The Informal Healthcare Sector in Urban Guinea-Bissau: A Scoping Review of Gynaecological and Obstetric Practices

In urban African settings, the informal healthcare sector is a primary source of gynaecological and obstetric care. In Guinea-Bissau, where formal health systems face substantial challenges, a comprehensive synthesis of informal sector practices is absent. Understanding this sector is critical for public health planning and improving maternal health outcomes. This scoping review aimed to map and synthesise existing literature on the role, practices, and characteristics of the informal healthcare sector in providing gynaecological and obstetric services in urban Guinea-Bissau. A scoping review methodology was employed. Peer-reviewed and grey literature were systematically identified, screened, and selected. Data were charted and analysed thematically to address the review objectives. The review identified a significant reliance on informal providers, including traditional birth attendants, herbalists, and informal drug vendors. A prominent theme was the concurrent use of informal and formal services. Practices were influenced by cost, accessibility, and cultural beliefs. However, concerns regarding safety, variable practices, and a lack of regulation were consistently reported across the literature. The informal healthcare sector is an integral yet under-regulated component of the urban healthcare ecosystem for women's health in Guinea-Bissau. It operates in parallel with formal services, filling critical access gaps but also presenting documented risks. Future research should employ robust primary methodologies. Policy initiatives must engage with informal providers to develop collaborative, training, and referral frameworks that prioritise patient safety without undermining a vital community resource. informal healthcare, maternal health, traditional birth attendants, urban health, Guinea-Bissau, scoping review This review provides the first consolidated synthesis of evidence on informal gynaecological and obstetric care in urban Guinea-Bissau, establishing a foundation for future research and informed policy dialogue.