Towards a cervical cancer-free future: women’s healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa

Abstract

ObjectiveWe investigated the association between women’s healthcare decision making and cervical cancer screening uptake in sub-Saharan Africa.DesignSecondary data from the Demographic and Health Surveys of six countries in sub-Saharan Africa were used. We employed multilevel binary logistic regression modelling.SettingSub-Saharan Africa.ParticipantsWomen aged 15–49 years in Benin (n=5282), Côte d’Ivoire (n=1925), Cameroon (n=7558), Kenya (n=6696), Namibia (n=1990) and Zimbabwe (n=5006).Primary outcome measuresCervical cancer screening uptake.ResultsThe overall prevalence of cervical cancer screening across the six sub-Saharan African countries was 13.4%. Compared with women whose healthcare decisions were made solely by husbands/partners/someone else, the likelihood of cervical cancer screening uptake was significantly higher among women who took healthcare decisions in consultation with their husbands/partners (aOR=1.38; 95% CI 1.19 to 1.59), but highest among those who made healthcare decisions alone (aOR=1.66; 95% CI 1.44 to 1.91). Women aged between 40 and 45 years (aOR=5.18; 95% CI 3.15 to 8.52), those with higher education (aOR=2.13; 95% CI 1.57 to 2.88), those who had ever heard of cervical cancer (aOR=32.74; 95% CI 20.02 to 53.55), read newspaper or magazine at least once a week (aOR=2.11; 95% CI 1.83 to 2.44), listened to the radio at least once a week (aOR=1.35; 95% CI1.18 to 1.52) and those in households with richest wealth index (aOR=1.55; 95% CI 1.20 to 2.00) had significantly higher odds of screening for cervical cancer compared to their counterparts.ConclusionWomen who are able to make autonomous healthcare decisions and those who practice shared decision making are more likely to uptake cervical cancer screening. Therefore, policy interventions should focus on empowering women to be able to take autonomous healthcare decisions or shared decision making while targeting subpopulations (ie, multiparous and rural-dwelling women, as well as those in other religious affiliations aside from Christianity) that are less likely to uptake cervical cancer screening. Also, the radio and print media could be leveraged in raising awareness about cervical cancer screening to accelerate cervical cancer screening uptake in sub-Saharan Africa.

Baseline knowledge on risk factors, symptoms and intended behavior of women and men towards screening and treatment of cervical cancer in rural Uganda: a cross-sectional study

“…The women who made their own decisions were more knowledgeable on risk factors, most educated and younger than the two groups. This is in agreement with another study on women’s healthcare decision making and cervical cancer screening uptake done in 4 countries in SSA, which showed that women who are able to make autonomous healthcare decisions were most likely to uptake cervical cancer screening followed by those who decided in partnership with their husbands and least of all were those whose decisions were solely made by their husbands [ 36 ].…”

Perceptions of barriers and facilitators for cervical cancer screening from women and healthcare workers in Ghana: Applying the Dynamic Sustainability Framework

“…We also found that women with lower educational attainment were less likely to be aware of facilities that provide cervical cancer screening services. This is not surprising as higher educational attainment tends to empower women to access information including health information such as where to access cervical cancer screening services (36,37).…”

Prevalence and factors associated with rural mothers’ protection against tetanus: a cross-national analysis in 33 sub-Saharan African countries

“…This result can be explained from the perspective that higher maternal education predisposes or exposes women to health information and services that tend to increase their knowledge about the nature and importance of protecting themselves against tetanus, hence encouraging the uptake of preventive interventions such as the tetanus toxoid vaccine. Another possible explanation could be that mothers with a higher level of education are likely to be empowered to make autonomous decisions about their healthcare, 19 , 20 including taking actions to protect themselves from tetanus.…”