Researchers find that women in Southeast Nigeria are informed, willing, and ready for cervical cancer prevention. What is missing is a health system that meets them there.

It is a disease that should barely exist anymore. Cervical cancer can be prevented with a vaccine. It can be caught early and treated through routine screening. The scientific tools to eliminate it are decades old. Yet across Nigeria, it remains the third most common cancer in women, claiming the lives of more than seven thousand people every year.

A new study conducted among women attending primary health centres in Nnewi-North Local Government Area in Anambra State, Southeast Nigeria, offers one of the clearest explanations yet for why prevention is failing, and one of the most direct roadmaps for what could change.

The research, published in an international peer-reviewed journal and led by a team of eighteen academics and public health professionals, surveyed 402 women between the ages of 21 and 65. Its central finding is both encouraging and sobering. These women knew about cervical cancer. They understood the role of HPV. They expressed strong willingness to be screened. And almost none of them had ever actually accessed screening services.

“What we found was not a knowledge crisis. It was an access crisis,” said lead author Dr Gerald Ike Kenechi, a consultant histopathologist at Nnamdi Azikiwe University Teaching Hospital in Nnewi. “The assumption that low screening rates reflect low awareness or low motivation does not hold up when you look at the data carefully. These women are ready. The system is not meeting them.”

The numbers behind that conclusion are striking. Awareness of cervical cancer stood at 92 percent across the sample. Awareness of Pap smear screening reached 75.9 percent. Awareness of HPV vaccination was 86.3 percent, with 84.6 percent correctly identifying it as a preventive tool against cervical cancer. And yet just 11.2 percent of participants had ever undergone Pap smear screening.

“That gap between knowing and doing is the story this paper is telling,” said Dr Kennedy Oberhiri Obohwemu, Director of PENKUP Research Institute in Birmingham. “And crucially, it is not a gap caused by indifference. When respondents were asked whether they would attend free screening if it were offered, 93.3 percent said yes. When asked if they would recommend it to others, 96.8 percent said yes. The demand is overwhelming. The supply is not.”

The barriers respondents identified were, in a sense, reassuringly concrete. The most frequently cited obstacle was simply not knowing where to go for a test, reported by 38.6 percent of participants. Time constraints were identified by 25.4 percent. These are not cultural or attitudinal barriers requiring complex behavioural interventions. They are logistical and structural ones, amenable to logistical and structural solutions.

Uju Francisca Onwuegbuzina of Nnamdi Azikiwe University, whose background spans health promotion and public health education, said the implications for service design were clear. “Women should not have to research, travel, or navigate a bureaucratic system to access a cancer screening test. Services need to come to them, embedded in the primary health centres and community settings they already use. The evidence says they will come.”

Celestine Emeka Ekwuluo of Family Health International in Ukraine said integration into primary healthcare was the most direct and cost-effective pathway to scale. “If a woman is already attending a primary health centre for another reason, and cervical cancer screening is available as part of that visit, the logistical barrier disappears almost entirely. That is a policy choice, and it is one that Nigeria’s health system has the architecture to make.”

The study also examined the relationship between educational attainment and health knowledge, and found a pattern with significant implications for targeting. Women with higher levels of education were substantially more likely to be knowledgeable about cervical cancer, Pap smear screening, and HPV vaccination, and more willing to recommend the vaccine to others. Those with lower educational attainment were less informed and therefore at greater risk of being left behind by prevention efforts.

Dr Chika Oguguo of the PENKUP Research Institute said this finding should reshape how health communication resources were allocated. “Universal awareness campaigns have a role, but this data suggests that targeted, community-based education aimed specifically at women with lower educational attainment could have the greatest impact on the women who are currently most vulnerable.”

Tochukwu Patrick Ugwueze of University College Hospital in Ibadan said the willingness findings were among the most practically significant in the study. “In public health, we often spend enormous resources trying to shift attitudes and motivate behaviour change. Here, the motivation already exists at scale. The intervention priority should be removing the barriers between that motivation and the service, not trying to generate the motivation in the first place.”

