Adolescent effective access to sexual and reproductive health and rights in sub-Saharan Africa: a systematic review of legal, institutional and sociocultural barriers.

Introduction: Despite significant global efforts and advancements over the past few decades regarding adolescents' effective sexual and reproductive health and rights (SRHR), sub-Saharan Africa (SSA) continues to face a disproportionately high burden of adverse outcomes. Although there is a growing presence of favourable legal and policy frameworks, adolescents' effective access to these rights remains limited by multiple structural barriers. This significant and persistent disparity calls for an imperative strategic examination of the complex interplay among the institutional, legal and sociocultural factors and determinants that impede adolescents' access to SRHR. Objectives: The study aimed to identify and examine legal, institutional and sociocultural barriers that hamper adolescents' access to effective SRHR. Design: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and the PICOS (Populations, Interventions, Comparasion, Outcomes, Study design) framework. Data sources: An extensive search of scholarly databases identified 41 relevant publications from 2011 to 2026. Methodological quality was assessed according to the study type. Thus, we used Critical Appraisal Skills Program (CASP) for purely qualitative studies, STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) for observational studies and MMAT (Mixed Methods Appraisal Tool) for mixed methods studies. Eligibility criteria: Literature review includes qualitative, quantitative and mixed-methods studies. Studies conducted in sub-Saharan African countries and published from 2000 to 2026. Data extraction and synthesis: Data extraction grid (Excel) constituted of study identity, methodological characteristics, SRHR dimension covered, barriers, emergent features, innovative practices and policy implications. Results: We found a persistent and critical gap between the formal recognition of sexual and reproductive rights through multiple ratifications and their effective implementation through practical mechanisms and procedures in SSA. This review demonstrated how legal, social and institutional barriers interact and entangle to produce structural inequalities, particularly affecting adolescent girls and vulnerable women. Progress made over the past two decades in SSA remains significant. An excellent international and national commitment worth noting. The review, however, uncovered some fragilities in this progress and an uneven distribution. Conclusions: The effectiveness of SRHR in SSA requires a strategic, integrated approach that combines normative reform, the consolidation of governance mechanisms, social norm transformation and the strengthening of health systems.