Social norms, culture, and religious factors influencing sexual and reproductive health in low -middle-income countries: A scoping review protocol

Social norms, culture, and religious factors influencing sexual and reproductive health in low -middle-income countries: A scoping review protocol | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Social norms, culture, and religious factors influencing sexual and reproductive health in low -middle-income countries: A scoping review protocol Dr Deepika K, M Lekhna, Sneha Singh, Dr Denny John This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6896809/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective The objective of this scoping review will be to identify and map various perspectives on social norms, culture, and religious factors, influencing sexual and reproductive health in low- and middle-income countries (LMICs). Introduction Good sexual and reproductive health (SRH) is a state of complete physical, mental, and social well-being in all matters related to the reproductive systems. Key components of SRH include: access to accurate information, understanding unprotected sex risks, healthcare access, and a supportive environment. Various social norms, culture, and religion contributes to gender inequality, significantly influencing sexual knowledge and practices, among reproductive age groups thus impacting their health. Inclusion criteria This review will include all studies on social, cultural, and religious factors influencing sexual and reproductive health in LMICs. Participants will include individuals aged 12–49 years, irrespective of gender and settings. Methods The proposed review will follow the JBI methodology for scoping reviews. Databases to be searched will include PubMed (Ovid), Scopus, PsycINFO (EBSCOhost), CINAHL(EBSCO), Web of Science, Cochrane CENTRAL, ProQuest Dissertations and Theses, and Google Scholar (first 10 pages of the search). We will also search for grey literature and screen reference lists of relevant reviews. Two independent reviewers will screen the titles and abstracts, followed by full-text screening. Data will be extracted using a predefined form. The findings will be descriptively presented with supporting tables and diagrams, accompanied by a narrative summary. Sexual & Reproductive Medicine social norms culture religion sexual health reproductive health low-middle income countries Introduction Sexual health is “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity”. 1 Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. 2 Sexual health is essential for the general health and well-being of people, couples, and families, the social and economic growth of communities and nations. Sexual health, when regarded positively, necessitates a positive and respectful approach to sexuality and sexual relationships, as well as the ability to have joyful and safe sexual encounters devoid of compulsion, prejudice, and violence. Men and women's ability to achieve sexual health and well-being is determined by their: Individuals should have access to high-quality information about sex and sexuality, understand the risks associated with unprotected sexual activity, have access to sexual health care, and live in a supportive environment. 3 In low- and middle-income countries (LMICs), sexual health is crucial because limited access to sexual health services, education, and safe environments increases vulnerability to sexual violence, discrimination, and sexually transmitted infections. Ensuring sexual health in LMICs promotes gender equality, reduces healthcare burdens, and fosters the overall well-being and economic growth of communities 4 . Social norms are customary standards that govern behaviour in groups, cultures, or societies. They reflect what a group deems acceptable in a social context in terms of appropriate and inappropriate values, beliefs, attitudes, and behaviours. 5 Social norms are defined as unwritten, mandatory standards that specify proper and acceptable actions in a society and are enforced by the reference group. 6 Social norms also contribute to gender inequality. Gendered societal norms disproportionately influence adolescent girls. 7 Myths and misconceptions surround sexual and reproductive health education and services for teenagers. This has resulted in unsafe sexual behaviours with significant health consequences. In recent years, there has been a surge of interest in studying the impact of societal norms on sexual and reproductive health behaviour, as well as access to contraception treatments. Some societal norms are restrictive, preventing teenagers from making independent decisions about accessing reproductive health care and contraception as they wish. This condition is compounded by early sexual intercourse and forced early marriage. This condition is exacerbated by early sexual intercourse, coerced early marriage, undesired pregnancy, and sexually transmitted illnesses. Adolescent females should be able to make their own decisions regarding contraception to avoid these negative reproductive health consequences, however this is not the case. Social standards are imposed, accepted and absorbed from a young age, and have a significant impact on how individuals manage their reproductive health decisions. 8 In LMICs, harmful social norms restrict adolescent girls' autonomy in sexual and reproductive health, leading to early marriage, unintesrhnded pregnancies, and higher rates of STIs. These norms create barriers to accessing education, contraception, and healthcare, perpetuating gender inequality and poverty. Addressing these norms is crucial for improving health outcomes, empowering women, and fostering economic and social development. 9 Culture is a collective expression for all behavior patterns acquired and socially transmitted through symbols. Culture includes customs, traditions, and language. 10 , 11 Teenagers frequently experience SRH issues such as unexpected pregnancies, sexually transmitted infections (STIs), and challenges during pregnancy and childbirth as a result of risky sexual behaviours. 