Knowledge–access–outcome gap in sexual and reproductive health among adolescents with disabilities in sub‐Saharan Africa: A scoping review with framework synthesis

The aim of this review is to synthesize and map existing evidence on sexual and reproductive health (SRH) knowledge, behaviors, and service access among adolescents with disabilities in low‐ and middle‐income countries, with particular focus on sub‐Saharan Africa, and to examine the gap between knowledge, contraceptive access and health outcomes. Following the Arksey and O'Malley framework and the refinements by Levac and others, and reported per PRISMA‐ScR guidelines, six databases were searched (MEDLINE/PubMed, EMBASE, Global Health, CINAHL, PsycINFO, Google Scholar) plus gray literature from WHO, UNFPA and UNICEF. Studies published between 2000 and 2024 reporting original SRH data on adolescents with disabilities aged 10–24 years were eligible. Data were synthesized using framework synthesis anchored to the knowledge–access–outcome gap framework. Forty‐three studies met the inclusion criteria. A central paradox emerged where 60%–70% of adolescents with disabilities demonstrated good SRH knowledge, yet contraceptive access remained critically low and unsafe sexual practices were prevalent. Three barrier clusters were identified as individual‐level (stigma, shame, communication barriers), institutional‐level (non‐inclusive facilities, inadequate teacher training), and structural‐level barriers (poverty, discriminatory policies, provider attitudes). Adolescents with visual impairments consistently demonstrated superior knowledge, and coercive sexual experiences were disproportionately reported among females. SRH knowledge alone is insufficient without concurrent improvements in access infrastructure. Urgent action is needed from WHO, Ghana Health Service, and analogous bodies, encompassing disability‐inclusive curricula, disability‐competent provider training and removal of structural contraceptive barriers. Future research should prioritize longitudinal and participatory methodologies.