Social Determinants of Women's Reproductive Health: A Systematic Review

Abstract

Context: Health, in all its aspects, is an important human right. There are various factors for the health of individuals with complex relationships with other cultural and social characteristics of a society that lead to inequality in health. Social determinants of health have a critical role in health matters; their impact on women's fertility and childbearing must be viewed as an important field to macrolevel and microlevel health scope decision-making and policy development. Objectives: This study aims to extract and determine the social determinants that affect women's reproductive health based on existing studies and strong evidence. Methods: This study was a systematic review that searched reputable medical databases and sites, including PubMed, Scopus, ISI, IranDoc, and SID, utilizing keywords like "social," "reproductive health/fertility/childbearing," and "women/female/woman". The scope of the study was limited to articles published between 2010 and 2019 due to the large volume of data available, and articles written in languages other than English or Persian were excluded from the review. The segregated articles concerning the abstract content were screened by two independent individuals to match the research objectives and keywords. The relevant abstracts were separated for review in the next step, and the full text of the obtained articles was read separately by two independent individuals to ensure their alignment with the research objectives. The articles were reviewed for quality and accuracy using the CASP tool, and those scoring above 75% entered the final stage of the study. Results: In the initial database search, 1731 articles were found, and after removing duplicates, 1516 remained. Of these, 1313 were removed for not meeting the research objectives, leaving 203 articles for the next stage. After further review, 92 articles were excluded, resulting in 107 articles for further review. Out of these, 84 articles were evaluated for compliance with research objectives, with 26 articles entering the critical evaluation stage. All articles scored above 75% on evaluation tools and entered the final stage of information extraction. Conclusions: The social determinants that impact women's reproductive health and childbearing, based on studies worldwide, include racial, ethnic, and national discrimination (for immigrants and minorities), micro and macroeconomic factors (income, costs of living, and healthcare), socio-cultural factors (education, employment, family norms), and socio-geographical factors (residence and urban status).