Abstract
Background: There is evidence that persons with disabilities often encounter grave barriers when accessing sexual and reproductive health services. This evidence is however not systematically documented in Sub-Saharan Africa. We conducted a systematic review on barriers persons with disabilities face in accessing sexual and reproductive health services in Sub-Saharan Africa. Methods: A systematic review was conducted using PRISMA guidelines (PROSPERO protocol registration below). An electronic search was conducted in Medline, EMBASE, CINAHL, PsycINFO, and Web of Science from 2001 to 2017. Manual search of reference list was also conducted. Studies were included if they reported on barriers persons with disability face in accessing sexual and reproductive health services. The Critical Appraisal Skills Programme and Centre for Evidence Based Management (CEBMa) appraisal tools were used to assess methodological quality of eligible studies. Findings: A total of 497 studies were identified. Only 17 studies covering 11 Sub-Saharan African countries were eligible for analysis. A total of 31 specific barriers including inaccessible physical health infrastructure and stigma and discrimination were identified. These barriers were further categorised into five levels: broader national level barriers; healthcare system/institutional barriers; individual level barriers; community level barriers; and economic barriers. Interpretation: Persons with disabilities face a myriad of demand and supply side barriers to accessing sexual and reproductive healthcare in Sub-Saharan Africa. Multilevel interventions are urgently needed to address these barriers. Funding Statement: This research was funded by an Early Career Research Fellowship grant from the Stellenbosch Institute for Advanced Study (STIAS) at Stellenbosch University, South Africa. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: A systematic review was conducted using PRISMA guidelines (PROSPERO protocol registration number: CRD42017074843).
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