INTRODUCTION:
Armed conflict disproportionately affects Africa, often driven by insurgent groups that seize control of subnational regions. Women and girls in these settings face severe sexual and reproductive health (SRH) consequences due to restricted access to essential services. This umbrella review synthesizes current evidence on the political, institutional, economic, and cultural barriers that limit SRH service utilization in conflict-affected areas of sub-Saharan Africa.

METHODS:
A qualitative evidence synthesis approach was used to analyze ten peer-reviewed articles that examined SRH access barriers in conflict-affected settings. Eligible studies were identified through academic databases and met predetermined inclusion criteria. Data were extracted and coded to identify recurring themes across countries. This review intentionally focused on qualitative evidence to capture lived experiences, and contextual factors influencing SRH access.

RESULTS:
Findings revealed a multifaceted set of barriers that interact to exacerbate limited SRH access during conflict. Armed conflict intensifies existing structural inequities through the destruction of health facilities, reduced health workforce capacity, economic collapse, and widespread displacement. Cultural norms, stigma, and patriarchal systems further restrict women and girls’ autonomy in seeking SRH services. Across the studies, humanitarian organizations were identified as primary providers of emergency SRH care; however, reliance on external actors limits long-term sustainability and fails to strengthen national health systems. Only one study addressed post-conflict recovery efforts, revealing a major evidence gap related to long-term resilience of SRH systems.

CONCLUSIONS:
This review underscores the urgent need for sustained political commitment and resilient health systems capable of delivering SRH services during both conflict and recovery. Two key recommendations emerge: expanding research in post-conflict contexts to guide long-term rebuilding strategies, and establishing government-operated mobile health units to maintain continuity of care when fixed facilities are compromised. Implementing these measures can strengthen preparedness, reduce inequities, and improve SRH outcomes for women and girls across sub-Saharan Africa.