Risk factors of cervical cancer among women in Ethiopia: a systematic review and meta-analysis (2000–2025)

Abstract Background Cervical cancer remains a major public health burden in Ethiopia and is among the leading causes of cancer-related morbidity and mortality among women. Evidence on context-specific risk factors in Ethiopia is fragmented and inconsistent, with variations in study design, populations, and reported exposures leading to inconclusive findings. Identifying and synthesizing the associated factors for cervical cancer is essential for identifying high-risk populations, informing effective prevention strategies, and improving the efficiency and effectiveness of cervical cancer screening programs. Therefore, this study aimed to systematically review and quantitatively synthesize the risk factors associated with cervical cancer among Ethiopian women. Methods This systematic review and meta-analysis was conducted following the Joanna Briggs Institute (JBI) methodological guidance and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review question was developed using the PECO framework (Population, Exposure, Comparison, and Outcome). Multiple electronic databases, including PubMed/MEDLINE, Scopus, Web of Science, EMBASE, the Cochrane Library, African Journals Online, and Google Scholar, were systematically searched for observational studies (case-control, cross-sectional, and cohort) published between January 2000 and 31 December 2025, with the final search conducted on this date. Only peer-reviewed articles published in English were included. Grey literature was not considered, which may introduce a risk of publication bias. A total of 1,276 records were identified, and after screening titles, abstracts, and full texts, 27 studies were included in the final analysis. Study selection, data extraction, and quality assessment were conducted independently by two reviewers. Study quality was assessed using the Newcastle–Ottawa Scale (NOS), with a modified version applied for cross-sectional studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using a random-effects model to account for variability across studies in terms of design, population, and setting. Statistical heterogeneity was assessed using the I² statistic, with values greater than 50% indicating substantial heterogeneity. All statistical analyses were performed using R software (version 4.2.1). Results Older age (≥ 40 years) was significantly associated with cervical cancer (OR = 3.87; 95% CI: 2.75–5.44). Other significant factors included early sexual debut (OR = 3.66; 95% CI: 2.48–5.40), HIV-positive status (OR = 3.37; 95% CI: 2.19–5.18), multiple sexual partners (OR = 2.88; 95% CI: 2.30–3.61), and a history of sexually transmitted infections (OR = 3.66; 95% CI: 2.31–5.82). Reproductive factors such as oral contraceptive use (OR = 2.99; 95% CI: 1.87–4.78) and multiparity (≥ 5 births) (OR = 1.51; 95% CI: 1.13–1.82) were also associated with increased risk. Conclusions Cervical cancer among women in Ethiopia is consistently associated with sexual behavior, infectious comorbidities, and reproductive factors. These findings highlight the importance of strengthening integrated prevention strategies, including expanding HPV vaccination coverage, improving access to cervical cancer screening, and enhancing integration with HIV care services. Addressing modifiable associated factors may help reduce the burden of cervical cancer in Ethiopia.