Barriers to utilisation of cervical cancer screening in Sub Sahara Africa: a systematic review
Open accessAbstract
BACKGROUND: Cervical cancer is the commonest cause of cancer-related death in Sub Sahara Africa (SSA). Both primary and secondary preventive services are available but utilisation remain low. This systematic review aims to summarise reported barriers preventing women from utilising cervical cancer screening services in SSA. METHOD: Electronic searches on MEDLINE, EMBASE, PsycINFO, BIOSIS preview, Global Health, PubMed, Cochrane library, CINAHL, ISI Web of Knowledge and Google scholar and quality assessment of the included studies were performed. A meta-analysis was applied to identify major themes. RESULTS: Eight studies exploring reasons women did not utilise cervical cancer screening were included. Women in SSA reported similar barriers despite cultural and language diversity in the region. Women reported fear of screening procedure and negative outcome, low level of awareness of services, embarrassment and possible violation of privacy, lack of spousal support, societal stigmatisation, cost of accessing services and health service factors like proximity to facility, facility navigation, waiting time and health care personnel attitude. CONCLUSION: Strategies for improving uptake and utilisation of cervical screening in SSA should focus on improving cervical health education, addressing cultural beliefs and practices and improving spousal support and empowering women, as well as addressing physical access problem, costs and improving staff attitude.
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The stigma finding concurs with other studies which have also found that having pre cancer or cervical cancer has been stigmatized with women fearing being "talked" about or facing discrimination.
“it concurs with other studies which have also found that having pre cancer or cervical cancer has been stigmatized with women fearing being “talked” about or facing discrimination [37, 39].”
From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [39]
The ‘Stigma and shame of disease’ section reports fear of societal rejection and ostracism after disclosure of early symptoms, supporting the claim about feared discrimination. It discusses stigma chiefly around cervical screening and symptom disclosure, however, rather than specifically establishing stigma from having precancer or cervical cancer. Page number is unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe finding on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam.
“The findings on pelvic exam as a barrier to screening is consistent with other studies done in Africa and Asia [18, 19, 33–35] which showed concerns around speculum use, embarrassment, and reluctance to have a male provider perform the exam [37–39].”
From Perspectives of women participating in a cervical cancer screening campaign with community-based HPV self-sampling in rural western Kenya: a qualitative study (2019) · cites this paper as [39]
The Modesty section reports that embarrassment, undressing, and having a male caregiver can deter cervical screening; the Stigma and shame of disease section links embarrassment to pelvic examinations. The review does not identify concern about speculum use as a barrier, and its findings concern sub-Saharan Africa rather than Asia. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe prevalence of fear as a barrier to screening was also highlighted in a previous review of studies based in sub-Saharan Africa.
“The prevalence of fear as a barrier to screening was also highlighted in a previous review of studies based in sub-Saharan Africa. 131”
From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [131]
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Using thematic analysis in psychology
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Chan, R. J., Milch, V. E., Crawford‐Williams, F., Agbejule, O. A., Joseph, R., Johal, J., Dick, N., Wallen, M. P., Ratcliffe, J., Agarwal, A., et al. (2023) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.21788 · Cited by 274 · see citing works
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“131 ,49,50,59, 68, 70 , 78, 87, A lack of awareness and knowledge surrounding CC and screening was consistently reported as a barrier for young women across countries.”
- Authors
- Lim, J. N. W., & Ojo, A. A.
- Affiliations
- Anglia Ruskin University (GB)
- National Health Service (GB)
- Corresponding author
- Lim, J.N.W.
- ORCID
- Lim, J.N.W.
- Venue
- European Journal of Cancer Care
- Publisher
- Wiley
- Published
- 2016-02-07
- Volume
- 26
- Issue
- 1
- Pages
- e12444
- ISSN
- 0961-5423 (ISSN-L)
- OpenAlex
- W2279802099
- Cited by
- 220
- References
- 1
- Citations by year
- 2026: 10 · 2025: 21 · 2024: 28 · 2023: 30 · 2022: 34 · 2021: 27 · 2020: 32 · 2019: 14 · 2018: 9 · 2017: 14 · 2016: 1
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Cancer Care (publishedVersion)
- PubMed (publishedVersion)
- Wolverhampton Intellectual Repository and E-Theses (University of Wolverhampton) (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- cervical cancer screening, barriers to screening, sub-Saharan Africa, fear of screening, spousal support, social stigma, health care costs, health care access, women's empowerment
- MeSH terms
- Attitude of Health Personnel, Uterine Cervical Neoplasms, Communication Barriers, Costs and Cost Analysis, Culture, Fear, Female, Health Services Accessibility, Household Work, Humans, Interpersonal Relations, Health Knowledge, Attitudes, Practice, Patient Acceptance of Health Care, Patient Education as Topic, Self Concept, Shame, Stereotyping, Africa South of the Sahara, Spouses, Early Detection of Cancer
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