Current rates of screening uptake are the lowest in 20 years. Additionally, there is evidence that physically disabled and autistic women are less likely to attend and often face additional barriers.

According to statistics:

• Physically disabled women are 33% less likely to attend cervical screening than the general population.
• Autistic women also face inequalities in access, often due to communication needs or sensory issues.
• Cervical screening prevents around 83% of cervical cancer cases, yet national uptake remains below 70%.
• Disabled and autistic women have the right to equal access to high-quality, respectful care.

• lack of access to transport or buildings
• limited access to appropriate equipment (for example, adjustable couches, hoists)
• pain or fear during the procedure
• assumptions about sexual activity or consent
• previous poor experiences with health care.

• offer double appointments where needed
• allow home visits when appropriate
• use adjustable equipment and positioning aids
• follow trauma-informed care principles
• opportunity to bring a friend, relative or personal assistant with them
• offer the patient the opportunity to insert their own speculum if they prefer
• always involve the woman in decision-making.

• discomfort from lights, sounds, smells or touch
• difficulty processing spoken information or understanding body cues
• anxiety around unfamiliar situations or loss of control
• difficulty describing symptoms or experiences
• barriers to accessing information in an understandable format.

• offer quiet appointments or time at the end of the clinic
• provide clear, step-by-step explanations
• allow time for questions and processing
• use easy-to-read materials or written information
• encourage use of communication tools like speech-to-text apps.

• treat the person as the expert on their own body
• listen respectfully and plan care together
• avoid assumptions about sexual activity or the need for screening
• explain the purpose, risks and benefits of screening clearly
• use the person’s preferred name, pronouns and language
• provide a calm, private environment to ensure comfort and dignity.

• use a head torch or different speculum sizes if needed
• provide a chaperone if requested
• allow time for reassurance and discussion
• ensure hygiene and comfort needs are met
• assess equipment and environment in advance.

• accessible websites with videos and easy-to-read leaflets
• posters and leaflets featuring diverse and inclusive imagery
• availability of double-length or end-of-day appointments
• adjustable couches and mobility aids
• trained sample-takers with experience in supporting additional needs
• regular audit of local screening uptake rates.

Physically disabled and autistic women may also face other barriers, such as racism, poverty, language barriers, or gender identity exclusion. It's important to provide care that is inclusive of all identities.

• Don't assume everyone attending is a woman.
• Use inclusive language, especially for trans and non-binary people.
• Provide interpreters when needed—do not rely on family.
• Ensure communication materials are accessible for a range of needs.

Self-sampling for HPV may increase access in the future, but it is not yet widely available and may not suit everyone. Some women may still require a follow-up cervical examination if high-risk HPV is found.

There is limited evidence about how acceptable self-sampling is to physically disabled or autistic women. Services need to remain flexible and ensure support is still in place for those who find attending difficult.

All cervical samplers must complete approved training and refresh it every three years.

Ongoing training should cover:

• supporting physically disabled and autistic people
• making appropriate adjustments to care
• using different equipment and positions
• knowing when and how to refer for specialist help.

Nurses and midwives play a leadership role in improving local services and advocating for inclusive care. They are key to driving change, influencing practice and improving outcomes.

• England: Training and continuing professional development (CPD) for professionals working in the NHS Cervical Screening Programme is available via the GOV.UK website. A three-yearly update is provided through the NHS England e-Learning for Healthcare (e-LfH) hub.
• Scotland: Training is provided by the Scottish Cytology Training School.
• Wales: The Screening Division of Public Health Wales delivers training on national screening programmes.
• Northern Ireland: Education and training for cancer screening is provided by the Public Health Agency.

Physically disabled and autistic women often face significant barriers to cervical screening. These include practical challenges, emotional distress, past trauma and communication difficulties. As a result, attendance is lower and therefore the cancer risk may be higher.

By taking the time to listen, offer personalised support and make reasonable adjustments, we can ensure that all women and people with a cervix have equal access to this important preventative service.

Inclusive care must be respectful, informed and centred around the person’s needs and preferences. With thoughtful planning, flexible options and a kind approach, screening can become a more positive and accessible experience for everyone.

Download the full PDF to explore this topic in more detail. This may include case studies, images, tables, good practice checklists, glossaries and suggested questions to ask patients. You’ll also find a concise list of references and links to useful organisations and websites.