12 . This obstacle is frequently linked to socio-cultural difficulties surrounding sexuality, resulting in challenges especially with adolescent girls. Culture establishes rules of sexual conduct between sexes, which shape adolescent girls' sexual knowledge, beliefs, and practices, as well as influence SRH. However, empirical information on the role of culture in influencing sexuality and its impact on adolescent girls' SRH in pastoral communities is limited. 13 Culture has a profound impact on sexual and reproductive health. Individuals go through a sexual socialization process in which they learn the ideas of femininity and masculinity, as well as sexual urges, feelings, roles, expressions, and practices from their culture. Sexuality is partially determined by culture, which is learned socially at the family, neighbourhood, and community levels. 14 Culture influences adolescent girls' sexual knowledge, beliefs, and practices, all of which have an impact on SRH. The cultural ideology of sexuality is essential because it influences how adolescent females seek SRH services such as contraception, maternal and childcare services, STI prevention and diagnosis, and the usage of information services. This is critical because it influences SRH outcomes for vulnerable populations of adolescent girls, particularly those living in traditional settings such as pastoralists. However, culture gives standards of sexual conduct between sexes, such as where, when, and with whom to have sex; these rules also serve as a guide to picking a suitable partner, such as knowledge of one's heritage. 15 In LMICs, cultural deeply influences adolescent girls' sexual and reproductive health by shaping their access to information, services, and support. These can perpetuate harmful practices and limit the use of SRH services, especially in traditional communities, leading to higher risks of unintended pregnancies, STIs, and poor maternal health outcomes. Addressing cultural influences is essential for improving SRH outcomes. 16 Religion is a set of beliefs concerning the nature, cause, and purpose of the universe, especially when considered as the creation of a superhuman agency. It usually involves devotional and ritual observances and often a moral code for the conduct of human affairs. 17 Scholars from all major religious traditions, including Judaism, Christianity, Islam, Hinduism, Sikhism, and Buddhism, have reflected on the meaning of sexuality in some way, providing frameworks for good and bad sexuality, male and female sexual characteristics, and family planning strategies. Religion, therefore, is inextricably linked to sexuality and reproductive health. All major religions share a specific belief system that seeks to guide committed followers on sexual and reproductive health issues. 18 However, it is less understood that religion may have a greater or less substantial influence on faithful people's real-life practices; personal interpretations of any faith can range from very liberal to conservative and conventional. In LMICs, religion significantly influences sexual and reproductive health by shaping attitudes and behaviors related to sexuality, contraception, and family planning. Religious beliefs can either support or hinder access to SRH services, impacting health outcomes. Understanding religious influences is crucial for designing culturally sensitive health interventions that respect religious beliefs while promoting SRH. 19 An initial search of PubMed (MEDLINE), the Cochrane Database of Systematic Reviews, JBI Systematic Reviews, PROSPERO and Google Scholar was carried out and could not identify any ongoing scoping or systematic reviews on the topic. Scoping reviews can be used to thoroughly explore and analyze a topic to better understand the phenomenon being studied. This scoping review will focus on comprehensively identifying all existing literature that explores the perspective on social norms, culture, and religion factors influencing SRH in low-middle income countries. Understanding these factors in the context of LMICs will contribute to inclusive health care services for provision of sexual and reproductive health. Operational Definition Social Norms Social norms are the perceived informal, mostly unwritten, rules that define acceptable and appropriate actions within a given group or community, thus guiding human behavior. 20 Culture The set of distinctive spiritual, material, intellectual and emotional features of society or a social group … [which] encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs. 21 Religion A religion is a belief in divine (superhuman or spiritual) being(s) and the practices (rituals) and the moral code (ethics) that result from that belief. 22 Sexual and reproductive health A person’s right to a healthy body; the autonomy, education and healthcare to freely decide who to have sex with; and the knowledge and healthcare products to avoid sexually transmitted infections or unintended pregnancy. Sexual health is an integral part of overall health and well-being, ensuring people can have pleasurable and safe sexual experiences, free of coercion, discrimination, or health risks. 23 Low- middle income countries(LMICs) For the year 2024, countries with a gross national income (GNI) per capita between $ 1,136 and $ 4,465. 24 Review question What are the social norms, culture, and religious factors influencing sexual and reproductive health in LMICs? Inclusion criteria Participants The review will include population of reproductive age groups 12–49 years. The age group of 12–49 years represents a critical span in the life course, encompassing early adolescence to late reproductive years. This broader range captures individuals at various reproductive stages, from the onset of puberty to the typical end of reproductive capacity. In LMICs, this approach is particularly relevant due to variations in menarche age, early marriage practices, and the socioeconomic factors shaping reproductive health. 