Sexual and reproductive health rights service utilisation and barriers in humanitarian and fragile settings in East Africa: a systematic review.
- 1Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences,University of Gondar, Gondar, Ethiopia.
- 2Evidence Generation Department, Afya na haki institute, Kampala, Uganda.
- 3Afya na Haki Institute, Kampala, Uganda.
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.
Related
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- Beyond global AMR targets: toward equitable and actionable implementation targets in humanitarian settings
- Quality of Maternal and Newborn Care in Humanitarian and Crisis Settings in Sub‐Saharan Africa: An Umbrella Review
- Novel Mobile and Facility Reproductive Health Kits: enhancing safe abortion and post-abortion care during disasters and humanitarian crises.
- Overlooked health and protection needs of older women in humanitarian settings: A qualitative study of practitioners
BibTeX
@article{angaw2026sexual,
title = {{Sexual and reproductive health rights service utilisation and barriers in humanitarian and fragile settings in East Africa: a systematic review.}},
author = {Dessie Abebaw Angaw and Nimrod Muhumuza and Nana Koomson and Maria Birungi and Frank Ssekamwa and Stuart Ssebibubbu and Moses Mulumba},
journal = {BMJ public health},
year = {2026},
month = oct,
doi = {10.1136/bmjph-2025-003351},
url = {https://europepmc.org/article/MED/42921215},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Sexual and reproductive health rights service utilisation and barriers in humanitarian and fragile settings in East Africa: a systematic review.
AU - Dessie Abebaw Angaw
AU - Nimrod Muhumuza
AU - Nana Koomson
AU - Maria Birungi
AU - Frank Ssekamwa
AU - Stuart Ssebibubbu
AU - Moses Mulumba
PY - 2026
DA - 2026/10/21
JO - BMJ public health
DO - 10.1136/bmjph-2025-003351
UR - https://europepmc.org/article/MED/42921215
AB - 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.
SN - 2753-4294
ER -