Determinants of women’s agency in accessing and utilising reproductive healthcare services; a systematic review

Abstract

Women’s agency is vital to access and use reproductive healthcare services, particularly in contexts where patriarchal beliefs and cultural norms limit women’s desire to act on their goals or affect their access to essential resources. However, less is known about what resources enable women to exercise agency to access these services. A comprehensive systematic review was conducted to summarise existing evidence on the determinants of women’s agency in accessing and using reproductive healthcare services. Various determinants were identified, including individual characteristics; household structure; reproductive health-related determinants; social relations; and economic factors. These determinants of women’s agency in accessing reproductive healthcare services were strongly associated with social norms and cultural beliefs. Several gaps in the literature included inconsistent definitions and measurement of women’s agency; lack of considering cultural sensitivities and socially acceptable practices in the conceptualisation and measurement of women’s agency; a narrow focus on services related predominantly to pregnancy and birth, with other aspects of services including sexual health and safe abortion being largely unreported. The literature focused on developing countries in Africa and Asia, leaving a significant gap in knowledge about women’s agency to access services in other geographical areas or among immigrant or refugee populations living in developed countries.

Keywords:

• Social norms
• cultural beliefs
• reproductive healthcare services
• women’s agency
• determinants

Acknowledgements

We thank Roya Balaghi Inanloo who assisted in screening titles and abstracts.

Disclosure statement

None.

Additional information

Funding

The first author was supported by a doctoral scholarship from Macquarie University, Sydney, Australia. We acknowledge the following sources of funding: GNT, the NHMRC Partnership Centre for Health System Sustainability (ID9100002).