25 Including younger adolescents (12–14 years) is crucial, as it allows for the consideration of early reproductive health challenges, such as the onset of menstruation, early sexual activity, and adolescent pregnancies—issues often influenced by cultural norms. Extending the upper limit to 49 years ensures that the experiences of women approaching menopause are included, addressing the full range of reproductive health concerns in these settings. 26 There will be no restriction on demographic variables (e.g., sex, ethnicity, religion), or sampling techniques. Concept The concept to be explored encompasses the social norms, culture, and religious factors that influence sexual and reproductive health. This review will systematically map existing literature to identify and analyze how these factors contribute to sexual and reproductive health in LMICs. Social norms, which reflect a group's accepted values, beliefs, attitudes, and behaviors, play a critical role in shaping sexual and reproductive practices. Culture, encompassing customs, traditions, and language, further influences these practices by defining sexual conduct and expectations. Religion, with its moral codes and ritual observances, also profoundly impacts sexual and reproductive health decisions. Understanding these factors is essential for promoting positive sexual health outcomes, including safe and respectful sexual experiences, free from coercion, discrimination, and violence in LMICs. Context The review will focus on populations from low- and middle-income countries (LMICs) as classified by the World Bank criteria. The context will be the social norms, culture, and religious factors influencing sexual and reproductive health experiences in LMICs. However, articles will be included regardless of any factors related to social norms, culture, and religion. Types of studies This review will include all participative studies, including quantitative, qualitative, and mixed methods studies. This review also includes experimental and quasi-experimental designs, descriptive studies, qualitative studies such as in-depth interviews, focus group discussions, action research, participant observation, feminist research, grounded theory, and ethnographic approaches. In addition, approaches such as thematic, content, or phenomenological analysis studies will be considered. Methods The review will follow the JBI methodology for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. 27 , 28 Search strategy A 3-step search strategy will be used in this review. Initially, a limited preliminary search was conducted on PubMed (MEDLINE) to identify articles on the topic. The titles, abstracts, and index terms extracted from these studies, along with MeSH terms provided by the Yale MeSH Analyzer, were utilized to develop an extensive search strategy specifically for PubMed (MEDLINE) (See Appendix I). 29 To ensure thoroughness in identifying existing published literature, the search strategy will be customized, including index terms and keywords, for each individual database. Databases to be searched include, PubMed (MEDLINE), Scopus, PsycINFO (EBSCOhost), Cochrane CENTRAL, CINAHL (EBSCOhost), and Google Scholar (first 10 pages of the search). Additionally, the reference lists of included articles and relevant reviews will be manually scrutinized to identify any additional studies. There will be no language or date restrictions on the articles included in the study. If necessary, relevant papers in other languages will be translated by colleagues and associates who are native speakers. However, we anticipate that the number of non-English-language papers will be minimal, as English is widely spoken in LMICs. Study selection Following the search across various databases, the identified citations will be consolidated and imported into Zotero v. 6.0.26 (Corporation for Digital Scholarship and Roy Rosenzweig Center for History and New Media, VA, USA). Duplicate studies will be removed during this stage. A pilot will be undertaken for study selection. The potentially relevant papers will be obtained, and the finalized citation will be entered into the Rayyan Software. Subsequently, two reviewers (DK, ML) will evaluate the titles and abstracts against the inclusion criteria. After the initial screening, selected articles will undergo a thorough full-text assessment, independently conducted by the same two reviewers. In the event of any discrepancies between reviewers during title/abstract or full-text screening, discussions will be held to achieve consensus, or if necessary, a third reviewer (SS) will be consulted. Reasons for excluding full-text papers that do not meet the inclusion criteria will be documented and reported in the review. The results of the search process and research selection will be compiled in the final scoping review and presented using a PRISMA flow diagram. 30 Data extraction Using the Rayyan software, a data extraction tool that has been modified by the review team (Appendix II), two reviewers (DK, SS) will independently extract data from the included papers, capturing details such as author, title, year of publication, country of origin, study aims, methodology, study design, study outcomes, and key findings. 26 Any disagreements between the reviewers, will be resolves them through discussion or seek input from a third reviewer (ML). Authors will be contacted if more or missing data is needed. An independent reviewer will collect information from any articles written by the reviewers. The data extraction tool will be adjusted as appropriate during the data extraction process and any changes will be recorded and reported in the scoping review. Data presentation and analysis The collected data and the selection process will be visually represented in a diagram or a table, align with the objective and review questions. The tables will be accompanied by narrative summaries. The results will be categorized according to the main concepts discussed above: basic information of the article, factors reported, and the outcome measures. Consultation exercise Through the co-author (Dr Praveena Daya) other experts will be invited to provide consultations. Their expertise will offer valuable insights that complement the perspectives derived from our literature searches. Additional information provided