# Young women's healthcare screening behaviours and sexual autonomy in Ghana: a spatial distribution and socioeconomic inequality analysis of a large population-based survey

## TL;DR

This study explores how young women in Ghana access healthcare screenings and exercise sexual autonomy, finding significant regional and socioeconomic disparities.

## Contribution

The study provides a spatial and socioeconomic analysis of screening behaviors and sexual autonomy among young women in Ghana using nationally representative data.

## Key findings

- Only 12.1% of young women in Ghana had undergone breast cancer screening, and 3.6% had cervical cancer screening.
- Sexual autonomy significantly increased the likelihood of breast and cervical cancer screening.
- Higher screening uptake and autonomy were clustered in southern and coastal regions, with lower levels in the northern belt.

## Abstract

In Ghana, disparities in screening behaviours and sexual autonomy persist across socioeconomic and geographic lines. This study examined the spatial distribution, determinants, and socioeconomic inequalities in HIV testing, breast, and cervical cancer screening, and sexual autonomy among young women using nationally representative data.

Data were drawn from the 2022 Ghana Demographic and Health Survey (GDHS) comprising 1,183 currently partnered women aged 15–24 years. Weighted analyses were performed to estimate screening and autonomy prevalence across regions. Multilevel mixed-effects logistic regression identified predictors of screening behaviours, while socioeconomic inequalities were assessed using the Wagstaff concentration index and Theil's index. Spatial analyses were conducted to map regional variations and clustering patterns.

Nationally, 63.9% of young women had ever tested for HIV, while only 12.1% and 3.6% had undergone breast and cervical cancer screening, respectively. Sexual autonomy prevalence was 77.2%. Education, wealth, health insurance, and media exposure significantly predicted screening uptake. Sexual autonomy independently increased the likelihood of breast (AOR = 2.75; 95% CI: 1.27–5.93) and cervical cancer screening (AOR = 5.45; 95% CI: 1.43–20.73). Spatial maps revealed strong north–south gradients, with higher autonomy and screening uptake clustered in southern and coastal regions (Eastern, Volta, and Central), and markedly lower levels in the northern belt (Northern, North-East, and Savannah). Wealth-related inequalities were pronounced for HIV (CI = 0.288) and breast cancer screening (CI = 0.334), but not for cervical cancer screening. Theil's indices confirmed substantial inequity across region and residence.

Targeted strategies such as expanding school-and-community-based health education for young women, integrating HIV and cancer screening into routine primary and antenatal care, strengthening health insurance coverage for preventive services, leveraging mass media to promote screening awareness, and prioritizing mobile and outreach screening services in northern and rural regions are critical for reducing socioeconomic and spatial inequalities in preventive healthcare among young women in Ghana.