OBJECTIVE: To identify the determinants of cervical cancer (CC) screening among underserved rural women in Zimbabwe. DESIGN: Community-based cross-sectional survey. SAMPLE: 840 rural women (25-65 years). MEASUREMENTS: A structured, pretested questionnaire was used to collect data on sociodemographic characteristics and factors influencing screening. The outcome was defined as self-reported ever screening for CC. Multivariable logistic regression was used to examine the association between CC screening and independent variables. RESULTS: Of the 840 women included, 33% had a history of screening. Women 25-45 years (adjusted odds ratio (aOR): 0.43
95% CI: 0.30-0.61) and without medical insurance (aOR: 0.66
95% CI: 0.45-0.97) had reduced odds of CC screening. Conversely, women who had seen or heard messages on CC screening (aOR: 1.48
95% CI: 1.03-2.13), were living with HIV (aOR: 1.87
95% CI: 1.22-2.87) reported recent antibiotic use (aOR: 4.50
95% CI: 1.47-13.79) and had malaria in the last 6 months (aOR: 2.45
95% CI: 1.02-5.86) had increased odds of CC screening. CONCLUSION: There is a need for intensified efforts to improve CC screening uptake, particularly in underserved rural areas with suboptimal screening rates and high CC burden. Strategies should include widespread tailored awareness messaging targeting younger women, women living with HIV, and women without medical insurance.