by these members will potentially guide adjustments in our data analysis. This consultation is pivotal, as it incorporates a wide range of social and cultural perspectives rooted in stakeholders’ expertise and interests. These diverse perspectives are expected to enhance and enrich the ensuing discussions. Ethics and Dissemination This review will be based on the secondary analysis of published literature, does not involve human participants or new data collection, and ethics approval is not required. The PRISMA-ScR checklist will serve as a framework for translating the findings. The results will be shared through publications in peer-reviewed journals and presented at conferences through abstracts and presentations. PATIENT AND PUBLIC INVOLVEMENT Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research. References World Health Organisation (2024) Defining sexual health. Available from https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health Accessed August 22, 2024 Douglas JM, Fenton KA (2013) Understanding Sexual Health and Its Role in More Effective Prevention Programs. Public Health Rep 128(Suppl 1):1–4 World Health Organisation (2024) Sexual health. Available from https://www.who.int/health-topics/sexual-health . Accessed August 22, 2024 Desrosiers A, Betancourt T, Kergoat Y, Servilli C, Say L, Kobeissi L (2020) A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings. BMC Public Health 20(1):666. 10.1186/s12889-020-08818-y Cislaghi B, Heise L (2020) Gender norms and social norms: differences, similarities and why they matter in prevention science. Sociol Health Illn 42(2):407–422. 10.1111/1467-9566.13008 Social Roles and Social Norms In Psychology. Accessed August 22 (2024) https://www.simplypsychology.org/social-roles.html#Social-Norms Stark L, Asghar K, Seff I et al (2018) How gender- and violence-related norms affect self-esteem among adolescent refugee girls living in Ethiopia. Glob Ment Health 5:e2. 10.1017/gmh.2017.28 Taiwo MO, Oyekenu O, Hussaini R (2023) Understanding how social norms influence access to and utilization of adolescent sexual and reproductive health services in Northern Nigeria. Front Sociol 8:865499. 10.3389/fsoc.2023.865499 Parida SP, Gajjala A, Giri PP (2021) Empowering adolescent girls, is sexual and reproductive health education a solution? J Fam Med Prim Care 10(1):66–71. 10.4103/jfmpc.jfmpc_1513_20 The Center for Advanced Research on Language Acquisition (CARLA): Culture. Accessed August 22 (2024) https://carla.umn.edu/culture/definitions.html Culture (2024) | Definition, Characteristics, Examples, Types, Tradition, & Facts | Britannica. Accessed August 22. https://www.britannica.com/topic/culture Wight D, Plummer M, Ross D (2012) The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation. BMC Public Health 12(1):788. 10.1186/1471-2458-12-788 Achen S, Rwabukwali CB, Atekyereza P (2021) Socio-cultural perceptions of sexuality influencing the sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda. Soc Sci Humanit Open 4(1):100191. 10.1016/j.ssaho.2021.100191 Gillespie B, Balen J, Allen H, Soma-Pillay P, Anumba D (2022) Shifting Social Norms and Adolescent Girls’ Access to Sexual and Reproductive Health Services and Information in a South African Township. Qual Health Res 32(6):1014–1026. 10.1177/10497323221089880 Achen S, Atekyereza P, Rwabukwali CB (2021) The role of culture in influencing sexual and reproductive health of pastoral adolescent girls in Karamoja sub-region in Uganda. Pastoralism 11(1):25. 10.1186/s13570-020-00188-9 Salam RA, Faqqah A, Sajjad N et al (2016) Improving Adolescent Sexual and Reproductive Health: A Systematic Review of Potential Interventions. J Adolesc Health 59(4 Suppl):S11–S28. 10.1016/j.jadohealth.2016.05.022 Stanford Encyclopedia of Philosophy (2022) The Concept of Religion. Available from: https://plato.stanford.edu/entries/concept-religion/ . Accessed on 26 August 2024 Arousell J, Carlbom A (2016) Culture and religious beliefs in relation to reproductive health. Best Pract Res Clin Obstet Gynaecol 32:77–87. 10.1016/j.bpobgyn.2015.08.011 Odii A, Akamike IC, Mbachu CO, Onwujekwe O (2024) Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria. BMC Health Serv Res 24(1):643. 10.1186/s12913-024-11103-y Cialdini RB, Kallgren CA, Reno RR (1991) A Focus Theory of Normative Conduct: Recycling the Concept of Norms to Reduce Littering in Public Places, vol 24. Advances in Experimental Social Psychology Ogundare T (2020) Culture and mental health: Towards cultural competence in mental health delivery. J Health Social Sci 5(1):023–034 Learn Religions (2024) Religious References on Definition of Religion From Various Sources. Learn Religions. Available from: https://www.learnreligions.com/defining-religion-250676 . Accessed August 22, 2024 Migration C (2022) What is sexual and reproductive health? MSI Reproductive Choices. October 18, Accessed August 22, 2024. https://www.msichoices.org/latest/what-is-sexual-and-reproductive-health/ World Bank Country and Lending Groups – World Bank Data Help Desk (2024) Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups . Accessed August 22 Guttmacher Institute (2020) Adding It Up: Investing in the Sexual and Reproductive Health of Adolescents in Low- and Middle-Income Countries. Guttmacher Institute. https://www.guttmacher.org/report/adding-it-up-investing-in-sexual-reproductive-health-adolescents-lmics . Accessed September 4, 2024 World Health Organization (2023) Maternal, Newborn, Child and Adolescent Health and Ageing. WHO. https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health . Accessed September 4, 2024 Tricco AC, Lillie E, Zarin W et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467–473. 10.7326/M18-0850 Peters MDJ, Marnie C, Tricco AC et al (2020) Updated methodological guidance for the conduct of scoping reviews. JBI Evid Synth 18(10):2119–2126. 10.11124/JBIES-20-00167 Nardini HG (2024) The Yale MeSH Analyzer. Harvey Cushing/John Hay Whitney Medical Library. November 2, 2015. Accessed August 22. https://library.medicine.yale.edu/news/yale-mesh-analyzer Page MJ, McKenzie JE, Bossuyt PM et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. 