Reproductive and Sexual Health Rights (Srhr) In Developing Countries: A Systematic Review
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Abstract
Sexual and reproductive health and rights (SRHR) remain a critical global public health challenge, particularly in low- and middle-income countries where disparities in access, utilization, and outcomes continue to persist. Despite growing research output, the evidence base remains fragmented across populations, settings, and outcome domains, limiting its utility for policy and programmatic decision-making. This systematic review therefore aimed to synthesize available evidence on SRHR outcomes, appraise study characteristics and methodological quality, and examine heterogeneity and certainty of evidence across included studies. A systematic review and meta-analytic approach were employed to identify and synthesize empirical studies on SRHR across diverse populations and contexts in developing countries. Eligible studies included cross-sectional, cohort, qualitative, observational, survey, and intervention designs. Data were extracted on study characteristics, target populations, outcome domains, and methodological quality. Risk of bias was assessed across selection, measurement, confounding, and outcome assessment domains. Heterogeneity was quantified using the I² statistic, while meta-regression analyses were conducted to identify potential sources of variability. Findings indicate that cross-sectional studies dominated the evidence base (47.4%), followed by qualitative studies (26.3%) and cohort designs (15.8%). Adolescents
(44.7%) and women (36.8%) were the most frequently studied populations. Sexual behaviour (18.4%), SRHR service access (15.8%), and contraceptive use (13.2%) were the most reported outcomes, whereas health equity remained the least examined domain (5.3%). Overall heterogeneity was moderate (I² = 65%), with substantial variability observed in contraceptive use (72.6%), sexual behaviour (69.7%), and SRHR access (65.1%). Rural settings exhibited higher heterogeneity (I² = 69%) compared with urban settings (I² = 57%). Risk of bias was predominantly moderate, with confounding control identified as the principal limitation. Certainty of evidence was generally moderate, high for HIV/STI outcomes, and low for gender-based violence domains. Meta-regression revealed significant associations with publication year, sample size, geographic region, study quality, and setting (p < 0.05). Finally, the SRHR evidence base is methodologically moderate but highly heterogeneous, with notable gaps in equity-focused, intervention, and structural determinant research, which are suggested areas for further studies.
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