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

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.

Automated summary

Women's agency is crucial for accessing and utilizing reproductive healthcare services, especially in societies with patriarchal beliefs and cultural norms that hinder women's decision-making ability and resource access. This study conducted a comprehensive systematic review to summarize the determinants of women's agency in accessing and using reproductive healthcare services. Various determinants were identified such as individual characteristics, household structure, reproductive health-related factors, social relations, and economic factors. These determinants were strongly influenced by social norms and cultural beliefs. However, there were gaps in the literature including inconsistent definitions and measurements of women's agency, lack of consideration for cultural sensitivities, and limited focus on services beyond pregnancy and birth. Moreover, the literature primarily focused on developing countries in Africa and Asia, leaving a significant knowledge gap regarding women's agency to access services in other geographic areas or among immigrant and refugee populations in developed countries.