Oladipo Vincent Akinmade of the University of Warwick said the digital health dimension of the challenge offered underexplored opportunities. “Mobile connectivity in Southeast Nigeria is high and growing. There are real possibilities for using community messaging platforms and digital health tools to address the most cited barrier, not knowing where to go for a test, at very low cost and very high reach.”

Oluwafemi Emmanuel Ooju of the World Health Organisation in Abuja said the study aligned with what practitioners in the field consistently observed. “Demand is not the limiting factor. When services are made free, when they are located where women already go, when they are delivered by trusted health workers, uptake follows. This study provides the evidence base to make that case to policymakers and funders with confidence.”

Dr Ulunma Ikwuoma Mariere of the Federal Medical Centre in Bayelsa said the equity dimension of the education finding could not be overlooked. “The women who are hardest to reach with conventional health communication are the same women who face the highest risks. Any serious prevention strategy has to prioritise them, not treat them as a secondary or harder-to-reach population to be addressed after the easier gains have been made.”

Dr Bumi Jang of the University of Wolverhampton said the study’s grounding in community-level primary data gave it a practical utility that broader national surveys often lacked. “Policy designed from national averages can miss the specific realities of particular communities. This study gives local health authorities in Anambra State, and by extension comparable settings across Southeast Nigeria, a precise, locally grounded evidence base to work from.”

Daniel Obande Haruna of St. Mary’s University in London said the sociocultural context deserved sustained rather than superficial engagement. “There are deeply rooted beliefs about gynaecological health, about the meaning of cancer, and about what it signals to seek preventive care. Health education that acknowledges and engages with those beliefs, rather than simply broadcasting information over them, is far more likely to reach the women who need it most.”

Abba Sadiq Usman of Action Against Hunger in Maiduguri said the study reinforced the case for treating women’s health as a connected system rather than a set of isolated conditions. “Nutrition, maternal health, and cancer prevention are not separate problems for the women who experience them. Health systems and health workers that take an integrated view of women’s health are better placed to build the trust and continuity that preventive care requires.”

Dr Chisom Lucky Emeka of the World Health Organisation’s Vaccine Preventable Diseases Unit said the HPV vaccination data offered a strong platform for accelerating immunisation coverage. “Eight in ten women in this study already knew that HPV vaccination prevents cervical cancer. That is an exceptional foundation. Converting that knowledge into vaccination requires supply chain investment and community outreach, not persuasion.”

Dr Bartholomew Ituma Aleke of Global Banking School and Oxford Brookes University Partnership in Leeds said the study’s significance extended beyond Nigeria. “Cervical cancer disproportionately kills women in low and middle-income countries, not because prevention is unavailable in principle, but because the conditions for prevention, accessible services, trained health workers, reliable supply chains, are insufficiently resourced. Evidence from studies like this one is essential for sustaining the international case for investment.”

Solomon Atuman of FHI 360 said the partnership dimension of the response was equally important to the service design dimension. “Sustainable progress on cervical cancer prevention requires long-term commitment from national governments, local health authorities, and international partners working together, not short project cycles with isolated outcomes. This study makes the case for that sustained, coordinated investment.”

Dr Festus Ituah of Regent College London said the human reality behind the statistics should anchor the entire discussion. “Seven thousand women. In one year. From a preventable disease. Every one of those deaths represents a point at which a system could have intervened and did not. This research is about closing those gaps, not in the abstract, but in the specific, practical, community-level ways that save actual lives.”

Barth Onyekachi Nwokedi of the PENKUP Research Institute said the paper’s recommendations were both evidence-based and actionable. “Integrate screening into primary care. Train and deploy community health workers. Target education at the women with the lowest current knowledge. Make services free. These are not complicated asks. They are achievable ones, and this study gives decision-makers the evidence they need to prioritise them.”
Jerry Soni of the United Nations World Food Programme in Damascus said the study was ultimately a document of what was possible. “The women in this study are not a problem to be managed. They are partners in their own health who have told researchers clearly what they need. The only question is whether the systems responsible for their care are prepared to listen.”

The research is published open access in the Global Journal of Medicine and Public Health: doi.org/10.55640/gjmps/Volume05Issue03-01.