A new study finds high awareness and willingness among women in Southeast Nigeria, but a stark gap between intention and access that is costing lives

Cervical cancer is one of the most preventable cancers known to medicine. Effective screening tools exist. A vaccine exists. The knowledge to eliminate it by 2030 exists. And yet in Nigeria, it killed more than seven thousand women in a single year.

A new study published in an international peer-reviewed journal has set out to understand why, focusing on women attending primary health centres in Nnewi-North Local Government Area in Anambra State, Southeast Nigeria. What the researchers found was not apathy, ignorance, or resistance. It was a public health system failing women who were, by and large, ready and willing to be helped.

“The narrative that low screening uptake reflects low interest or poor health literacy is not supported by our data,” said lead author Dr Gerald Ike Kenechi, a consultant histopathologist at Nnamdi Azikiwe University Teaching Hospital in Nnewi. “The women in this study knew about cervical cancer. They had positive attitudes toward prevention. The overwhelming majority said they would attend free screening if it were available. The barrier is access, not attitude.”

The study surveyed 402 women aged 21 to 65, drawing on a multistage random sampling approach across primary health centres in the area. Its findings paint a picture of a significant and troubling gap between awareness and action. While 92 percent of respondents had heard of cervical cancer and more than three quarters were aware of Pap smear screening, only 11.2 percent had ever actually been screened. The gap between knowing and doing was not a matter of choice. It was a matter of availability.

Dr Kennedy Oberhiri Obohwemu, Director of UK-based PENKUP Research Institute said the findings had clear implications for how cervical cancer prevention programmes were designed and delivered. “When more than nine in ten women say they would undergo free screening, and fewer than one in eight have ever done so, that is not a behaviour change problem. That is a service delivery problem. It requires a service delivery response.”

The barriers respondents identified were practical rather than ideological. The most commonly cited obstacle was not knowing where to get tested, reported by 38.6 percent of participants. Time constraints were identified by a further 25.4 percent. These are not intractable problems. They are addressable ones, if the political and institutional will exists to address them.

Uju Francisca Onwuegbuzina of Nnamdi Azikiwe University in Awka, whose background is in health promotion and public health education, said the findings pointed directly to the need for community-based approaches. “Women should not have to navigate a complex or unfamiliar health system to access cervical cancer screening. If we bring services closer to where women already are, in their communities, in primary care settings they already trust, the data suggests they will use them.”

Celestine Emeka Ekwuluo of Family Health International in Ukraine said the study’s focus on primary health centres was deliberate and strategically important. “Primary healthcare is the backbone of the health system for most Nigerian women. If we can integrate cervical cancer screening into the routine services that women already access at that level, we remove the most significant practical barriers in one step.”

Dr Chika Oguguo of the PENKUP Research Institute said the scale of the awareness finding on HPV vaccination was one of the most striking aspects of the results. “Eighty-six percent of respondents were aware of HPV vaccination, and 84.6 percent knew it prevents cervical cancer. That level of awareness in a primary healthcare population in Southeast Nigeria is genuinely encouraging. The challenge now is converting that awareness into uptake, and that requires removing barriers, not running more awareness campaigns.”

Tochukwu Patrick Ugwueze of University College Hospital in Ibadan noted that the willingness figures in the study were among the most compelling indicators of where the intervention priority should lie. “When 93.3 percent of women say they would undergo free screening and 96.8 percent say they would recommend it to others, you have a population that is primed for prevention. What is missing is not motivation. It is provision.”

Oladipo Vincent Akinmade of the University of Warwick’s Digital Health and Rights Project said the digital health dimension of the challenge deserved greater attention. “Health communication strategies for cervical cancer prevention in Nigeria need to move with the population. Mobile phone penetration is high. Community messaging platforms are well used. There are real opportunities to reach women with accurate information about where and how to access services through channels they already use every day.”

Oluwafemi Emmanuel Ooju of the World Health Organisation in Abuja said the findings aligned with what public health practitioners working in the field observed on the ground. “There is genuine demand for these services. What we consistently see is that when services are made free, accessible, and embedded in trusted community settings, women come forward. The evidence from this study reinforces that message powerfully.”

