ReviewGlobal mental health (Cambridge, England)2026
Barriers and facilitators to sexual and reproductive healthcare access for women with severe mental illness in low- and middle-income countries: A qualitative systematic review and meta-aggregation.
Review in Global mental health (Cambridge, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Women with severe mental illnesses (SMI) in low- and middle-income countries (LMICs) appear to have poorer sexual and reproductive health (SRH) compared to women without SMI and men with SMI. Previous research suggests that women with SMI experience higher rates of HIV and other sexually transmitted diseases, sexual violence and variable contraceptive use. This review seeks to identify key barriers and facilitators affecting access to SRH services for women with SMI in LMICs by systematically synthesizing relevant research. A qualitative systematic review was conducted using the Joanna Briggs Institute (JBI) methodology. Electronic searches were made on July 31, 2024, in MEDLINE, EMBASE, PsycINFO and citation tracking covering the period from 2004 to 2024. Studies conducted in LMICs that explored barriers and facilitators for accessing SRH services for women aged 18 years or older diagnosed with SMI were included. Data extraction and methodological quality assessments were completed and findings were compiled using the JBI meta-aggregation approach. The confidence of these findings was evaluated using the ConQual method. Eleven studies met the inclusion criteria. Four synthesized findings were: (a) Variable knowledge of SRH and low risk perception hinder access to SRH care for women with SMI; (b) Service availability shapes access to SRH care for women with SMI; (c) Restricted autonomy and exclusion from health decisions prevent women with SMI from accessing SRH care that reflects their needs and rights; and (d) Stigma and gendered expectations around mental illness and sexuality, reinforced by societal norms, discourage care-seeking for the SRH needs of women with SMI. All of these findings were assessed to have moderate confidence. Women with SMI in LMICs face distinct challenges in accessing SRH services. By considering the multifaceted barriers and facilitators identified in this review, policymakers can create more targeted and equitable interventions that improve accessibility of SRH services for this population.
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