A retrospective cross-sectional study analyzed data from 2320 women aged 20–65 years from southwest China who had undergone cytology or HPV testing in the previous 3 years. Younger age (aOR = 0.96 per year; 95% CI: 0.94–0.98) and higher education (aOR = 2.30; 95% CI: 1.84–2.87) were independently associated with higher participation in cervical cancer screening. Urban residence (aOR = 2.13; 95% CI: 1.78–2.54), health insurance coverage (aOR = 4.12; 95% CI: 3.19–5.33) and shorter distance to health facilities (aOR = 0.39 for >15 km; 95% CI: 0.28) significantly increased participation. Not smoking and regular physical activity were also positively associated with participation. Patterns were consistent across both urban and rural subgroups with no significant interactions. The study recommends targeted interventions to strengthen education, expand insurance coverage, and improve access to screening for greater equity in prevention.