Working Status and Cervical Cancer Screening Experience among Urban Women in Indonesia: Evidence from the 2023 Indonesia Health Survey

Abstract

Cervical cancer remains the second most common cancer among women in Indonesia, while lifetime cervical cancer screening remains low. This study examined the association of current working status, age, education, and household wealth with self-reported lifetime cervical cancer screening experience among urban women in Indonesia. This cross-sectional study used secondary data from the 2023 Indonesia Health Survey (Survei Kesehatan Indonesia/SKI), including urban women aged ≥15 years eligible for the cervical cancer screening item (G43.G) (n=156,722; n=156,716 in the multivariable model due to missing wealth-quintile data). Analyses accounted for the multistage stratified cluster sampling design, including primary sampling units, strata, and sampling weights. Design-based chi-square tests and weighted multivariable logistic regression were performed. Overall, 8.97% (95% CI: 8.71–9.25%) of urban women reported ever undergoing cervical cancer screening by Pap smear or visual inspection with acetic acid (IVA). After adjustment, non-working women had lower odds of ever being screened than working women (aOR=0.91; 95% CI: 0.86–0.97; p=0.002). Screening odds were higher among women aged up to 45–54 years, those with higher education (aOR=3.42 for university graduates versus no formal education), and those in higher wealth quintiles (aOR=2.05 for the wealthiest versus poorest quintile). Working status, education, and household wealth were significantly associated with cervical cancer screening experience among urban Indonesian women. Equity-focused strategies should prioritize non-working, less-educated, and economically disadvantaged women to improve screening coverage and support cervical cancer elimination efforts.