10.1136/bmj.n71 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6896809","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":471416320,"identity":"0bbc895d-8fe0-428a-ab73-3864a2174bc7","order_by":0,"name":"Dr Deepika K","email":"","orcid":"","institution":"M S Ramaiah University of applied Science","correspondingAuthor":false,"prefix":"Dr","firstName":"Deepika","middleName":"","lastName":"K","suffix":""},{"id":471416321,"identity":"ef7e7e35-ba35-436c-8988-28e049f3f4f2","order_by":1,"name":"M Lekhna","email":"","orcid":"","institution":"M S Ramaiah University of Applied Science","correspondingAuthor":false,"prefix":"","firstName":"M","middleName":"","lastName":"Lekhna","suffix":""},{"id":471416322,"identity":"d083bf76-26b6-4121-b178-7876e437f8c2","order_by":2,"name":"Sneha Singh","email":"","orcid":"","institution":"M S Ramaiah University of Applied Science","correspondingAuthor":false,"prefix":"","firstName":"Sneha","middleName":"","lastName":"Singh","suffix":""},{"id":471416323,"identity":"7c5181c5-b4f4-49b7-9138-f6da23891897","order_by":3,"name":"Dr Denny John","email":"data:image/png;base64,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","orcid":"","institution":"M S Ramaiah University of Applied Science","correspondingAuthor":true,"prefix":"Dr","firstName":"Denny","middleName":"","lastName":"John","suffix":""}],"badges":[],"createdAt":"2025-06-15 06:42:56","currentVersionCode":1,"declarations":{"humanSubjects":false,"vertebrateSubjects":true,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":false,"humanSubjectConsent":false,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":true},"doi":"10.21203/rs.3.rs-6896809/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6896809/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84774623,"identity":"3fdb9b63-3df8-4d55-80ae-54f508a40b2f","added_by":"auto","created_at":"2025-06-17 08:46:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":454701,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6896809/v1/d670ac7c-08fa-4e95-b9bc-6c229057a47c.pdf"},{"id":84773596,"identity":"4a0d4446-78ae-4af2-85fa-875819eb6b71","added_by":"auto","created_at":"2025-06-17 08:38:02","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":18664,"visible":true,"origin":"","legend":"","description":"","filename":"Appendices.docx","url":"https://assets-eu.researchsquare.com/files/rs-6896809/v1/3f9a1b5f90fe45eb9e2a01ba.docx"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSocial norms, culture, and religious factors influencing sexual and reproductive health in low -middle-income countries: A scoping review protocol\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSexual health is \u0026ldquo;a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity\u0026rdquo;.\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Sexual health is essential for the general health and well-being of people, couples, and families, the social and economic growth of communities and nations. Sexual health, when regarded positively, necessitates a positive and respectful approach to sexuality and sexual relationships, as well as the ability to have joyful and safe sexual encounters devoid of compulsion, prejudice, and violence. Men and women's ability to achieve sexual health and well-being is determined by their: Individuals should have access to high-quality information about sex and sexuality, understand the risks associated with unprotected sexual activity, have access to sexual health care, and live in a supportive environment.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e In low- and middle-income countries (LMICs), sexual health is crucial because limited access to sexual health services, education, and safe environments increases vulnerability to sexual violence, discrimination, and sexually transmitted infections. Ensuring sexual health in LMICs promotes gender equality, reduces healthcare burdens, and fosters the overall well-being and economic growth of communities\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eSocial norms are customary standards that govern behaviour in groups, cultures, or societies. They reflect what a group deems acceptable in a social context in terms of appropriate and inappropriate values, beliefs, attitudes, and behaviours.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Social norms are defined as unwritten, mandatory standards that specify proper and acceptable actions in a society and are enforced by the reference group.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e Social norms also contribute to gender inequality. Gendered societal norms disproportionately influence adolescent girls.\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Myths and misconceptions surround sexual and reproductive health education and services for teenagers. This has resulted in unsafe sexual behaviours with significant health consequences. In recent years, there has been a surge of interest in studying the impact of societal norms on sexual and reproductive health behaviour, as well as access to contraception treatments. Some societal norms are restrictive, preventing teenagers from making independent decisions about accessing reproductive health care and contraception as they wish. This condition is compounded by early sexual intercourse and forced early marriage. This condition is exacerbated by early sexual intercourse, coerced early marriage, undesired pregnancy, and sexually transmitted illnesses. Adolescent females should be able to make their own decisions regarding contraception to avoid these negative reproductive health consequences, however this is not the case. Social standards are imposed, accepted and absorbed from a young age, and have a significant impact on how individuals manage their reproductive health decisions.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e In LMICs, harmful social norms restrict adolescent girls' autonomy in sexual and reproductive health, leading to early marriage, unintesrhnded pregnancies, and higher rates of STIs. These norms create barriers to accessing education, contraception, and healthcare, perpetuating gender inequality and poverty. Addressing these norms is crucial for improving health outcomes, empowering women, and fostering economic and social development.