Prevalence and predictors of cervical cancer screening among married women in India: A cross-sectional analysis of National Family Health Survey-5 data

ABSTRACT Background: Cervical cancer is a major public health issue in India despite affordable screening options due to their low utilization. Objectives: The primary objective was to estimate the prevalence of cervical cancer screening among married women in India, while the secondary objective was to identify the predictors, barriers, and facilitators influencing screening uptake in this population. Materials and Methods: This cross-sectional analysis was conducted at the Indian Institute of Public Health - Delhi, under the Public Health Foundation of India, from January to March 2024. In this study, we utilized data from the National Family Health Survey-5 (NFHS-5: 2019-2021) conducted by the International Institute of Population Studies. The study outcomes measured were the self-reported uptake of cervical cancer screening and their sociodemographic and behavioral determinants. Statistical analyses comprised descriptive statistics, bivariate analyses, and multivariable negative binomial regression, supplemented by dominance analysis to assess the comparative significance of predictors. Results: We analyzed responses from 330,345 married women aged 30-49 years. The prevalence of cervical cancer screening was low ( n = 5074, 1.9%, 95% CI: 1.8-2.1). Significantly higher odds of cervical cancer screening were observed among women of age 40-49 years, having higher education level, urban residence, wealthier quintiles, and with additional comorbidities. Conversely, tobacco and alcohol consumption and higher parity were associated with lower screening rates. Dominance analysis identified wealth index as the strongest predictor of cervical cancer screening among married Indian women, with higher rates in southern regions. Conclusion: Cervical cancer screening uptake among Indian women is critically low, with significant disparities driven by socioeconomic status, education, and geography indicative of the need for augmenting its awareness, access, and availability.