# Key Findings
- Increased demand: Humanitarian conditions amplify unintended pregnancies and the need for abortion services.
- Safety gaps: Health system disruptions prevent access to safe care, pushing women toward unsafe alternatives.
- Method risks: Women resort to unsafe methods using traditional substances, detergents, or harmful objects because of legal restrictions, stigma, and limited family planning.
- Care delays: Distance, cost, lack of confidentiality, and fear of legal consequences delay abortion care, resulting in complications.
- Multi‑level barriers: Barriers operate across individual, community, health system, and policy levels, reinforcing inequities.
# Study Overview
This systematic review followed PRISMA guidelines and synthesized evidence from studies across African humanitarian and fragile settings. Searches ran through 15 February 2025, but the review notes limited quantitative synthesis and high heterogeneity among included studies.
# Limitations
- No meta‑analysis was conducted; findings are based on thematic content analysis only.
- Included studies vary in design and quality, introducing heterogeneity.
- Legal and contextual variability across African humanitarian settings may limit generalisability.
- Reliance on MAXQDA‑guided thematic analysis introduces potential interpretive subjectivity.