ArticleBMJ open2026
Understanding contemporary challenges to safe abortion access in Africa through a health systems lens: a systematic review protocol.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
0 citing papers in PubMed.
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Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundUnsafe abortion remains a major public health concern in Africa, contributing substantially to maternal morbidity and mortality across the continent. Although legal restrictions, stigma and socio-cultural factors are well-documented barriers to safe abortion access, health systems-related barriers are not adequately explored. This systematic review aims to examine how health systems-related barriers hinder access to safe abortion in clinic settings in Africa over the past decade. METHODS AND ANALYSIS: A comprehensive search strategy will be employed to retrieve relevant studies from electronic databases, including PubMed, Web of Science and African Journals Online. Search terms such as "health system barriers", "structural barriers", "healthcare financing", "healthcare governance", "healthcare leadership", "poor referral systems" and "conscientious objection" will be combined with "abortion access" and "abortion provision" using Boolean operators. The review will include empirical studies, with designs such as cross-sectional, longitudinal, experimental and exploratory on abortion barriers in Africa that are linked to the WHO's health system building blocks. Non-empirical publications (eg, literature reviews and commentaries) will be excluded. Titles, abstracts and full texts will be screened independently by reviewers according to predefined inclusion and exclusion criteria, with discrepancies resolved by consensus. The primary outcome of interest is how health system-related barriers affect access to safe abortion in clinics. The quality of studies will be evaluated using the Mixed Methods Appraisal Tool and data will be synthesised narratively. ETHICS AND DISSEMINATION: Ethical approval is not required for this study, as it involves analysis of data from published literature and does not include any primary data collection. Results for the main review will be submitted for publication in a journal. Additionally, the results will be disseminated by the African Coalition for Research and Communication on Abortion. PROSPERO REGISTRATION NUMBER: PROSPERO 2025 CRD420251156948.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.