SynthesisBMJ open2026
Access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings in Africa: a systematic review.
Synthesis 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.
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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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Authors and funding
5 authors.
Funding
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Abstract
objectivesTo assess access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings across Africa.
designSystematic 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.
resultsHumanitarian 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.
conclusionsIn 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.
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