Intersecting Upstream Factors: Inequities in Cervical Cancer Screening in Malawi

Abstract

Sub-Saharan African countries like Malawi have been experiencing a rapid increase in cervical cancer incidence and mortality. Cervical cancer screening services are essential for reducing cancer incidence and associated fatalities. Previous attempts to understand the determinants of cervical cancer testing have predominantly focused on the independent influence of residence and socioeconomic status on the utilization of screening services. This has limited our understanding of intersectional sources of inequities in healthcare usage. Guided by an intersectionality framework, we used data from the 2015 to 2016 Malawi Population-Based HIV Impact Assessment Project (n = 11,313) to examine the intersecting effects of women’s residence and socioeconomic status on cervical cancer screening tests. We found residential and socioeconomic inequalities in cervical cancer screening in Malawi. Respondents’ levels of education and household wealth had a statistically significant effect on the use of both lifetime and past-3-years cervical cancer screens. Further results showed a significantly greater influence of household wealth among rural than among urban Malawian women in both lifetime and past-3-years cervical cancer screens. Conversely, a significantly lower influence of education in rural compared to urban areas in lifetime cervical cancer screening was observed. Our study highlights the need to consider the residential context’s role in modifying socioeconomic inequalities in cervical cancer screening among women. Such structural considerations are necessary to increase cervical cancer screening and health and well-being among women in the global south.

Keywords:

• Gynecological cancers
• education
• wealth
• reproductive healthcare disparities
• rural–urban divide

Data Availability Statement

The data that support the findings of this study are openly available on Population-Based HIV Impact Assessment Project (PHIA) website at https://phia.icap.columbia.edu/about/.