Wealth-related inequalities of women's cervical cancer screening in 11 Sub-Saharan African countries: evidence from a pooled decomposition analysis.

Cervical cancer is a preventable disease and ranks as the fourth most common cancer, as well as a major cause of cancer deaths among women globally. Despite initiatives by the World Health Organization to reduce cervical cancer incidence through vaccination, screening, and treatment, significant inequalities in healthcare access persist, particularly in low-income regions where economic and infrastructural barriers hinder access to screening services. Therefore, this study aimed to examine wealth-related inequalities in cervical cancer screening among women in Sub-Saharan African countries. The study analyzed 138,605 weighted samples of reproductive-aged women from DHS data spanning 2015 to 2023 across SSA countries. To assess socioeconomic-related inequality in cervical cancer screening uptake, the Erreygers normalized concentration index and its concentration curve were utilized. Additionally, a decomposition analysis was conducted to identify factors contributing to this inequality. The weighted Erreygers normalized concentration index was 0.25 with a standard error of 0.0078 (P value < 0.0001), indicating a statistically significant pro-rich distribution of wealth-related inequalities in cervical cancer screening uptake among reproductive-aged women. The decomposition analysis identified media exposure (20%), wealth index (15.58%), educational status (6.23%), and place of residence (2.18%) significantly contribute to screening inequalities. To address cervical cancer screening disparities in SSA, targeted strategies such as awareness campaigns for low-income groups, free screening services, mobile units in rural areas, and health literacy programs are recommended. Training community health workers and policy advocacy are also crucial. Comprehensive interventions should enhance media outreach, health education, and healthcare accessibility in both urban and rural areas to ensure equitable screening rates.