A Systematic Review of Health System Barriers to Safe Abortion Access for Women Living with HIV in Ethiopia: An African Perspective (2021–2026)

This systematic literature review synthesises evidence from 2021 to 2026 to examine the health system barriers impeding safe abortion access for women living with HIV (WLHIV) in Ethiopia. Despite a liberalised legal framework, intersecting stigmas exacerbate health risks for this population. Adhering to the PRISMA framework, we systematically searched five electronic databases (PubMed, Scopus, CINAHL, AJOL, and Global Health) and relevant grey literature. Following rigorous screening and quality assessment, 18 studies met the inclusion criteria and were analysed using a thematic synthesis approach. The analysis identifies interconnected, multi-level barriers: pervasive stigma and discrimination from providers, who often conflate abortion with HIV status; fragmented service integration, necessitating navigation of separate clinics; critical shortages of trained personnel and essential medical commodities, particularly in primary care settings; and widespread misinformation regarding legal provisions among both clients and staff. These systemic failures collectively drive WLHIV towards unsafe alternatives, compounding their health vulnerabilities. The review underscores an urgent need for structural interventions within Ethiopia and similar contexts. Primary recommendations include mandating comprehensive, rights-based provider training, formally integrating sexual and reproductive health services with HIV care, strengthening supply chains for essential commodities, and implementing community sensitisation programmes to counteract dual stigmas. Addressing these barriers is fundamental to achieving equitable sexual and reproductive health outcomes for this marginalised group.