healthcare decisions alone (aOR = 0.85, 95% CI = 0.81, 0.91) and those involved in shared decision-making (aOR = 0.94, 95% CI = 0.90-0.99) had lower odds of screening. Screening uptake was higher among older, more educated, and wealthier women and those with media exposure, but lower among women with inequitable gender attitudes and living in rural areas and those reporting distance barriers. Significant country-level variation was observed.
Healthcare decision-making is an important, context-dependent determinant of cervical cancer screening uptake in SSA. Context-specific, gender-responsive strategies that strengthen women's participation in healthcare decision-making are needed to accelerate cervical cancer elimination.
This cross-sectional study pooled Demographic and Health Survey data (2019-2024) from 114,764 ever-partnered women aged 25-49 years across fourteen SSA countries. Multivariable logistic regression models estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Country-by-healthcare decision-making interaction terms and adjusted predicted probabilities assessed contextual variation.
Overall, 13.00% of women reported ever being screened for cervical cancer. Compared with women making healthcare decisions independently, women whose partners made healthcare decisions alone (aOR = 0.85, 95% CI = 0.81, 0.91) and those involved in shared decision-making (aOR = 0.94, 95% CI = 0.90-0.99) had lower odds of screening. Screening uptake was higher among older, more educated, and wealthier women and those with media exposure, but lower among women with inequitable gender attitudes and living in rural areas and those reporting distance barriers. Significant country-level variation was observed.
Healthcare decision-making is an important, context-dependent determinant of cervical cancer screening uptake in SSA. Context-specific, gender-responsive strategies that strengthen women's participation in healthcare decision-making are needed to accelerate cervical cancer elimination.