A qualitative systematic review of the sociocultural barriers accessing ART experienced among subfertile women across Africa and Europe

Background In many countries across Sub-Saharan Africa and Europe, women with subfertility search relentlessly for treatment. However, few studies consider how the experience of subfertility and accessing Assisted Reproductive Technology (ART) is formed by their social positions. Effective strategies that address sociocultural barriers to ART are required to mitigate its potential long-term physical, financial and psychological effects in order to inform the design of more inclusive as well as supportive interventions. Methods Databases representing the disciplines of medicine, nursing and social sciences as well as grey literature were searched for English language citations from 1978 to 02 October 2025 using keywords related to infertility, Europe and Africa. Results Of 493 citations identified, 11 qualitative papers being included. Most of the studies (73%) were conducted in Nigeria, Ghana, The Gambia, Mozambique and Botswana. Sociocultural aspects explored include factors associated with religious and cultural proscriptions, such as spirituality, medical pluralism and adoption and fostering. Factors related to social strain include marital strain and social support. The complex health seeking behaviours of women revealed they sought biomedical and holistic treatment as well as help from religious places of worship. Although treatment choice was related to the perceived aetiology of subfertility, it was also influenced by beliefs, family and social networks. Those from a lower socioeconomic background who faced barriers to treatment were also more likely to be confronted with intimate partner violence. Conclusion By highlighting how in particular scenarios, certain groups experience greater psychosocial barriers accessing ART and thus are more vulnerable than others, an intersectional approach that informs public health strategies and social policy may be promoted. Health authorities may need to further invest in working with organisations, like the British Fertility Society, to provide information and counselling on issues related to infertility prevention and treatment. The availability of locally applicable guidelines for infertility management at all levels of the health system would facilitate such steps to better integrate care and widen engagement.