Abstract

Background: - Access to sexual and reproductive healthcare for adolescents is often overlooked in Sub-Saharan Africa due to different barriers. However, there is a high shortage of synthesized research evidence in the region. This study aimed to identify social-ecological barriers to adolescents' sexual and reproductive healthcare access and utilization in Sub-Saharan Africa.    Methods: - A systematic review and synthesis of qualitative studies conducted in SSA was conducted.  The PRISMA and scoping review methodological framework were used to conduct a comprehensive literature search. Peer-reviewed and published articles in between 2012 and 2021 from four electronic databases were included in the study. The identified results (barriers) are structured following the socio-ecological framework. Enhancing Transparency in Reporting the Synthesis of Qualitative Research was used to report synthesis of included studies.

Results: A total of 4854 articles were identified through a database search and an additional 36 studies from other sources. After the full-text screening, 28 qualitative articles were met the inclusion criteria and were included in the review. The finding of this systematic review show that like any regions of the world, adolescents in Sub-Saharan Africa faced multiple levels like, limited knowledge of adolescents about sexual and reproductive health services and information, adolescents fear of being recognized by others, adolescents perception towards SRH services, attitudes and beliefs about SRH services use, adolescents low self-esteem and financial constraints,  lack of parental support, community stigma and bad attitude for those adolescents who access and utilized SRH services, negative attitude of healthcare workers towards adolescents, disrespect, disappointing and discrimination of adolescents, judgmental attitude of health workers were the main barriers identified  access and utilization of SRH services by adolescents in Sub-Saharan Africa.   Conclusion: Individual, interpersonal, organizational, community, and societal-level barriers are hindering the access and utilization of SRH services by adolescents in the Sub-Saharan Africa.  Designing and implementing multipronged preventive and primitive activities by governmental and non-governmental organizations are recommended.

Keywords: - Systematic review; Adolescents; sexual and reproductive health services; barriers; sub-Saharan Africa