Work

Sexual and reproductive health rights service utilisation and barriers in humanitarian and fragile settings in East Africa: a systematic review

Year: 2026

Type: review

Abstract: Objectives: To assess the status of sexual and reproductive health and rights (SRHR) services in humanitarian and fragile settings and identify the specific barriers hindering their implementation in East Africa. Design: This systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data source: SCOPUS, PubMed, ScienceDirect, Epistimonikos and Hinari, as well as two search engines (Google and Google Scholar), were searched up to 28 January 2025. Eligibility: We included qualitative and quantitative studies on SRHR conducted in East African humanitarian or fragile settings and published after 2000. We excluded editorials; narrative, literature and scoping reviews; and individual or expert opinions from the analysis. Data extraction and synthesis: Reviewers developed a data extraction template before starting extraction, piloting it on six included articles. Thematic content analysis, guided by the Socio-Ecological Model, was performed using MAXQDA software. Results: After screening 1721 articles retrieved from electronic databases and search platforms, we included 59 studies that met all eligibility criteria. Several barriers impede access to sexual and reproductive health services. These barriers are categorised as intrapersonal (perceptions, age, menstrual shame, marital status and knowledge), interpersonal (family size, patriarchal practices and household income), community (social stigma, socioeconomic factors, cultural attitudes and norms) and systemic (lack of friendly services, safety/security issues, food/water insecurity, legal abortion restrictions and insufficiently trained personnel, especially in humanitarian contexts). Conclusion: In humanitarian settings, significant gaps in SRHR service access and utilisation, compounded by displacement and trauma, negatively impact women's health and community well-being. Addressing these gaps requires a multifaceted approach that strengthens healthcare infrastructure, trains healthcare workers, empowers women through education and fosters trust between refugees and providers. Integrated strategies focusing on immediate needs and long-term empowerment are essential to safeguard the SRHR of women in humanitarian settings. PROSPERO registration number: CRD420251000754.

Source: BMJ Public Health

DOI: 10.1136/bmjph-2025-003351