Awareness and Barriers to Cervical Cancer Screening and HPV Vaccination in Rural Ebonyi State: A Multicenter Cross-sectional Study

Cervical cancer is a disease that begins with a common virus called human papillomavirus, or HPV. This virus spreads easily between people, and while most infections clear up on their own, some persist and slowly change healthy cells in the cervix into cancer over many years. Because this process takes so long, doctors have developed two powerful ways to stop it before it becomes deadly. The first is a vaccine that teaches the body to fight off the virus before it ever enters. The second is a screening test, a simple check-up that can spot the early warning signs of trouble so they can be treated immediately. In many wealthy nations, these tools have made cervical cancer rare. However, in many parts of the world, particularly in rural areas where health services are hard to reach, the disease remains a leading cause of death for women. The gap between having these life-saving tools and actually using them is where the story of this research begins.

Researchers set out to understand why these tools are not being used in rural Ebonyi State, a region in southeastern Nigeria. They traveled to remote communities to speak directly with women, asking them what they knew about cervical cancer and what stopped them from getting vaccinated or screened. The team gathered information from 683 women, ranging in age from 18 to over 60, during health outreach programs held between January and December 2025. These women were mostly married, had several children, and lived in a landscape where the nearest hospital might be far away. The goal was not just to count how many people knew about the disease, but to listen to the real reasons why prevention was not happening.

The findings revealed a stark reality. When asked if they knew about the screening tests that could find cervical cancer early, only a small fraction of the women said yes. Just over one in six women, or 17.1 percent, were aware that such tests existed. This lack of knowledge meant that for the vast majority, the first line of defense against the disease was invisible. The situation was even more dire when it came to the HPV vaccine. Only 3.1 percent of the women reported having received the vaccine themselves, and only 7.6 percent said they had vaccinated their daughters. Despite the fact that Nigeria officially added this vaccine to its routine immunization schedule in 2023, it had not yet reached the people who needed it most in these rural settings.

When the researchers asked why the women had not been vaccinated, the answers pointed to a single, overwhelming obstacle: access. It was not that the women were afraid of the vaccine or believed false rumors about it. Instead, the most common reason given, by more than 70 percent of the women, was that they simply could not get to a place where the vaccine was available. For their daughters, the barrier was even higher, with 76 percent citing access issues. The second most common reason was a lack of awareness, with about a quarter of the women saying they did not know the vaccine existed or did not understand its purpose. Cultural beliefs played a very minor role, mentioned by only a tiny fraction of the group. This suggests that the problem is not a refusal to accept medical advice, but a failure of the system to bring that advice to the people.

The women in this study faced a perfect storm of risk factors that made these barriers even more dangerous. Many had started having children at a young age and had large families, which increases the number of times they are exposed to the virus. Nearly one in five women had begun sexual activity before the age of 15, a time when the body is particularly vulnerable to infection. In a place where the virus is common and the tools to stop it are scarce, these life patterns create a high risk for developing cancer later in life. The study also found that most women were not using any form of family planning, and very few had been tested for other sexually transmitted infections, highlighting a broader gap in reproductive health services.

The researchers concluded that the solution lies in fixing the broken links in the supply chain and bringing services closer to the villages. They found that the main barrier was not the women's attitudes, but the physical distance to clinics and the lack of vaccines in stock. To change this, they recommend that the government and health organizations stop waiting for women to travel to distant hospitals. Instead, they must bring the vaccines and screening tests directly to the communities through outreach programs. This requires a steady supply of vaccines, reliable transportation to keep them cold, and health workers who can explain the benefits in a way that builds trust. Without these structural changes, the goal of eliminating cervical cancer will remain out of reach for the women in rural Ebonyi State, no matter how effective the medicine itself might be.