Grant: Travel Awards - Institute Community Support

The Sustainable Development Goals (SDG) adopted in 2015 by the international community aims at "leaving no one behind" by including all populations in development processes, irrespective of sex, age, wealth, etc. In particular, the SDG on Health promotes universal health coverage in sexual and reproductive health (SRH) in regions where disparities among populations are still high. To contribute to future interventions, we examined the relationships between pro-equity legislation and policy, and the utilisation of SRH services by vulnerable populations in sub-Saharan Africa. Methods: We searched nine bibliographic databases for relevant original studies, conducted and published in English and French between 1994 and 2017. Analysis is ongoing. Results: Among 4,759 initial citations, 49 references were selected. Most research examined user fee exemption policies in maternal health services, while others explored the effects of abortion laws on the uptake of induced abortion and family planning. A few studies examined the utilisation of HIV related services. Initial results suggest that all wealth groups (poor to rich) are benefiting from these measures, however there are differences between concerned populations based on place of residence, education, religion, ethnicity and region. In several studies, the poorest benefited the least from the implementation of pro-equity legislation and policy on SRH. Discussion/conclusion: In spite of the well-intentioned policy and legislative pieces which promote SRH rights and services among vulnerable populations, certain marginalised groups are still excluded. Sub-Saharan Africa is home to the majority of people living with HIV and people with disabilities. Yet their absence in these initial findings is striking. The study of the intersection of law, policy and health service utilisation must go beyond removing policy and financial barriers, and urgently address social health determinants at population and health system levels.