Background of the study: Early detection of the precursor lesion before the invasive stage of cervical cancer prevents further damage to the neighbouring tissues and organs. Bethesda system which applies cytological techniques is primarily used as a screening test while Richarts score is based on predicting the biological behaviour of abnormal epithelium. Laboratories in not so wellendowed settings should find the most predictive technique in assessing the cervical lesions. Objective: To Compare Bethesda System and Richart Score in the evaluation of Cervical Lesions among women on contraceptives attending Machakos Level V Hospital. Design: A descriptive cross-sectional study. Setting: Machakos level V Hospital, Machakos County, Kenya Subjects/participants: One hundred and seventy-six (176) women aged >22 <60 years in their reproductive age who sought clinical services at the facility. Results: This study evaluated 176 women with an average age of 40.5 years, a median of 43 and a range of 22 to 58 years. Several types of contraceptives evaluated in this study were classified into hormonal and non-hormonal. The sensitivity of Bethesda system was 88%, Specificity 61%,Positive predictive values 49%, Negative predictive values 93%, Kappa 0.810, McNemar 0.035 at 95% CI and Fishers exact <0.001 in comparison to the Richart score. Conclusion: In this study Bethesda system achieved a high level of accuracy in terms of specificity, sensitivity and predictive values.