Peer-reviewed article
Sexual and reproductive health and maternal welfare among Afghan refugee women in Pakistan: a systematic review.
Rotondi E, Sayeeda RJ, Ching C, Flynn D, Preston C et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review synthesizes evidence from 21 studies on sexual and reproductive health and maternal welfare among Afghan refugee women in Pakistan. Afghan refugee women face significant barriers to accessing healthcare services, including distance, cost, stigma, and inadequate education about reproductive health. The review finds that 67% of maternal deaths were preventable and 81% of women who died from pregnancy-related causes faced barriers to care. High illiteracy rates (93.3%) contribute to difficulties accessing information about pregnancy risks. The review identifies gaps in research on long-term interventions and women's resilience in this population.
Key points
- 67% of maternal deaths among Afghan refugee women in Pakistan were deemed preventable
- 81% of women who died from maternal-related causes faced barriers to accessing care
- Afghan refugee women report limited knowledge about medical and pharmaceutical contraceptives and reproductive tract infections
- High illiteracy rate of 93.3% among this population contributes to difficulties accessing educational materials about pregnancy risk factors
- Major barriers to healthcare access include distance, cost, stigma, and inadequate sexual and reproductive health education
Limitations
This is a systematic review that synthesizes existing studies rather than conducting new research, so it reflects the limitations of the primary studies included. The review identifies a significant research gap, noting that few studies examined long-term SRH interventions and only one study analyzed how Afghan women exhibit resilience and self-agency.
Abstract
Introduction Women and children make up over 70% of Afghan refugees worldwide. Sexual and reproductive health (SRH) is essential for overall well-being, yet Afghan refugee women living in Pakistan face significant barriers to accessing health services. Limited access to this care contributes to numerous negative health outcomes and can have potentially lasting effects on subsequent generations. This review synthesizes evidence on the experiences, knowledge, and challenges faced by Afghan refugee women in accessing SRH services, focusing on maternal welfare. Materials and methods Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this systematic review includes qualitative, quantitative, and mixed-methods studies from January 2000 to January 2026. Searches were conducted in databases including Boston University Online Library Database, PubMed, Science Direct, Web of Science, Embase, and EBSCOhost. Two authors independently screened titles, abstracts, and full-texts followed by completing data extraction. The quality of the study was assessed using the Mixed Methods Appraisal Tool. Results The search yielded 679 initial search results, of which 21 studies met the inclusion criteria. Findings highlight a lack of education and awareness regarding medical and pharmaceutical contraceptives and reproductive tract infections. Afghan refugee women were found to face significant barriers to accessing healthcare, including distance, cost, stigma, and inadequate SRH education. 67% of maternal deaths were deemed preventable, and 81% of women who died from maternal-related causes faced barriers to accessing care. This population group experiences a high rate of illiteracy (93.3%), which contributes to difficulties accessing educational materials about pregnancy risk factors, leading to increased instances of pregnancy loss. Few studies examined the effects of long-term SRH interventions, and only one study analyzed how Afghan women in Pakistan exhibit resilience and self-agency in the face of structural oppression. Conclusion This review identified key areas of limited research on SRH services and maternal welfare for commonly overlooked demographics within Afghan refugees in Pakistan, such as women of reproductive age. While maternal health outcomes of Afghan refugees have improved since 2000, women still face limited access to essential SRH services, ultimately impacting their well-being and that of future generations. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577910, PROSPERO CRD42024577910.