A Meta-Analysis of Health System Barriers to Adolescent Sexual and Reproductive Health Service Access for Young People with Disabilities in Freetown's Urban Informal Settlements, Sierra Leone

Adolescents with disabilities in urban informal settlements face considerable challenges in accessing sexual and reproductive health (SRH) services. In Freetown, Sierra Leone, these challenges are exacerbated by a fragile health system. A clear understanding of the specific health system barriers is needed to inform interventions. This meta-analysis aimed to systematically identify, synthesise, and quantify the predominant health system barriers to SRH service access for adolescents with disabilities living in Freetown’s informal settlements. A systematic search of electronic databases and grey literature was conducted. Included studies reported primary data on health system barriers for the target population. Data were extracted using a standardised form. Thematic synthesis was used for qualitative findings, and quantitative data on barrier prevalence were pooled where possible. The synthesis identified four primary health system barrier domains: (1) physical inaccessibility of infrastructure, (2) critical shortages of trained staff and essential commodities, (3) discriminatory attitudes among healthcare providers, and (4) a near-total absence of disability-inclusive SRH information. Pooled analysis indicated that over 80% of participants across studies reported experiencing at least one form of provider stigma or discrimination. Pervasive health system barriers severely restrict SRH service access for adolescents with disabilities in Freetown’s informal settlements. These systemic barriers reflect a failure to mainstream disability inclusion within SRH service delivery. Immediate priorities include mandatory disability sensitivity training for SRH providers, investment in accessible clinic infrastructure, and the co-development of accessible SRH information materials with young people with disabilities. Policy reform should mandate reasonable accommodations within the national SRH framework. adolescent health, sexual and reproductive health, disabilities, health systems, access to healthcare, Sierra Leone This meta-analysis consolidates evidence on health system barriers to SRH access for a marginalised adolescent population in an urban informal settlement context, providing a basis for targeted health system strengthening and policy reform.