An ecological model of barriers to accessing care for pregnancy resulting from sexual violence: a rapid review

It is estimated that 30% of women globally have experienced sexual violence (SV) and many of these cases result in sexual violence related pregnancies (SVRP). Social and structural inequities may impact access to reproductive healthcare for those who become pregnant as a result of SV. Using Bronfenbrenner’s Bioecological Systems Theory as an organizing framework, we conducted a rapid review to identify barriers to accessing reproductive healthcare after SV. We reviewed studies published between 2010 and 2024, synthesizing results from PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Educational Resources Information Center (ERIC), Scopus, Global Health, and Embase. A total of 15 studies met the following inclusion criteria: (a) published in a peer-reviewed journal between January 2010 and February 2024, (b) written in English, and (c) evaluated barriers to reproductive healthcare services and resources for people who become pregnant as a result of SV. Study populations were located both within and outside the US. The primary barriers identified included: lack of access to care, lack of provider training in trauma-informed care, fear of stigmatization, victim blaming, internalized shame, and retaliation. This review can be used to understand specific barriers to reproductive healthcare for those who have experienced SV and the level or levels at which they are functioning. These findings can be used to tailor reproductive health policy, training, and community-based interventions aimed at mitigating and/or eliminating these barriers.