Table 1 Characteristics of included studies
N | Author/year | Country | Study Design and data collection method | study population/participants | Study objectives | Outcomes of interest to the review | Quality assessment score(%) |
|---|---|---|---|---|---|---|---|
1 | Janighorban, Mojgan et al. (2022) [21] | Iran | Qualitative: in-depth interviews | 14–19-years-old vulnerable adolescent girls and twenty-two key informants and health professionals | To explore the barriers to the access of vulnerable adolescent girls to sexual and reproductive health | The study underscores the vital need for comprehensive sexual and reproductive health education in Iran to overcome cultural barriers, ensuring adolescents can make informed decisions about their sexual and reproductive health | 100 |
2 | Boaventura Manuel Cau [22] | Mozambique | Quantitative study: the 2011 Demographic and Health Survey (DHS) | Married (or in union) women aged 15–49 years | To examine the mechanisms through which community context influences women’s use of modern contraception | In Mozambique, cultural norms and gender dynamics influence contraceptive use, with larger family desires and male dominance limiting women's choices, while community-level women's empowerment promotes modern contraceptive methods | 80 |
3 | Mardi, A (2018) [23] | Iran | qualitative study: in-depth semi-structured interviews | Married women aged 13–19 years who attended in urban–rural healthcare center in Ardabil | to explore factors influencing the use of contraceptives from the perspective of teenage women living in the city of Ardabil in Iran | In Iranian society, societal pressures and norms around fertility and adulthood drive teenage women to early pregnancies, exacerbated by limited knowledge of and access to contraception, leaving them without control over their reproductive choices | 100 |
4 | Rosemary Morgan 2017 [24] | Uganda | qualitative study: Group discussions | Three districts in Eastern Uganda were surveyed, covering women who recently gave birth, fathers of recent newborns | To identify key gender dynamics affecting maternal health and maternal health care | Gender power dynamics heavily influence maternal healthcare access and outcomes, affecting resource allocation, labor division, societal norms, and decision-making, amidst challenges like workload, male involvement, and healthcare provider attitudes | 100 |
5 | Kazaura, M. 2015 [25] | Tanzania | Quantitative study: a quasi-experimental study GEM Scale | A sample of 1,620 adult women and men | To assess how attitudes and beliefs respond to the spread of HIV and gender-based violence (GBV) in Tanzania | Findings reveal that changing gender dynamics, attitudes, and societal norms significantly mediate HIV transmission risks between genders, highlighting the need to address gender inequalities to mitigate differential HIV risks | 70 |
6 | Drioui, C. 2021 [26] | Morocco | Quantitative study: Survey | The data are from two surveys, the 2003–2004 Population and Family Health Survey and the 2011 National Population and Family Health Survey | To measure women's empowerment, particularly in the domestic sphere and in relation to spouses, and its effect on women's fertility preferences | Women's empowerment, marked by independence and improved bargaining power, decreases desired family size through enhanced couple communication and education access, simultaneously challenging male violence and influencing reproductive decisions broadly | 80 |
7 | Ouahid, H 2023 [27] | Morocco | A qualitative study: semi-structured interviews and focus groups | women and men aged over 18 years old, living in the urban and rural areas of the Marrakech-Safi region in Morocco | To explore how gender norms influence access to sexual and reproductive health services | The study highlights how entrenched gender norms stigmatize and restrict women's access to sexual and reproductive healthcare, demonstrating the need for interventions to dismantle these gender-based barriers and enhance women's healthcare autonomy | 100 |
8 | Delbiso, T.D. 2013 [28] | Ethiopia | Quantitative study: structured questionnaire | 317 married couples | The objective of assessing gender power relations in reproductive decision-making (DM) | Younger women [15,16,17,18,19,20, 29,30,31,32] often have husbands controlling contraceptive and maternal health decisions, while women with one or two children tend to share decision-making, reflecting varied reproductive health participation across demographics | 80 |
9 | Rizvi, N. 2014 [33] | Pakistan | A qualitative study: group discussions | semi-structured group discussions with women, through snowballing from different age and socio-economic categories | The study identifies reasons for gender role repetition and examines their impact on women's reproductive health | In patriarchal systems, male dominance limits women's autonomy in sexual and reproductive health, leading to increased risks and reliance on abortion, particularly for female fetuses | 100 |
10 | Cerezo, A et al. 2023 [34] | U.S.A | an exploratory qualitative study: semi-structured interviews and focus groups | with twenty sexual minority gender expansive women of Latinx and African American descent | To explore participants'access to health services and the impact of cultural factors on their health decisions and behaviors | Participants face barriers to healthcare due to income disparities, provider discrimination, and familial discouragement, often leading to delayed medical care seeking influenced by early life experiences and family messages | 100 |
