Access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings in Africa: a systematic review
Dessie Abebaw Angaw, Nimrod Muhumuza, Nana Koomson, Gertrude Nakanwagi, Moses MulumbaObjectives
To assess access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings across Africa.
Design
Systematic review following Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines.
Data source
Scopus, PubMed, Epistemonikos, along with websites like Google and Google Scholar were searched through 15 February 2025.
Eligibility criteria
Studies conducted in African humanitarian settings that focus on abortion, postabortion care and abortion-related complications were included, regardless of study design or language.
Data extraction and synthesis
Before commencing actual data extraction, a prior data extraction template was developed by reviewers through using a sample of two included articles. The thematic content analysis was conducted using MAXQDA software, guided by the socioecological model.
Results
Humanitarian conditions increased unintended pregnancies and demand for abortion services while health system disruptions limited access to safe care. Women were frequently resorting to unsafe abortion methods using traditional substances, detergents or harmful objects because of legal restrictions, stigma and limited access to family planning. Delays in abortion care are often driven by distance, cost, lack of confidentiality and fear of legal consequences. Cultural influences and cost concerns also led women to delay seeking healthcare, resulting in complications. Common challenges across many humanitarian settings included limited access to family planning, inadequate health system infrastructure and shortages of trained healthcare providers. Barriers are operated across individual, community, health system and policy levels, reinforcing inequities in access and outcomes.
Conclusions
In African humanitarian settings, barriers to safe abortion and postabortion care are amplified in humanitarian settings through interconnected social, structural and policy factors including legal ambiguity. Implementing comprehensive strategies such as empowering women, engaging communities, reforming policies and strengthening health systems can help improve access, safety and maternal health outcomes in humanitarian settings, thereby reducing unsafe abortions and enhancing postabortion care.
Trial registration number
CRD420251026961.