Women's autonomy and cervical cancer screening in the Lesotho Demographic and Health Survey 2009

Rationale: There are vast global disparities in the burden of cervical cancer; 85% of incident cases and 87% of deaths occur in the developing world. There is a growing body of literature asserting that women's autonomy is associated with a broad range of health outcomes. Objective: This study examined the relationship between women's autonomy and cervical cancer screening to inform interventions in global cervical cancer care. Methods: A generalized estimating equation approach to logistic regression was used to analyze associations between women's autonomy indicators and both cervical cancer screening knowledge and personal history in a cross sectional sample of 4049 married women in Lesotho. Results: More than half of the women surveyed (65.2%) had never heard of a pap smear, and only 7.2% had ever had one. Women who participated in all types of household decision-making were 1.4 times more likely to have heard of a pap smear (estimated risk ratio = 1.4, 95% confidence interval: 1.0, 1.8) compared to women with lower participation levels (p = 0.032). Conclusions: This study extends earlier research demonstrating that women's autonomy predicts improved health outcomes, to include cervical cancer screening awareness, but not action. This finding, that augmenting women's autonomy improves cervical cancer screening awareness, adds yet another to the myriad reasons for focusing global attention on issues of gender equity.