A Systematic Review of Livelihood Interventions and Sexual and Reproductive Health Agency Among Young Women Engaged in Transactional Sex in Kampala, Uganda

Transactional sex is a significant livelihood strategy for many young women in Kampala, Uganda, exposing them to heightened risks of poor sexual and reproductive health (SRH) outcomes. Livelihood interventions have been implemented to address economic vulnerability, but their specific impact on SRH agency within this population remains unclear. This systematic review aimed to synthesise evidence on the effects of livelihood interventions on the sexual and reproductive health agency of young women engaged in transactional sex in Kampala, Uganda. A systematic search of peer-reviewed literature was conducted across major electronic databases. Studies were included if they evaluated a livelihood intervention and measured SRH agency outcomes among young women in transactional sex in Kampala. Standard systematic review procedures for screening, data extraction, and quality assessment were followed. Of the initially identified records, only three studies met the full inclusion criteria. The limited evidence suggested a potential positive association between combined economic empowerment and psychosocial support interventions and increased condom negotiation self-efficacy. However, no study demonstrated a direct, significant effect on broader SRH agency metrics, such as autonomous decision-making or reduced transactional sex engagements. The evidence base on the impact of livelihood interventions on SRH agency for this specific population in Kampala is extremely limited. The available studies are insufficient to draw definitive conclusions about effectiveness. Future research should employ robust, mixed-methods designs with standardised measures of SRH agency. Programmes should integrate tailored SRH education and empowerment components within livelihood initiatives and prioritise participatory approaches to address the complex drivers of transactional sex. Transactional sex, livelihoods, sexual and reproductive health, agency, young women, Uganda, systematic review This review consolidates the scarce existing evidence and highlights a critical gap in knowledge, providing clear directions for future research and programme design aimed at enhancing SRH outcomes for a vulnerable population.