Background:
Nigeria bears one of the highest burdens of cervical cancer in West Africa, yet uptake of prevention services specifically HPV vaccination and screening remains critically suboptimal relative to the WHO 90-70-90 elimination targets. While financial and logistical barriers are frequently cited in literature, the landscape of socio cultural determinants acts as a persistent, often invisible bottleneck. Prevailing religious norms, patriarchal decision making structures, and intersectional stigma regarding reproductive health discourage young women from accessing even free services. Understanding these nuances is essential for designing culturally safe implementation strategies in high burden settings.

Objectives:
This study aimed to quantify the knowledge/practice gap regarding cervical cancer prevention among young women in Southern Nigeria while isolating specific socio cultural drivers of hesitancy, focusing on gender dynamics and religious misconceptions. Furthermore, the research sought to provide evidence based recommendations for community led advocacy interventions that address these specific cultural barriers.

Methods:
We employed a mixed methods design to ensure depth of understanding. A cross sectional survey was administered to 385 women aged 18 to 35 to assess Knowledge, Attitudes, and Practice (KAP) regarding cervical cancer. Concurrently, six Focus Group Discussions (FGDs) were conducted with women, alongside Key Informant Interviews (KIIs) with community and religious leaders. Data were analyzed using descriptive statistics and thematic content analysis to identify recurring socio cultural motifs hindering access.

Results:
Quantitative data revealed a stark disparity. While 68.5% of respondents demonstrated high awareness of cervical cancer, only 4.2% had ever accessed screening or vaccination services. Qualitative analysis identified three primary determinants for this delay. First, partner refusal was a dominant factor, where 42% of women cited the inability to obtain spousal permission for reproductive care. Second, myths of infertility were pervasive, with 29% of respondents believing the HPV vaccine or speculum exams compromise future conception. Finally, religious fatalism played a significant role, where cancer was frequently viewed as a spiritual attack requiring prayer rather than medical intervention. Notably, uptake was significantly lower in semi urban areas lacking youth led digital advocacy programs.

Conclusions/Implications:
Socio cultural barriers, particularly partner influence and fertility myths, currently outweigh financial constraints as primary drivers of hesitancy. To achieve the 90-70-90 targets, implementation strategies must shift from purely clinical models to social availability. We recommend integrating “Male Engagement” strategies to convert partners into advocates, utilizing culturally tailored visual storytelling to dismantle infertility myths, and decentralizing advocacy through trusted community networks.