Why did we do this study? Cervical cancer can often be prevented if women get regular screenings every three years. These screenings catch early signs of cancer before it becomes hard to treat. However, some groups of people, like those with lower education or income, don’t get screened as often as they should. Even when comparing people with similar education and income, those with a migration background—meaning they or their parents were born in another country—tend to get screened less often than the native population. What were we trying to find out? People with migration backgrounds often face language barriers and cultural differences when navigating healthcare systems, or they may not fully understand how these systems work. These factors can influence a person’s health literacy. Health literacy is the ability to understand and use health information. We anticipate that people with migration backgrounds might have lower health literacy and this could partially explain why they are less likely than natives to participate in cervical cancer screening. Therefore, we wanted to explore if this migration-related inequality in screening might be mediated (in part) through health literacy. How did we do it? We looked at data from the Belgian Health Interview Survey, which collects health information from people across Belgium every five years. We grouped people with migration backgrounds into six categories, based on whether they were first or second-generation migrants, whether they were from the EU or outside the EU, and how long they had been in Belgium. We compared these groups to the native population. We checked health literacy levels that were obtained with the help of a specific questionnaire and checked it against the uptake of cervical cancer screening in the past three years. What did we find? We found that people with migration backgrounds, especially those from outside the EU who had been in Belgium for a shorter time, were less likely to fill out the health literacy questionnaire, leading to systematic bias in the health literacy index. However, for those who did complete the questionnaire, health literacy levels were similar between migrants and natives. We also found that people who didn’t fill out the questionnaire were less likely to get screened for cervical cancer. Even when health literacy was taken into account, first-generation non-EU migrants with a short stay in Belgium still got screened less often than natives. What do our findings mean? Our findings showed that the screening inequalities related to migration background are not due to differences in health literacy. But this should be interpreted with caution. The way health literacy is measured might not work well for people with migration backgrounds; because they often don’t complete the questionnaire. These people are also less likely to get screened for cervical cancer. This research shows the need to create better health literacy tools that everyone can understand and feel comfortable using. Having a more inclusive tool for measuring health literacy might help explain health inequalities. By improving how we measure health literacy, we can come up with better health literacy interventions that leave no one behind. We can help ensure equitable access to life-saving health services like cancer screening. This could lead to better health outcomes, reduce health inequalities, and ultimately save lives.