Factors influencing parental hesitancy toward HPV vaccination in Sub-Saharan Africa: a scoping review

Background The prevalence of cervical cancer is highest in Sub-Saharan Africa (SSA), yet the region’s coverage of the human papillomavirus (HPV) vaccine is still low and varies greatly between and within nations. HPV vaccination targets adolescents, making parental and caregiver consent and decision-making essential to vaccination program success. Parental hesitancy is a major determinant of whether national vaccination programs result in population-level protection, and a range of factors have been identified as drivers of parental reluctance. Objectives This scoping review aims to map and synthesize the evidence on factors influencing parental hesitancy toward HPV vaccination in Sub-Saharan Africa, including individual, household, sociocultural, informational, and health-system determinants, while identifying gaps for future research. Methods An initial multi-database search (PubMed/MEDLINE, SpringerLink, ProQuest and ScienceDirect; May to June 2026) identified 236 records, of which 79 unique records were screened and 36 studies met the eligibility criteria. An updated search with expanded terms was then run in PubMed, ScienceDirect and SpringerLink and a new database, AJOL; (200 records), which added 22 eligible studies, giving 58 studies in total. Hesitancy was defined as delay in acceptance or refusal of vaccination despite service availability; studies of acceptance, willingness, knowledge, attitudes or perceptions were eligible when they also reported determinants of hesitancy. Data were charted and synthesized narratively. Results The 58 included studies spanned ten Sub-Saharan African countries namely Nigeria, Cameroon, South Africa, Kenya, Ghana, Ethiopia, Tanzania, Uganda, Malawi, and Zambia, published between 2016 and 2026, and comprised cross-sectional surveys, qualitative studies, mixed-methods studies, a randomized survey experiment, quasi-experimental studies, and programmatic/stakeholder assessments. Recurring factors included wide variation in HPV/cervical cancer awareness, safety and side-effect concerns (including fears of infertility and conspiracy beliefs), cost and geographic access barriers, religious and cultural beliefs, the paradoxical relationship between caregiver education and hesitancy, and the influence of health workers, social media, and community/religious leaders. Conclusion Parental hesitancy toward HPV vaccination across Sub-Saharan Africa is shaped by overlapping informational, sociocultural, economic, and trust-related factors that vary substantially by country, delivery platform, and rollout maturity. Closing the region’s HPV vaccination gap may require country and community-tailored, multicomponent strategies combining trusted-messenger communication, dedicated safety-concern counseling, and continued attention to cost and access barriers, particularly in under-studied countries and rural settings.