# Perception, Practices, and Barriers to Cervical Cancer Screening Among Women in Rural and Urban Slums of Eastern India: A Community-Based Cross-Sectional Study

## TL;DR

This study finds that only a small percentage of women in rural and urban slums in Eastern India have been screened for cervical cancer, with major barriers including mistrust in public health services and poor awareness of free government programs.

## Contribution

The study provides novel insights into the low uptake of cervical cancer screening in underserved regions of India and identifies key barriers such as mistrust and lack of awareness.

## Key findings

- Only 6.7% of surveyed women had undergone cervical cancer screening, all through private facilities.
- 94-96% of women were unaware of free government screening services.
- Mistrust in public health services and accessibility issues were strongly linked to non-participation in screening.

## Abstract

Background

Despite being avoidable with prompt screening, one of the notable causes of death among Indian women is still cervical cancer. Awareness, access to screening, and perceptions of risk differ considerably, especially in rural and underserved urban populations.

Objective

The purpose of the study was to assess awareness, perceptions, screening practices, and perceived barriers related to screening of cervical cancer among women, between the ages of 30 and 65 years, living in rural and urban slum areas of Eastern India.

Methods

A descriptive cross-sectional study was carried out between November 2024 and February 2025 in the community under the field practice areas of a tertiary care hospital in Bhubaneswar, Odisha. A total of 400 women (200 each from rural and urban slums) were chosen by a two-stage random sampling method. Information was gathered using a predesigned, pre-tested semi-structured questionnaire. The data was analyzed using descriptive statistics and binary logistic regression. Statistical significance was defined as a p-value of less than 0.05.

Results

The participants' average age was 39.09 ± 8.93 years. Only 27 (6.7%) women had awareness regarding screening of cervical cancer and had ever undergone screening, all of which occurred in private health care facilities. Awareness regarding free government-run screening services was poor, with 192/200 (96.0%) of urban and 189/200 (94.5%) of rural women being unaware of such services. Major barriers to screening included mistrust in public health services (31.0%), difficulty accessing health centers (31.8%), and fear of pain (11.8%). Mistrust in health services and accessibility issues were significantly associated with non-utilization of screening services (p < 0.001). Among women who had undergone screening, healthcare workers were the primary source of motivation.

Conclusion

Less than one in fifteen women in rural and urban slum regions had ever been screened for cervical cancer, and there were significant gaps in knowledge of government-provided programs. Perceptual and structural obstacles, such as mistrust and limited accessibility, were prevalent. To increase screening participation, community-based awareness must be strengthened, public health services must be trusted, and accessibility must be improved.