Advancing sexual and reproductive health and rights in Africa

Sexual and reproductive health and rights (SRHR) are fundamental yet inadequately realized across Africa, undermining well-being, economic stability, and autonomy. This editorial synthesizes findings from 24 studies in a special collection, highlighting persistent challenges and innovative solutions. Key issues in family planning include low contraceptive uptake and discontinuation, particularly among women with HIV and adolescents, exacerbated by social pressures and systemic exclusion of marginalized groups like LGBTQ+ individuals and persons with disabilities. For comprehensive abortion care, access to quality post-abortion services remains low, though provider training shows promise for improving skills. Systemic inequities are evident in limited pre-exposure prophylaxis awareness, HIV-related fertility disparities, and high rates of gender-based violence (GBV), which is linked to adverse outcomes like repeat adolescent pregnancies. Evidence underscores that fragmented interventions fail; progress requires integrated, community-driven approaches. This includes combining HIV, mental health, and family planning services, empowering communities through peer-led networks, and implementing robust accountability mechanisms. Prioritizing the needs of marginalized populations-including adolescents, GBV survivors, and persons with disabilities-through inclusive policies, sustainable financing, and multi-level interventions is essential to building equitable SRHR systems that leave no one behind.