11 | Kingori, C. et al. 2018 [35] | U.S.A Ohio | A qualitative study: In-depth interviews | 27 Somali young adults aged 18–25 years | To identify sexual health knowledge barriers among Somali young adults in Ohio | Cultural and religious norms significantly influence sexual health knowledge in the Somali immigrant youth community, where stigma and judgment are prevalent. Research supports a multi-level approach to address these barriers, involving individual, interpersonal, and community interventions | 90 |
12 | Chiweshe, M.,Macleod, C. 2017 [36] | Zimbabwe | Qualitative research: in-depth semi-structured interviews | Six health service providers working in different facilities in Harare, Zimbabwe | We utilise positioning theory to show how the ways in which Zimbabwean health service providers’ position women and themselves are rooted in cultural and social power relations | The analysis reveals stigmatization of women who have abortions, portrayed as norm violators, while healthcare providers frame abortion as morally wrong and socially unacceptable, positioning themselves as experts and protectors of cultural values | 80 |
13 | Metusela, C. et al. 2017 [32] | Sydney, Australia, and Vancouver, Canada | Qualitative study: individual interviews, and focus groups | migrant and refugee women from Afghanistan, Iraq, Somalia, South Sudan, Sudan, India, Sri Lanka and South America participated in the study | to examine constructions and experiences of SRH in non-English-speaking migrant and refugee women, across a range of cultural groups | The study underscores the need for culturally safe sexual and reproductive health (SRH) education and services for migrant and refugee women post-resettlement to address barriers to access and adverse SRH outcomes influenced by taboos around menstruation and sexuality | 90 |
14 | Belay, A.D. et al. 2016 [37] | South Ethiopia | cross-sectional study: structured and pre-tested questioner | married women in the child bearing age. The women who were living in Mizan city were selected using the simple random sampling method | to assess the impact of women's decision making power on family planning use and its associated factors | The study found that a majority of married women (67.2%) reported increased autonomy in family planning decisions, with key contributing factors including secondary education, government employment, spouses with higher education, and younger age | 100 |
15 | Miani, C. 2021 [38] | 23 European countries | An ecological correlation study | The study utilizes various gender equality indices as the Gender Equity Index, Gender Inequality Index, and Social Institutions and Gender Index | To explore the association between medical abortion ratios and gender equality in Europe | In countries with higher gender equality, medical abortion is more prevalent than surgical, indicating potential influence of women's engagement on abortion methods, emphasizing feminist perspectives in shaping reproductive health policies | 70 |
16 | Farmer, D.B. et al. 2015 [39] | Rwanda | qualitative study interviews | Interviews with randomly selected male and female community members, community health workers, and health facility nurses | To investigate factors that contribute to family planning use, barriers to care, and quality of services from the community perspective | Study participants valued family planning benefits but leaned towards larger families due to cultural influences, while young, unmarried women faced stigma and lacked decision-making power, revealing a misunderstanding of family planning as primarily a woman's responsibility | 90 |
17 | Msoka, A.C. et al. 2019 [40] | Tanzania | Qualitative descriptive approach drawing on four group discussions | 20 purposively selected married women with two or more children | To investigate rural Tanzanian women's perceptions and cultural beliefs of the barriers to family planning services utilization | The study revealed factors impacting family planning, including method usage, cultural beliefs, and male dominance in decision-making, emphasizing the need for educational interventions to challenge myths and religious barriers | 100 |
18 | Amini, E., McCormack, M. 2021 [41] | Iran | a biographical life course approach, | interviews with 30 older Muslim women living in Tehran and Karaj | This article will show concepts of shame, stigma, and pollution are powerful ways of understanding the regulation of cathexis within a patriarchal gender order | In Iran, patriarchal and religious norms restrict women's rights, linking sexuality to shame and stigma, fostering silence and shame in puberty, with severe consequences for deviation from cultural emphasis on virginity and lack of sexual education | 60 |
19 | Kwambai, T.K. et al. 2013 [42] | Kenya | A qualitative study | Eight focus group discussions were conducted with 68 married men between 20–65 years of age in May 2011 | To explore men's perceptions of antenatal and delivery care services and identified factors that facilitated or constrained their involvement | Traditional gender roles often assign pregnancy support to women, viewing men primarily as providers, limiting their participation in reproductive healthcare processes, exacerbated by negative attitudes from healthcare workers and facilities ill equipped for couple involvement | 100 |
20 | Noge, S. et al. 2020 [43] | South Africa | A qualitative descriptive study/interviews/focus group | Mothers who gave birth to a stillborn and midwives | to describe the sociocultural norms contributing to the high number of stillbirths | Traditional norms and the involvement of figures like healers and mother-in-law, combined with social oppression and abusive behaviors, contribute to stillbirths and hinder pregnant women's autonomy in healthcare decisions | 90 |