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eCulture is a collective expression for all behavior patterns acquired and socially transmitted through symbols. Culture includes customs, traditions, and language.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Teenagers frequently experience SRH issues such as unexpected pregnancies, sexually transmitted infections (STIs), and challenges during pregnancy and childbirth as a result of risky sexual behaviours.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This obstacle is frequently linked to socio-cultural difficulties surrounding sexuality, resulting in challenges especially with adolescent girls. Culture establishes rules of sexual conduct between sexes, which shape adolescent girls' sexual knowledge, beliefs, and practices, as well as influence SRH. However, empirical information on the role of culture in influencing sexuality and its impact on adolescent girls' SRH in pastoral communities is limited.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Culture has a profound impact on sexual and reproductive health. Individuals go through a sexual socialization process in which they learn the ideas of femininity and masculinity, as well as sexual urges, feelings, roles, expressions, and practices from their culture. Sexuality is partially determined by culture, which is learned socially at the family, neighbourhood, and community levels.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Culture influences adolescent girls' sexual knowledge, beliefs, and practices, all of which have an impact on SRH. The cultural ideology of sexuality is essential because it influences how adolescent females seek SRH services such as contraception, maternal and childcare services, STI prevention and diagnosis, and the usage of information services. This is critical because it influences SRH outcomes for vulnerable populations of adolescent girls, particularly those living in traditional settings such as pastoralists. However, culture gives standards of sexual conduct between sexes, such as where, when, and with whom to have sex; these rules also serve as a guide to picking a suitable partner, such as knowledge of one's heritage.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e In LMICs, cultural deeply influences adolescent girls' sexual and reproductive health by shaping their access to information, services, and support. These can perpetuate harmful practices and limit the use of SRH services, especially in traditional communities, leading to higher risks of unintended pregnancies, STIs, and poor maternal health outcomes. Addressing cultural influences is essential for improving SRH outcomes.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eReligion is a set of beliefs concerning the nature, cause, and purpose of the universe, especially when considered as the creation of a superhuman agency. It usually involves devotional and ritual observances and often a moral code for the conduct of human affairs.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e Scholars from all major religious traditions, including Judaism, Christianity, Islam, Hinduism, Sikhism, and Buddhism, have reflected on the meaning of sexuality in some way, providing frameworks for good and bad sexuality, male and female sexual characteristics, and family planning strategies. Religion, therefore, is inextricably linked to sexuality and reproductive health. All major religions share a specific belief system that seeks to guide committed followers on sexual and reproductive health issues.\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e However, it is less understood that religion may have a greater or less substantial influence on faithful people's real-life practices; personal interpretations of any faith can range from very liberal to conservative and conventional. In LMICs, religion significantly influences sexual and reproductive health by shaping attitudes and behaviors related to sexuality, contraception, and family planning. Religious beliefs can either support or hinder access to SRH services, impacting health outcomes. Understanding religious influences is crucial for designing culturally sensitive health interventions that respect religious beliefs while promoting SRH.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAn initial search of PubMed (MEDLINE), the Cochrane Database of Systematic Reviews, JBI Systematic Reviews, PROSPERO and Google Scholar was carried out and could not identify any ongoing scoping or systematic reviews on the topic. Scoping reviews can be used to thoroughly explore and analyze a topic to better understand the phenomenon being studied. This scoping review will focus on comprehensively identifying all existing literature that explores the perspective on social norms, culture, and religion factors influencing SRH in low-middle income countries. Understanding these factors in the context of LMICs will contribute to inclusive health care services for provision of sexual and reproductive health.\u003c/p\u003e"},{"header":"Operational Definition","content":"\u003cp\u003e \u003cstrong\u003eSocial Norms\u003c/strong\u003e \u003cp\u003eSocial norms are the perceived informal, mostly unwritten, rules that define acceptable and appropriate actions within a given group or community, thus guiding human behavior.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCulture\u003c/strong\u003e \u003cp\u003eThe set of distinctive spiritual, material, intellectual and emotional features of society or a social group \u0026hellip; [which] encompasses, in addition to art and literature, lifestyles, ways of living together, value systems, traditions and beliefs.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eReligion\u003c/strong\u003e \u003cp\u003eA religion is a belief in divine (superhuman or spiritual) being(s) and the practices (rituals) and the moral code (ethics) that result from that belief.