Publications Publication soutenue par l'axe PPSP : Pro-equity legislation, health policy and utilisation of sexual and reproductive health services by vulnerable populations in sub-Saharan Africa: a systematic review


Une publication de Muriel Mac-Seing et collègues disponible en accès libre grâce au soutien du RRSPQ et de l'axe Politiques publiques et santé des populations (Concours de soutien à la publication 2019-2020). 

A publication by Muriel Mac-Seing and colleaguee - open access online thanks to the Network financial support (2019-2020 Support for scientific publications competition).


Muriel Mac-Seing, Kate Zinszer, Charity Oga Omenka,  Pierre de Beaudrap, Fereshteh Mehrabi and Christina Zarowsk

Authors' Abstract

Twenty-five years ago, the International Conference on Population and Development  highlighted the need to address sexual and reproductive health (SRH) rights on a global scale. The sub-Saharan Africa region continues to have the highest levels of maternal mortality and HIV,  primarily affecting the most vulnerable populations. Recognising the critical role of policy in  understanding population health, we conducted a systematic review of original primary research  which examined the relationships between equity-focused legislation and policy and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. We searched nine bibliographic  databases for relevant articles published between 1994 and 2019. Thirty-two studies, conducted in 14 sub-Saharan African countries, met the inclusion criteria. They focused on maternal health service utilisation, either through specific fee reduction/removal policies, or through healthcare reforms and insurance schemes to increase SRH service utilisation. Findings across most of the studies showed that health-related legislation and policy promoted an increase in service utilisation, over time,  especially for antenatal care, skilled birth attendance and facility-based delivery. However, social  health inequalities persisted among subgroups of women. Neither the reviewed studies nor the  policies specifically addressed youth, people living with HIV and people with disabilities. In the era of the sustainable development goals, addressing health inequities in the context of social determinants of health becomes unavoidable. Systematic and rigorous quantitative and qualitative research,  including longitudinal policy evaluation, is required to understand the complex relationships between policy addressing upstream social determinants of health and health service utilisation.