Background: Cervical cancer remains a major public health challenge in Nigeria. According to the latest GLOBOCAN 2022 estimates, there were 13,676 new cases and 7,093 deaths, making it the third most common cancer and a leading cause of cancer-related mortality among women in the country. Although Nigeria has adopted both national and global strategies supporting HPV vaccination and the elimination of cervical cancer by 2030, the uptake of Pap smear screening and other preventive services remains low. Assessing the knowledge, attitudes, and practices (KAP) of women regarding cervical cancer prevention is essential to identifying gaps in awareness, health communication, and service delivery. This study assessed the knowledge, attitudes, and practices regarding cervical cancer, Pap smear screening, and HPV vaccination among women aged 21–65 years in Nnewi-North LGA, Anambra State, Nigeria, and identified barriers to effective prevention and control.

Methods: A descriptive cross-sectional study was conducted among women attending primary health centres (PHCs) in Nnewi-North LGA. Using a multistage random sampling method, data were collected through a structured interviewer-administered questionnaire assessing socio-demographic characteristics, knowledge, attitudes, and practices related to cervical cancer prevention. Data were analysed with SPSS version 25 using descriptive and inferential statistics at a significance level of p < 0.05.

Results: Of the 427 questionnaires distributed, 402 were completed (response rate = 94.1%). The majority of respondents were aged 21–40 years and 65.2% were married. Most (92%) had heard of cervical cancer, and 58.2% correctly identified HPV infection as its cause. Awareness of Pap smear was moderate (75.9%), but only 11.2% had ever been screened. Major barriers included lack of information on where to test (38.6%) and time constraints (25.4%). Awareness of HPV vaccination was high (86.3%), and 84.6% knew it prevents cervical cancer. Overall, 93.3% expressed willingness to undergo free screening and 96.8% would recommend it to others.

Conclusion: Despite high awareness and generally positive attitudes toward cervical cancer prevention, actual uptake of Pap smear screening and HPV vaccination remains low among women in Southeast Nigeria. Educational level emerged as a key determinant of awareness and attitudes, with women who had higher education significantly more likely to be knowledgeable about cervical cancer, Pap smear screening, and HPV vaccination, and more willing to recommend HPV vaccination. Persistent knowledge gaps, sociocultural beliefs, and limited access to services continue to constrain preventive practices. Strengthening community-based health education particularly targeting women with lower educational attainment, improving service accessibility, and integrating cervical cancer screening into routine primary healthcare are essential to reducing the cervical cancer burden.