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eSexual and reproductive health\u003c/strong\u003e \u003cp\u003eA person\u0026rsquo;s right to a healthy body; the autonomy, education and healthcare to freely decide who to have sex with; and the knowledge and healthcare products to avoid sexually transmitted infections or unintended pregnancy. Sexual health is an integral part of overall health and well-being, ensuring people can have pleasurable and safe sexual experiences, free of coercion, discrimination, or health risks.\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eLow- middle income countries(LMICs)\u003c/strong\u003e \u003cp\u003e For the year 2024, countries with a gross national income (GNI) per capita between \u003cspan\u003e$\u003c/span\u003e1,136 and \u003cspan\u003e$\u003c/span\u003e4,465. \u003csup\u003e \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e \u003c/sup\u003e \u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eReview question\u003c/h2\u003e \u003cp\u003eWhat are the social norms, culture, and religious factors influencing sexual and reproductive health in LMICs?\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe review will include population of reproductive age groups 12\u0026ndash;49 years. The age group of 12\u0026ndash;49 years represents a critical span in the life course, encompassing early adolescence to late reproductive years. This broader range captures individuals at various reproductive stages, from the onset of puberty to the typical end of reproductive capacity. In LMICs, this approach is particularly relevant due to variations in menarche age, early marriage practices, and the socioeconomic factors shaping reproductive health.\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e Including younger adolescents (12\u0026ndash;14 years) is crucial, as it allows for the consideration of early reproductive health challenges, such as the onset of menstruation, early sexual activity, and adolescent pregnancies\u0026mdash;issues often influenced by cultural norms. Extending the upper limit to 49 years ensures that the experiences of women approaching menopause are included, addressing the full range of reproductive health concerns in these settings.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e There will be no restriction on demographic variables (e.g., sex, ethnicity, religion), or sampling techniques.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eConcept\u003c/h3\u003e\n\u003cp\u003eThe concept to be explored encompasses the social norms, culture, and religious factors that influence sexual and reproductive health. This review will systematically map existing literature to identify and analyze how these factors contribute to sexual and reproductive health in LMICs. Social norms, which reflect a group's accepted values, beliefs, attitudes, and behaviors, play a critical role in shaping sexual and reproductive practices. Culture, encompassing customs, traditions, and language, further influences these practices by defining sexual conduct and expectations. Religion, with its moral codes and ritual observances, also profoundly impacts sexual and reproductive health decisions. Understanding these factors is essential for promoting positive sexual health outcomes, including safe and respectful sexual experiences, free from coercion, discrimination, and violence in LMICs.\u003c/p\u003e\n\u003ch3\u003eContext\u003c/h3\u003e\n\u003cp\u003eThe review will focus on populations from low- and middle-income countries (LMICs) as classified by the World Bank criteria. The context will be the social norms, culture, and religious factors influencing sexual and reproductive health experiences in LMICs. However, articles will be included regardless of any factors related to social norms, culture, and religion.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eTypes of studies\u003c/h2\u003e \u003cp\u003eThis review will include all participative studies, including quantitative, qualitative, and mixed methods studies. This review also includes experimental and quasi-experimental designs, descriptive studies, qualitative studies such as in-depth interviews, focus group discussions, action research, participant observation, feminist research, grounded theory, and ethnographic approaches. In addition, approaches such as thematic, content, or phenomenological analysis studies will be considered.\u003c/p\u003e \u003c/div\u003e"},{"header":"Methods","content":"\u003cp\u003eThe review will follow the JBI methodology for scoping reviews and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eSearch strategy\u003c/h3\u003e\n\u003cp\u003eA 3-step search strategy will be used in this review. Initially, a limited preliminary search was conducted on PubMed (MEDLINE) to identify articles on the topic. The titles, abstracts, and index terms extracted from these studies, along with MeSH terms provided by the Yale MeSH Analyzer, were utilized to develop an extensive search strategy specifically for PubMed (MEDLINE) (See Appendix I).\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e To ensure thoroughness in identifying existing published literature, the search strategy will be customized, including index terms and keywords, for each individual database. Databases to be searched include, PubMed (MEDLINE), Scopus, PsycINFO (EBSCOhost), Cochrane CENTRAL, CINAHL (EBSCOhost), and Google Scholar (first 10 pages of the search). Additionally, the reference lists of included articles and relevant reviews will be manually scrutinized to identify any additional studies. There will be no language or date restrictions on the articles included in the study. If necessary, relevant papers in other languages will be translated by colleagues and associates who are native speakers. However, we anticipate that the number of non-English-language papers will be minimal, as English is widely spoken in LMICs.