Reducing inequalities in cervical cancer service utilization among vulnerable rural and urban women and girls in Zimbabwe: a social justice analysis

Background: Cervical Cancer (CxCa) has become a global health challenge accounting for 660,787 new cases globally, leading to 311,000 deaths, with the highest disease burden in low and medium-income countries predominantly in Sub-Saharan Africa (SSA) with at least 90% of global cases occurring there. In Zimbabwe, it is the leading cancer among all genders with 3520 cases recorded in 2022. Human papillomavirus (HPV) and Human immunodeficiency virus (HIV) comorbidities increase the disease burden, resulting in premature deaths. Inequalities exist between rural and urban women in access and availability of cervical cancer service utilization. This study aimed to explore the application of social justice principles in cervical cancer service utilization to reduce inequalities among rural and urban women and girls in the prevention, detection, and treatment of cervical cancer.Methods: The systematic review used Medical Subject Headings (MeSH) in formulating search terms used in Databases including PubMed, Google Scholar, ScienceDirect, and Elsevier. The inclusion criteria were for publications and reports published between 2013-2024. Documents included had at least two keywords and focused on “cervical cancer” in “Zimbabwe,” or SSA, or Low and Middle-Income Countries, other keywords including “Human Papillomavirus” “Human Papilloma Virus – Deoxyribonucleic (HPV DNA) testing”, “Papanicolaou (Pap) smear”, “cervical cancer screening”, and “treatment” were included. The findings were summarized in a descriptive narrative model based on the themes that emerged from the objectives. Results: Seventy-seven articles met the inclusion criteria, and the key themes that emerged included barriers such as distance from facilities, cost of treatment, and service unavailability. Social determinants of health influencing cervical cancer services utilization such as age, education, income status, and place of residence among others, enablers of cervical cancer service utilization including access to information, self-sampling, expansion and decentralization of services, and current practices in prevention, detection, and treatment including HPV vaccination, Visual Inspection with Acetic Acid and Cervicography (VIAC), HPV-DNA testing, and Pap smear and in treatment the use of Large Electrode Excision Procedure, cryotherapy, and thermal ablation. The results identified the inequalities that led to differential access to services. The inequalities influenced the social justice principles of equity, participation, non-discrimination, and empowerment affecting rural women and girls more. They also showed that considerable research had been done in line with barriers, knowledge attitudes, and practices, and less research was found on social justice.Conclusion: A wide range of barriers exists for both urban and rural women and girls in CxCa service utilization, however, they disproportionately impact rural women. These are because of the influence of social determinants of health and stem from current cervical cancer prevention, detection, and treatment practices. From a human rights perspective, there is need for policy adjustments to ensure equity of access, availability, affordability, and quality of services among all women and girls especially from the rural areas.