Abstract
Introduction Cervical cancer is South Africa’s second most common cancer among women, yet for complex reasons, Papanicolaou screening uptake remains suboptimal. Only a few studies have explored the interplay between sociodemographic characteristics, women’s empowerment, healthcare access, and lifestyle behaviors in influencing screening participation. We examined the associations between cervical cancer screening uptake and sociodemographic, women’s empowerment, healthcare access, and risky lifestyle behaviors factors. Methods Cross-sectional analyses of a nationally representative dataset of women ( n = 2789) aged 25–49 years were conducted from the 2016 South African Demographic and Health Survey. We used multivariable generalized linear regression models with Poisson distribution to estimate screening uptake (adjusted prevalence) ratios (aPRs, and 95% confidence intervals (95% CI)). We ordered the factors by their attributable fractions (AF), which takes the proportion of uptake per category into account. Results Being tested for HIV (aPR = 1.79; 95% CI:1.40–2.30; AF = 41.7%), population group (being Black) (aPR = 0.75; 95% CI:0.66–0.84; AF = 19.7%), rich (aPR = 1.34, 95% CI:1.08–1.67; AF = 15.9%), and education (aPR = 1.18, 95% CI:1.03–1.36; AF = 8.9%), were the most important determinants of cervical screening uptake in South Africa. Alcohol misuse (aPR = 1.23; 95% CI:1.10–1.38; AF = 6.1%), having health insurance (aPR:1.27; 95% CI:1.12–1.45; AF = 5.5%) and disempowerment (aPR = 1.10; 95% CI:1.00–1.22; AF = 5.5%) were less important drivers of screening uptake. Conclusions Pap smear uptake remains suboptimal, particularly among Black women. There is a need for enhanced awareness and education initiatives as well as novel strategies involving community-based screening programs to encourage the uptake of cervical screening.