The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review

• Published in: Journal of urban health Vol. 100; no. 3; pp. 525 - 561
• Main Authors: Akwara, Elsie, Pinchoff, Jessie, Abularrage, Tara, White, Corinne, Ngo, Thoai D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2023; Springer Nature B.V
• Subjects: Critical components; Developing countries; Epidemiology; Family planning; Health Informatics; Heterogeneity; HIV; Human immunodeficiency virus; Humans; LDCs; Literature reviews; Medicine; Medicine & Public Health; Neighborhoods; Norms; Populations; Poverty; Public Health; Reproductive Health; Reproductive Health Services; Reproductive Rights; Review; Right to Health; Sexual Behavior; Sexual health; Sexually transmitted diseases; Social behavior; STD; Urban areas; Urban environments; Urban populations; Sexual and reproductive health and rights; Urban; Poverty
• ISSN: 1099-3460; 1468-2869
• DOI: 10.1007/s11524-023-00724-z

By 2050, the Global South will contain three-quarters of the world’s urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010–2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (
n
 = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.