MUMBAI, India – Cervical cancer kills more than 75,000 women in India each year, according to figures recently disclosed in Parliament – yet it is one of the most preventable cancers.

In India, low human papillomavirus (HPV) vaccination coverage, limited access to routine screening and deep-rooted social behaviours – such as early marriage and low condom use – drive late diagnosis and high mortality.

Globally, cervical cancer is the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 reported deaths in 2022, accoridng to WHO.

Public health experts say these factors increase exposure to HPV, the underlying cause of nearly all cervical cancer cases, while allowing the disease to progress silently for years before detection.

For Neha, a 29-year-old hotel worker in the city of 12.5 million, India’s largest, the statistics reflect a deeply personal loss.

My two cousins died from cervical cancer,” she told Health Policy Watch. “What frightens me most is how silent it is. People seem completely normal for years, and then you discover they have had cancer for a long time  only when they are close to dying.

Early marriage and rising HPV exposure

Doctors say nearly all cervical cancer cases are caused by persistent infection with high-risk types of HPV, one of the most common sexually transmitted infections worldwide.

Mumbai physician, Dr Sonali Roy told Health Policy Watch that HPV exposure in India is closely tied to early marriage, low awareness and limited access to vaccination and screening, particularly in rural areas.

“In some villages, girls are married as young as 14 or 15,” Roy said. These marriages often do not last, and women may remarry multiple times. Each marriage increases exposure to HPV, especially when condoms are rarely used and sexual health awareness is very low.

Early marriage often leads to early sexual debut, repeated pregnancies and limited agency over reproductive health decisions, experts say  all of which raise the risk of persistent HPV infection. The biological vulnerability of the cervix during adolescence further increases susceptibility to the virus.

Unlike many high-income countries, India has yet to roll out a nationwide HPV vaccination programme, despite repeated recommendations from public health experts and the World Health Organization (WHO). While some states have launched pilot projects, coverage remains patchy and largely urban, leaving millions of girls unprotected before sexual debut.

Routine cervical cancer screening also remains uneven across Indian states, with weak outreach in rural areas and among informal urban settlements, where health services are often overstretched.

Evidence from research

Research supports the link between early sexual debut, multiple partners and higher HPV infection risk. A 2019 study reviewing medical records of 349 women who tested positive for high-risk HPV found that women who began sexual activity at a younger age or had multiple sexual partners faced a significantly higher risk of infection with HPV types 16 and 18, the two strains responsible for the majority of cervical cancer cases globally.

The study found that about one in five women was infected with HPV 16, while nearly 9% were infected with HPV 18 – the types of HPV most likely to cause cervical cancer. Women who reported their first sexual intercourse at age 19 or younger were significantly more likely to be infected with HPV 16 than those who became sexually active later.

The risk rose sharply with multiple partners. Women who reported more than three lifetime sexual partners were four times more likely to be infected with HPV 18 than women who had fewer partners.

Public health researchers caution that these findings reflect structural conditions rather than individual behaviour. “In many cases, women do not have the power to negotiate when to marry, when to have sex or whether protection is used,  ” said a health researcher.

Men refuse to use protection

Even when women understand the risks, many say they have little control over prevention. A 27-year-old woman from the East Mumbai suburb of Kurla, who spoke on condition of anonymity, told Health Policy Watch that her partner refuses to use condoms.“He says it affects his pride,” said Priya (not her real name). This is common, even in cities like Mumbai, India’s modern financial center.

She said stigma is far stronger in rural areas, where access to contraception is limited and social scrutiny is intense. Many women end up with these infections simply because men refuse to use protection.

Her account echoes broader national trends. A 2021 report found that fewer than one in 10  men in India use condoms, making male sterilisation and barrier contraception among the least-used family planning methods in the country.

Female sterilisation remains the dominant form of contraception, often placing the burden of reproductive health entirely on women. By comparison, a 2025 Zipdo educational report estimated that around 45% of sexually active people worldwide used a condom during their last sexual encounter.

Priya recalled a close friend who had part of her cervix surgically removed after an early cancer diagnosis. Doctors later told her that consistent condom use would likely have prevented the HPV infection that led to the disease.

Screening gaps

Nearly 90% of cervical cancer deaths occur in low- and middle-income countries, where routine screening programmes remain limited. In India, the absence of a structured nationwide screening system has meant that many women are diagnosed only at advanced stages of the disease when treatment is more expensive and survival rates drop sharply.

Under India’s National Programme for Prevention and Control of Non-Communicable Diseases and Ayushman Bharat, its health insurance for vulnerable families, women aged 30 to 65 are supposed to be screened for cervical cancer at primary health centres using visual inspection with acetic acid, a low-cost test known as VIA.

Coverage, however, remains extremely low. Only about 2% of eligible women are currently being screened, with wide variations across states based on education levels and rural–urban divides.

Health workers cite multiple barriers, including staff shortages, limited training, lack of privacy at health centres and social stigma around gynaecological examinations. For many women, domestic responsibilities and daily wage work also make preventive care a low priority.

Cancer means financial ruin

For some women, barriers go beyond awareness and access. A woman living on the rural outskirts of Mumbai, nearly 87 kilometres from the city centre, told Health Policy Watch that fear of financial ruin often outweighs concern about infection itself.

“May God save us from expensive diseases. Unfortunately, cancer is one,” said Afshana, not her real name. “Even though we have a five lakh cover [around $5,500 annually] under Ayushman Bharat [insurance plan], we often end up going to private hospitals because services are lacking.”

Her experience reflects broader systemic gaps. A 2024 NITI Aayog review of Health and Wellness Centres linked to Ayushman Bharat, India’s flagship government insurance scheme, found significant shortfalls in cancer screening delivery.

While most centres had initiated screening for noncommunicable diseases, fewer than 10% had completed a full annual round. Cervical cancer screening was “yet to be operationalised,” according to the report, while oral cancer screening was carried out only selectively.

The review also found that many auxiliary nurse-midwives, staff nurses and medical officers had not received adequate training to conduct screenings or manage referrals. Although most centres met basic infrastructure standards and provided essential medicines free of charge, service delivery continued to lag behind national goals for early detection and prevention.

A preventable tragedy

Cervical cancer is widely regarded as one of the most preventable forms of cancer. HPV vaccination, regular screening and timely treatment of precancerous lesions have dramatically reduced incidence and mortality in countries that have invested in these measures.

Public health experts warn that without urgent action, India risks continuing to lose tens of thousands of women each year to a disease that can largely be stopped.

“Cervical cancer is not just a medical issue,” Roy said. “It is a reflection of gender inequality, weak health systems and the failure to prioritise women’s health.”For women like Neha, the cost of that failure is already painfully clear. 

“If they had found it earlier, my cousins might still be alive,” she said. “No one should die from something that can be prevented.”

Image Credits: Saiyan Mondal/Pexels, Gurpreet Singh/ Unsplash, Han J et al, eClinicalMedicine, Vol. 84June 2025, Deon Black/ Unsplash, Bermix Studio/Unsplash, Richard Catabay/Unsplash.