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Afghan refugee women face significant barriers to sexual and reproductive health services in PakistanBarriers and high illiteracy rates impact maternal health for refugees

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Key Takeaway
Recognize that high illiteracy and structural barriers significantly hinder SRH access for Afghan refugee women.

This systematic review synthesizes 21 studies regarding the experiences, knowledge, and challenges faced by Afghan refugee women in Pakistan when accessing sexual and reproductive health (SRH) services. The scope includes an analysis of maternal welfare, contraceptive knowledge, and barriers such as distance, cost, and stigma.

The synthesis highlights significant systemic hurdles for this population. Specifically, 67% of maternal deaths were deemed preventable, and 81% of women who died from maternal-related causes faced barriers to care. A high illiteracy rate of 93.3% was reported among the studied population, which impacts awareness of pregnancy risks.

The authors note several limitations in the current evidence base. Few studies examined the effects of long-term SRH interventions, and only one study analyzed resilience and self-agency in the face of structural oppression. These findings highlight critical gaps in research regarding barriers like cost, stigma, and lack of education for women of reproductive age among Afghan refugees.

How this fits prior evidence

This systematic review addresses a gap in understanding the social and structural determinants of health for refugee populations. While prior coverage focused on biological factors such as virome and mycobiome roles in female reproductive tract health as potential ecosystem modulators, this evidence highlights how external barriers like 93.3% illiteracy and systemic obstacles impact maternal outcomes.

Imagine trying to care for a child or manage your own health while facing constant hurdles like high costs, long travel distances, and social stigma. For many Afghan refugee women in Pakistan, these are not just inconveniences; they are life-threatening barriers to basic medical care.

A review of 21 studies highlights the harsh reality of this situation. The data shows that 67% of maternal deaths in this group were considered preventable. Even more concerning, 81% of those who died from maternal causes faced significant obstacles when trying to get help. These women often struggle with a lack of information about birth control and other essential services.

The findings also point to a massive education gap. The illiteracy rate among these women is 93.3%. This makes it much harder for them to understand pregnancy risks or navigate complex healthcare systems. While the research shows clear systemic gaps, there is still very little information available on how long-term programs can help these women build resilience against such heavy obstacles.

What this means for you:
High illiteracy and social barriers like cost and stigma make it harder for refugee women to access life-saving care.

Common questions

What are the main barriers to care for these women?

Women face several major hurdles when trying to access reproductive health services. These include the high cost of care, long distances to clinics, and social stigma. These factors make it very difficult for them to get the medical help they need for maternal welfare.

How does education affect health outcomes in this group?

Education is a major factor because the illiteracy rate in this population is 93.3%. This high level of illiteracy makes it harder for women to understand pregnancy risks and find information about medical and pharmaceutical contraceptives.

How many maternal deaths were preventable?

The data shows that 67% of maternal deaths in this population were considered preventable. Additionally, 81% of the women who died from maternal-related causes faced specific barriers when trying to access care.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJul 2026
View Original Abstract ↓
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. 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. 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. 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. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577910, PROSPERO CRD42024577910.
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