Rural-urban differences and association of sexual autonomy with uptake of breast and cervical cancer screening services among women of reproductive age in Ghana

Résumé

Introduction Breast and cervical cancers are leading causes of morbidity and mortality among women in sub-Saharan Africa, yet screening uptake remains low in Ghana. Sexual autonomy, defined as a woman's ability to negotiate sexual activity and refuse unwanted sex, may influence health-seeking behaviours, including cancer screening. However, evidence on the association between sexual autonomy and screening uptake across rural-urban contexts is limited. This study examined the association between sexual autonomy and uptake of breast cancer (BC) and cervical cancer (CC) screening services among Ghanaian women in rural and urban areas using recent national-level data. Methods We analysed data from a weighted sample of 8,044 women aged 15–49 years in the 2022 Ghana Demographic and Health Survey (GDHS), conducted across all sixteen regions of Ghana. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed using Stata/SE version 17 with complex survey design adjustments. The main outcome measures were self-reported uptake of BC and CC screening services. Sexual autonomy was the primary explanatory variable. Results Overall, women with sexual autonomy were more likely to screen for BC (AOR = 2.10, 95% CI: 1.68–2.63) and CC (AOR = 1.95, 95% CI: 1.32–2.88). For BC screening, sexually autonomous women in both urban (AOR = 2.16, 95% CI: 1.57–2.98) and rural (AOR = 1.92, 95% CI: 1.40–2.63) areas had higher odds of screening, with the association being stronger among urban women. For CC screening, sexual autonomy was a statistically significant predictor only in urban areas (AOR = 2.06, 95% CI: 1.22–3.48); no statistically significant association was observed in rural settings. Conclusions This study demonstrates rural-urban differences in the relationship between sexual autonomy and uptake of breast and cervical cancer screening services among Ghanaian women of reproductive age. The findings highlight structural inequalities in women's empowerment and access to cancer screening services. Interventions aimed at improving screening uptake should address sexual autonomy alongside location-specific barriers, particularly in rural areas where cervical cancer screening remains suboptimal. Self-reported screening data may be subject to recall bias; responses to sexual autonomy questions may also reflect social desirability. These limitations should be considered when interpreting findings.

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