Rural-urban inequalities in mammography use among women aged 45 years and older in India

Background: Mammography use may indicate inequalities in access to imaging-based breast health services and diagnostic care in India. This study examined rural–urban differences in self-reported mammography use among women aged 45 years and older and decomposed the gap. Methods: We analyzed Wave 1 data from the Longitudinal Ageing Study in India, 2017–2018, including 35,009 women. Weighted prevalence estimates, multivariable logistic regression, and Fairlie decomposition were used. Results: Overall, 1.3% of women reported mammography use in the past two years. Use was nearly three times higher among urban than rural women, at 2.3% and 0.8%, respectively. Higher morbidity, household consumption, media exposure, and residence in some regions were associated with higher odds of mammography use, whereas widowed women and women aged 65–74 years had lower adjusted odds. Fairlie decomposition showed that observed characteristics explained 54.03% of the rural–urban gap. Education made the largest contribution, accounting for 63.18% of the explained component, followed by morbidity and media exposure. Conclusion: Mammography use among women aged 45 years and older in India is very low and unequally distributed between rural and urban areas. Improving equity requires better access to breast cancer early-detection, referral, and diagnostic services, particularly for rural and socially disadvantaged women.