Intersectional stigma and resilience in the uptake of cervical cancer prevention services in Nigeria: a qualitative study

Abstract

Background: Cervical cancer is one of the leading causes of death among women in Africa, but stigma often delays cervical cancer prevention. We explore the perceptions, enablers and nurturers through the lens of intersectional stigma in the uptake of cervical cancer prevention services in Nigeria.

Method: Indepth interviews and focus group discussions were conducted among women aged 30-65 years and girls aged 9-26 years in Lagos, Nigeria. Data were analysed thematically. Using the relationships and expectation domain of the PEN-3 cultural model, we identified perceptions, enablers and nurturers related to the uptake of primary and secondary cervical cancer prevention services in Nigeria. We also explored how social identities may intersect with health-related stigmas and affect the uptake of these services.

Result: We interviewed 31 women and 31 girls. 61% of the participants were Christians and 39% were Muslims and were from the three major ethnic groups in Nigeria: Igbo (34%), Hausa (38%) and Yoruba (28%). Themes emerging from the data: (1) positive perceptions (self-efficacy): many women understood the importance of protecting themselves and their daughters from cervical cancer and strongly believed that they could educate their partners/husbands and would not let other people's experiences with the vaccine influence them negatively. (2) Negative perceptions (anticipated stigma): some women expressed that because the human papillomavirus that causes cervical cancer is mainly sexually transmitted, they were concerned that they may be perceived as being promiscuous if they decide to commence routine cervical cancer screening. (3) Enablers (social support): nearly all women wanted the support of their spouses before receiving cervical cancer screening. (4) Nurturers (resilience): many clearly understood the complex social and economic realities faced by Nigerians that negatively affect their access to healthcare.

Conclusion: These findings offer intersectional insights into advancing public health and culturally anchored interventions to preventing cervical cancer-related stigma in Nigeria.

Keywords: Cancer; Maternal health; Public Health; Qualitative study; Screening.

Figure 1. Overview of key themes from the study, structured using the relationships and expectations domain of the PEN-3 cultural model. Perceptions, enablers and nurturers influence women’s and girls’ decisions around human papillomavirus vaccination and cervical cancer screening. Ethnicity and religion are cross-cutting social identities that interact with these domains, contributing to or mitigating stigma and shaping the uptake of cervical cancer prevention services in Nigeria.