21 | Bukuluki, P. et al. 2021 [44] | Uganda | cross-sectional survey | individuals from six districts (Amudat, Kaberamaido, Kasese, Moroto, Tororo and Pader) in Uganda | To investigate the factors that influence the social norm access to contraception by adolescent girls in six districts in Uganda | Social norms hinder adolescent girls'contraception access, but support rises with employment and positive attitudes, except in regions with low employment and reliance on less effective methods, barring respondents aged 30–34 | 100 |
22 | Achen, S. et al. 2021 [45] | Uganda | Qualitative methods. In-Depth Interviews, Focus Group Discussions, and Key Informant Interviews | Involving married adolescent girls aged 15–19, elderly women, and key informants | To explore the socio-cultural perceptions of sexuality and their influence on SRH among adolescent Karamojong girls | In Karamoja, cultural norms dictate the sexual and reproductive health (SRH) of adolescent girls, allowing sexual activity both within and as a commitment to marriage. These traditions, combined with societal views of girls as sources of wealth and labor, pressure them into early marriages, negatively influencing their SRH outcomes | 100 |
23 | Mbarushimana, V. et al. 2022 [46] | Rwanda | Qualitative study. semi-structured interviews | 16 purposively selected key informants from public and private institutions in Rwanda | To explore factors that enable or prevent young adolescents from accessing to SRHR information from the perspective of the key informants in Rwanda | The study explores factors affecting young adolescents'access to sexual and reproductive health information, including individual behaviors, parental communication, cultural norms, and societal factors like economic constraints and policy inadequacies, affecting availability and accessibility in both urban and rural settings | 100 |
24 | Sia, D. et al. 2020 [47] | Sub-Saharan Africa | Quantitative study. Cross sectional study | Using country-level panel data from 24 SSA countries. for the period between 2000 and 2016 | To quantify the extent to which country-level trends in HIV incidence in Sub-Saharan Africa were influenced by gender inequalities | The study found a link: as the Gender Inequality Index (GII) improved, HIV incidence decreased in Sub-Saharan Africa. Yet, it noted a troubling association—a one percent increase in GII could mean a 1.6 percent rise in HIV cases, underlining the urgency of addressing gender inequalities in HIV/AIDS prevention | 70 |
25 | White, D.et al. 2013 [48] | Mali | Quantitative study. Cross sectional study Survey | 317 households in two rural districts of central Mali, women who had given birth in the previous year, their husband and their mother-in-law | To understand how intrafamilial power dynamics and the attitudes of women, their husband and their mother-in-law are associated with maternal health practices | Mothers-in-law significantly influenced daughters-in-law's maternal health behaviors, while individual factors like self-efficacy and societal valuation, along with perceptions of health facility quality, independently shaped health behaviors, with husbands'preferences having no notable effect | 80 |
26 | Chandrasekaran, S. et al. 2023 [49] | USA | Qualitative study semi-structured interview | People of reproductive age over 18 that self-identified as Asian American or mixed race including Asian American, Native Hawaiian, and/or Pacific Islander, and had a medication abortion in the US between January 2016 and March 2021 | To fill gaps in research and understand how cultural and community views influence medication abortion access and experiences among AAs | Cultural and community factors deeply shaped participants'identities, especially second-generation individuals, as stigma surrounding sexual and reproductive health limited open family discussions, highlighting the need for culturally competent healthcare and community-centered mental health resources | 100 |
27 | Tesha, J. et al. 2023 [50] | Tanzania | qualitative study in-depth interviews of key informants and Focus Group Discussions | FGDs were conducted, comprised married women and men, unmarried women and men, and adolescent boys and girls aged 15 to 19 years | To explore gender-based enablers and/or barriers that influence women and girls'realization of their sexual and reproductive health and rights in the Simiyu Region of Tanzania | In the Simiyu region, patriarchal norms restrict women's access to reproductive health services, leading to adverse outcomes, exacerbated by male-dominated decision-making, economic disparities, and entrenched traditions, hindering women's autonomy and healthcare access | 100 |
28 | Garrison-Desany, H.M. et al. 2021[51] | Tanzania | Quantitative study multi-stage cluster sampling, stratified by area of residence | 2528 women aged 15–49 in all the sampled households and 1000 men aged 15–49 in area of residence (urban, rural, mixed) within the Simiyu region | To investigate the role of gender power relations within households on women’s health outcomes in Simiyu region, Tanzania | The study identifies significant associations between gender-related factors such as decision-making autonomy and health outcomes, stressing the importance of women's perceived autonomy and advocating for integrating gender considerations into maternal health interventions to address disparities and improve outcomes | 100 |
