To estimate awareness and prevalence of cervical smear testing among women in Nepal.A secondary analysis of data obtained as part of a nationwide household survey between May 25 and June 14, 2015, was undertaken. Information obtained from women aged 21–65years was included. Multiple regression analyses were performed to identify factors associated with having undergone cervical smear testing.A total of 829 women were included. Among 816 women who answered the relevant survey question, 710 (87.0%) had no knowledge of cervical smear tests. Only 39 (4.7%) of the 829 women had ever undergone a cervical smear. In multivariate analysis, having undergone a cervical smear was associated with literacy (adjusted odds ratio [aOR] 3.26, 95% confidence interval [CI] 1.25–8.51; P=0.016) and living in rural areas (aOR 0.48, 95% CI 0.24–0.96; P=0.038).Nepali women rarely undergo cervical smear screening, with the lowest prevalence recorded among the illiterate and those living in rural areas. To boost screening rates, educational campaigns and rural outreach are needed.