International Journal of Public Health

, Volume 54, Issue 4, pp 222–232

Inequalities in cervical cancer screening in Eastern Europe: perspectives from Bulgaria and Romania

  • Irina Todorova
  • Adriana Baban
  • Anna Alexandrova-Karamanova
  • Janet Bradley
Original article

DOI: 10.1007/s00038-009-8040-6

Cite this article as:
Todorova, I., Baban, A., Alexandrova-Karamanova, A. et al. Int J Public Health (2009) 54: 222. doi:10.1007/s00038-009-8040-6



The incidence of cervical cancer in Eastern Europe has been on the rise, in contrast to the reduction in incidence in most countries of Western Europe. The objectives of the paper are to delineate the inequalities in cervical cancer screening in Romania and Bulgaria and identify explanations for these inequalities.


Representative samples of women – 1 099 in Bulgaria and 1 053 in Romania, were interviewed through a structured questionnaire.


We found multiple dimensions of inequalities in cervical cancer prevalence and prevention, including disparities in comparison to other countries, disparities due to socioeconomic status, education, residency and ethnicity, as well as differential barriers faced by women in access to screening and in relationships with providers. We identified mediators of the effects of socio-economic status on screening history.


The study concludes that the effect of SES on screening is mediated mainly by the structural barriers in accessing the healthcare system, as well as women’s perceptions of the multiple costs of the smear. These conclusions are relevant to the development of national screening programs and health promotion in the two countries.


Cervical cancer screening Inequalities Eastern Europe 

Copyright information

© Birkhäuser Verlag, Basel 2009

Authors and Affiliations

  • Irina Todorova
    • 1
  • Adriana Baban
    • 2
  • Anna Alexandrova-Karamanova
    • 1
  • Janet Bradley
    • 3
  1. 1.Health Psychology Research CenterSofiaBulgaria
  2. 2.Babes-Bolyai UniversityCluj-NapocaRomania
  3. 3.EngenderHealthNew YorkUSA

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