29 | Zinke-Allmang, A. et al. 2023 [52] | Kenya | Qualitative study Interviews | 16 women, 10 men and 14 key influencers across 7 peri-urban wards in Nairobi, Kenya | to explore the role of key influencers (partners, parents and friends) in women’s FP use and how women anticipate normative reactions or sanctions | Women rely on a network of trusted individuals including parents, partners, friends, and healthcare workers for family planning decisions, while viewing mothers as understanding social risks and offering discreet advice, and aunts as trusted sources for impartial information on family planning benefits and drawbacks | 100 |
30 | Rodrigues, P. et al. 2022 [53] | Ethiopia | Mixed methods approach survey and in depth interview | randomly selected women in four kebeles (n = 120), and key informant interviews with local health experts (n = 5) | To examine possible determinants of women’s fertility preferences in rural southwestern Ethiopia | The study highlights how socio-economic, environmental, and cultural factors shape women's fertility preferences in southwest Ethiopia, noting increased contraceptive use despite challenges like religious constraints and male dominance | 100 |
31 | Yamin, A.E. et al. 2015 [54] | Tanzania, Ethiopia, Malawi, and South Africa | Qualitative study Focus group discussions, and in depth interviews | 115 key informants and 83 stakeholders were interviewed, and 290 people participated in focus group discussions, across settings | Identify gender as a fundamental driver not only of maternal, but also child health, through manifestations of gender inequity in household decision making, labor and caregiving | In African countries like Tanzania, Ethiopia, Malawi, and South Africa, socio-economic challenges hinder women's financial decision-making due to cultural norms, while maternal orphans, particularly girls, face vulnerability, exacerbating gender disparities despite female caregivers'efforts to facilitate children's access to healthcare and education | 100 |
32 | Bazié, F. et al. 2022 [55] | Burkina Faso | Qualitative study in depth interviews | women who reported an abortion in the last 10 years in an initial quantitative survey | to classify women’s abortion care-seeking experiences across the life course and social conditions into typologies using qualitative data | The study explores abortion experiences of 23 women in Burkina Faso, revealing distinct typologies and highlighting impacts of social stigma, economic constraints, and partner involvement across demographics | 100 |
33 | Jordal, M. et al. 2013 [56] | Sri Lanka | Qualitative study semi-structured interviews | unmarried pregnant women or single mothers | To explore and describe how unmarried women facing single motherhood in Sri Lanka handle their situation | The study unveils women's complex challenges with premarital pregnancies, navigating familial dependence, concealing pregnancies to avoid stigma, coping with societal stigma through various strategies, showcasing the interplay between societal expectations, individual agency, and survival instincts | 100 |
34 | Thatte, N. et al. 2016 [57] | Ghana | Quantitative study cross sectional | Ghanaian youth | To assess how perceived barriers differed depending on the service being sought between common services accessed by young people: HIV/STI testing, abortion, and contraception | Key barriers to accessing sexual and reproductive health services varied by type, with gender differences revealing nuanced challenges across demographics and communities, like boys facing religious prohibition for HIV testing and girls fearing social stigma for contraception | 90 |
35 | Tiruneh, F.N. et al. 2017 [58] | Ethiopia | Quantitative study cross sectional | Data from the 2005 and 2011 Ethiopia Demographic and Health Surveys | To assess whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization | Modest improvements in maternal healthcare utilization from 2005 to 2011, alongside positive shifts in attitudes like domestic violence, reflect changing demographic and socioeconomic characteristics, necessitating targeted interventions to address persistent disparities | 70 |
36 | Sougou, N.M. et al. 2020 [59] | Senegal | Propensity score matching (PSM) is a quasi-experimental method | Women aged 15–49 | To analyze the effect of women's autonomy over decision-making regarding their health and access to family planning in Senegal in 2017 | Only 6.26% of women had health-related decision-making autonomy, mostly relying on partners, yet autonomy correlated with a notable 1414.42% reduction in unmet family planning needs, despite no apparent change in modern contraceptive use, indicating a positive impact on family planning outcomes | 60 |
37 | Rizkianti, A. et al. 2020 [60] | Indonesia | Quantitative study cross sectional | Women of reproductive age (15–49 years) who had given birth within one year preceding the survey | To examine the influence of Indonesian women's decision-making within the household regarding the use of maternal health services | The Women's Participation Index correlated with higher antenatal care service utilization but didn't significantly affect skilled birth attendance or facility-based delivery, suggesting other factors. Older age, higher education, and wealth were associated with increased maternal healthcare service usage | 80 |
38 | Tesfa, D. et al. 2022 [61] | Ethiopia | Quantitative study cross sectional | currently married women aged (15–49 years)who are not pregnant and are currently not using family planning preceding five years the survey | To analyze women’s independent decision-making power and determinants of not using contraceptives | Individual and community-level factors influence women's independent contraceptive decision-making, underscoring the need for policies empowering women at both individual and regional levels to enhance their autonomy in reproductive choices | 100 |