Barriers and facilitators to contraception access for South Asian women in high-income, English-speaking countries: a systematic review

BACKGROUND: Access to high quality contraception care and related information can enable women to exercise their reproductive autonomy and is commonly delivered in primary care. However, populations such as migrant women may face additional barriers to accessing contraception care. This systematic review aimed to establish evidence on the barriers and facilitators to accessing contraception information and care for South Asian women living in high-income, English-speaking countries. METHODS: The five databases, Ovid-Medline, Embase, Scopus, PsycINFO, CINAHL were systematically searched for relevant literature up to July 2024. Following PRISMA guidelines, two independent reviewers screened all titles and abstracts and full text data for relevant studies. The quality of each included study was appraised using the KMET Standard Quality Assessment Criteria for Evaluating Primary Research framework tool. Following data extraction, a narrative synthesis was used to report the findings about contraception use and the barriers and facilitators of contraception access. RESULTS: Of 3541 records, eleven studies were identified, six followed qualitative methodology and five followed quantitative methodology. The included studies were set in the United Kingdom and The United States of America and included South Asian women from India, Pakistan, Bangladesh or Sri Lanka. The barriers to accessing contraception identified by the studies centred around, culturally informed beliefs about the unacceptability of contraception, a lack of information and the obstacles in the delivery of care. The availability of formal information provision through schooling and from trusted primary healthcare providers were reported as the most beneficial factors in enabling women to make informed contraception choices. CONCLUSION: This review highlights the persistence of barriers to accessing contraception information and care for South Asian women in high-income, English-speaking countries. The facilitators uncovered by the included studies highlight how access to contraception could be improved for South Asian women through the provision of accurate information and the delivery of culturally informed contraception care in primary care settings. This could ultimately promote women's ability to make informed decisions on contraception use that align with their reproductive intentions.