Unmet need for family planning among reproductive-age women living with HIV in Africa: a systematic review and meta-analysis

Unmet need for family planning remains a major challenge worldwide, particularly in Africa, contributing to unintended pregnancies, unsafe abortions, and increased maternal morbidity and mortality. Reducing the unmet need is paramount in improving maternal and newborn health, reducing unintended pregnancies, and preventing mother-to-child transmission of HIV. In Africa, many women living with HIV continue to experience unmet need for family planning, and existing studies in the region report highly inconsistent findings. Thus, this study aimed to estimate the combined prevalence of unmet need for family planning and to determine the associated factors among women living with HIV in Africa. Primary studies in this systematic review and meta-analysis were retrieved through comprehensive searches in PubMed, ScienceDirect, Research4Life, and Google Scholar. The Joanna Briggs Institute quality assessment tool was used to check the quality of each study. STATA version 17 statistical software was applied to analyze the pooled prevalence of unmet need for family planning. The I-squared (I2) statistic was employed to check statistical heterogeneity among the included studies, and publication bias was evaluated using a funnel plot and Egger’s test. A random-effects model was used to estimate the overall prevalence and associated factors of unmet family planning needs. A total of 40 primary studies with 22,914 study participants were included in this review. The pooled prevalence of unmet need for family planning among women living with HIV in Africa was 29.26% (95% CI: 25.54–32.99). The unmet need was associated with younger age, rural residence, having a living child, and unknown partner HIV status. Additionally, women with no formal education, those who did not receive contraceptive counseling, inadequate knowledge of maternal and child health, unfavorable attitudes toward family planning, and shorter duration on antiretroviral therapy had higher odds of unmet need for family planning. This meta-analysis reveals that nearly one in three women living with HIV experiences unmet need for family planning. Strengthening the integration of reproductive health programs and HIV services and addressing the identified barriers are essential to reduce the unmet need and improve maternal health. The protocol for this systematic review was registered in PROSPERO (Registration Number: CRD420251125860).