Accessibility and barriers to maternal health services for adolescents in Sub-Saharan Africa: a scoping review

Abstract

Background Globally, adolescent girls aged 15–19 years give birth to approximately 16 million children annually, accounting for 11% of all births. Low- and middle-income nations carry the burden of these births, with 95% happening in Africa, where maternal mortality rates continue to be high. In Sub-Saharan Africa, early marriages persist, with roughly half of women delivering before age 20. Objectives This scoping review aimed to map evidence on the accessibility and barriers to maternal health services for adolescent girls in Sub-Saharan Africa. Eligibility criteria Included studies were peer-reviewed articles published in English between 2014 and 2025, focusing on adolescent girls (10–19 years) and maternal health services in Sub-Saharan Africa. Sources of evidence Literature searches were conducted in PubMed, Scopus, Web of Science, Directory of Open Access Journals and Google Scholar. Charting methods The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 Scoping Review extension guidelines. Data were extracted using a pre-designed template and analysed thematically. Results were synthesized narratively and presented in tables. Results A total of 652 records were identified, with 26 articles included. Key findings indicate that financial constraints, stigma, geographical distance and restrictive policies are significant barriers to access. While most studies focused on accessibility, aspects of quality such as provider attitudes, adherence to guidelines and respectful care were less frequently and deeply explored, representing a significant evidence gap. Community-based programmes and youth-friendly services were identified as key facilitators. Unmarried adolescents and those with lower education levels faced compounded barriers. Conclusion Given their reproductive health vulnerabilities, maternal health services targeting adolescents should be prioritized in Sub-Saharan Africa. Interventions must address both access barriers and critically improve service quality, including provider training in adolescent-sensitive care, though the current evidence base on quality-specific interventions is limited. Further research is needed to develop standardized metrics for quality care in this population.