Dr Ulunma Ikwuoma Mariere of the Federal Medical Centre in Bayelsa, whose specialty is community medicine and public health, said the education findings in the study raised important equity concerns. “The study found that women with higher levels of education were significantly more likely to be knowledgeable about cervical cancer and more willing to recommend HPV vaccination. That means the women at greatest risk of falling through the gaps are those with less formal education, and that is precisely who targeted community health education needs to reach.”

Dr Bumi Jang of the University of Wolverhampton said the findings contributed valuable primary evidence to an area where robust local data remained scarce. “Much of the policy discussion around cervical cancer prevention in Nigeria has relied on extrapolated or regional data. Community-level studies like this one, grounded in the specific realities of a defined population, are essential for designing interventions that actually fit the context they are trying to address.”

Daniel Obande Haruna of St. Mary’s University in London said the sociocultural dimension of the barriers identified in the study required sensitive and sustained engagement. “Knowledge gaps are only part of the picture. Sociocultural beliefs about the body, about illness, and about what it means to seek screening for a gynaecological condition shape behaviour in ways that information alone cannot address. Community health education that engages with those beliefs respectfully and directly is essential.”

Abba Sadiq Usman of Action Against Hunger in Maiduguri, whose background is in nutrition and public health, said the study reinforced the importance of integrated approaches to women’s health. “Cervical cancer prevention cannot be treated in isolation from the broader conditions shaping women’s health-seeking behaviour. Nutrition, maternal health, and preventive screening are interconnected. Health systems that address them together, rather than in silos, are more likely to reach the women who need them most.”

Dr Chisom Lucky Emeka of the World Health Organisation’s Vaccine Preventable Diseases Unit in Abuja said the HPV vaccination findings had direct relevance for Nigeria’s national immunisation strategy. “High awareness of HPV vaccination is a significant foundation to build on. The task now is to ensure that awareness translates into vaccine delivery, and that means addressing the supply chain, healthcare worker training, and community engagement dimensions of rollout simultaneously.”

Dr Bartholomew Ituma Aleke of Global Banking School and Oxford Brookes University Partnership in Leeds said the study made a contribution that extended beyond Nigeria’s borders. “Cervical cancer is a disease of inequality. It kills women in low and middle-income countries at rates that are entirely preventable with tools that already exist. Evidence from community-level studies like this one is essential for building the global case for investment in accessible, integrated prevention programmes.”

Solomon Atuman of FHI 360 said the findings underlined the importance of sustained partnership between international health organisations and local health systems. “The knowledge and willingness are there. What is needed now is consistent, well-resourced, community-anchored service delivery. That requires long-term commitment from both national governments and international partners, not short-term project cycles.”

Dr Festus Ituah of Regent College London said the human cost of the current situation should not be lost in the policy discussion. “More than seven thousand women died of cervical cancer in Nigeria in a single year, from a disease that is largely preventable. Each of those deaths represents a failure of the systems that should have protected them. This research is ultimately about ensuring that failure is not repeated.”

Barth Onyekachi Nwokedi of the PENKUP Research Institute said the paper’s conclusions pointed toward a clear and achievable set of priorities. “Strengthen community health education, integrate screening into primary care, make services free and geographically accessible, and focus particular effort on women with lower educational attainment. These are not novel recommendations. But this study gives them a specific, evidence-based foundation in the Southeast Nigerian context.”

Jerry Soni of the United Nations World Food Programme in Damascus said the study was a reminder of how much could be achieved when health research was grounded in the realities of the communities it sought to serve. “The women in this study are not passive subjects of a public health problem. They are people who want to protect their own health and are asking for the means to do so. That is where every effective public health response has to start.”

The study was conducted by researchers from institutions across UK, Nigeria, Ukraine, and Syria with support from UK-based PENKUP Research Institute. It is published open access in the Global Journal of Medicine and Public Health and is available via doi.org/10.55640/gjmps/Volume05Issue03-01.

Dr Gerald Ike Kelechi, a Consultant Histopathologist at Nnamdi Azikiwe University Teaching Hospital in Nnewi