Exploring the Barriers and Challenges in Delivering SRHR Services to Adolescent Girls in Fragile Settings : An integrative review

Sammanfattning

Background: In fragile settings, gender inequalities and the risk of gender-based violence are exacerbated, particularly for vulnerable groups such as adolescent girls. In these contexts, Sexual and Reproductive Health and Rights (SRHR) programs face significant barriers, including restrictive socio-cultural norms and unstable living conditions that must be addressed and require targeted interventions. Aim: This thesis synthesises evidence on barriers affecting adolescent girls’ access to SRHR services in fragile settings and identifies strategies to improve service responsiveness. Methodology: An integrative review of 14 systematically selected studies from PubMed, CINAHL, and Scopus was conducted using the SPIDER framework and appraised with JBI tools. A semi-deductive approach guided by Bronfenbrenner’s Ecological Systems Theory was applied. Results: Guided by Bronfenbrenner’s Ecological Systems Theory, the review identified multi-level and interconnected barriers across the microsystem, mesosystem, exosystem, macrosystem, and chronosystem. The barriers to access SRHR services included service availability, policy constraints, sociocultural norms, as well as the dynamics of displacement. Conclusion: Adolescent girls in fragile settings face interconnected barriers to accessing SRHR services across multiple levels of their environment. Limited health system capacity, weak coordination, and restrictive gender norms jointly hinder access. Improving services requires integrated, gender-sensitive, and participatory approaches that strengthen health systems, address stigma, and respond to the complex realities of fragile contexts.