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStudy selection\u003c/h2\u003e \u003cp\u003eFollowing the search across various databases, the identified citations will be consolidated and imported into Zotero v. 6.0.26 (Corporation for Digital Scholarship and Roy Rosenzweig Center for History and New Media, VA, USA). Duplicate studies will be removed during this stage. A pilot will be undertaken for study selection. The potentially relevant papers will be obtained, and the finalized citation will be entered into the Rayyan Software. Subsequently, two reviewers (DK, ML) will evaluate the titles and abstracts against the inclusion criteria. After the initial screening, selected articles will undergo a thorough full-text assessment, independently conducted by the same two reviewers. In the event of any discrepancies between reviewers during title/abstract or full-text screening, discussions will be held to achieve consensus, or if necessary, a third reviewer (SS) will be consulted. Reasons for excluding full-text papers that do not meet the inclusion criteria will be documented and reported in the review. The results of the search process and research selection will be compiled in the final scoping review and presented using a PRISMA flow diagram.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData extraction\u003c/h2\u003e \u003cp\u003eUsing the Rayyan software, a data extraction tool that has been modified by the review team (Appendix II), two reviewers (DK, SS) will independently extract data from the included papers, capturing details such as author, title, year of publication, country of origin, study aims, methodology, study design, study outcomes, and key findings.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e Any disagreements between the reviewers, will be resolves them through discussion or seek input from a third reviewer (ML). Authors will be contacted if more or missing data is needed. An independent reviewer will collect information from any articles written by the reviewers. The data extraction tool will be adjusted as appropriate during the data extraction process and any changes will be recorded and reported in the scoping review.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eData presentation and analysis\u003c/h2\u003e \u003cp\u003eThe collected data and the selection process will be visually represented in a diagram or a table, align with the objective and review questions. The tables will be accompanied by narrative summaries. The results will be categorized according to the main concepts discussed above: basic information of the article, factors reported, and the outcome measures.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eConsultation exercise\u003c/h2\u003e \u003cp\u003eThrough the co-author (Dr Praveena Daya) other experts will be invited to provide consultations. Their expertise will offer valuable insights that complement the perspectives derived from our literature searches. Additional information provided by these members will potentially guide adjustments in our data analysis. This consultation is pivotal, as it incorporates a wide range of social and cultural perspectives rooted in stakeholders\u0026rsquo; expertise and interests. These diverse perspectives are expected to enhance and enrich the ensuing discussions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eEthics and Dissemination\u003c/h2\u003e \u003cp\u003eThis review will be based on the secondary analysis of published literature, does not involve human participants or new data collection, and ethics approval is not required. The PRISMA-ScR checklist will serve as a framework for translating the findings. The results will be shared through publications in peer-reviewed journals and presented at conferences through abstracts and presentations.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePATIENT AND PUBLIC INVOLVEMENT\u003c/h2\u003e \u003cp\u003ePatients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of our research.\u003c/p\u003e \u003c/div\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organisation (2024) Defining sexual health. Available from \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/sexual-and-reproductive-health-and-research/key-areas-of-work/sexual-health/defining-sexual-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e Accessed August 22, 2024\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDouglas JM, Fenton KA (2013) Understanding Sexual Health and Its Role in More Effective Prevention Programs. Public Health Rep 128(Suppl 1):1\u0026ndash;4\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organisation (2024) Sexual health. 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BMJ 372:n71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmj.n71\u003c/span\u003e\u003cspan address=\"10.1136/bmj.n71\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"M S Ramaiah University of Applied Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"social norms, culture, religion, sexual health, reproductive health, low-middle income countries","lastPublishedDoi":"10.21203/rs.3.rs-6896809/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6896809/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThe objective of this scoping review will be to identify and map various perspectives on social norms, culture, and religious factors, influencing sexual and reproductive health in low- and middle-income countries (LMICs).\u003c/p\u003e\u003ch2\u003eIntroduction\u003c/h2\u003e \u003cp\u003eGood sexual and reproductive health (SRH) is a state of complete physical, mental, and social well-being in all matters related to the reproductive systems. Key components of SRH include: access to accurate information, understanding unprotected sex risks, healthcare access, and a supportive environment. Various social norms, culture, and religion contributes to gender inequality, significantly influencing sexual knowledge and practices, among reproductive age groups thus impacting their health.\u003c/p\u003e\u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eThis review will include all studies on social, cultural, and religious factors influencing sexual and reproductive health in LMICs. Participants will include individuals aged 12\u0026ndash;49 years, irrespective of gender and settings.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe proposed review will follow the JBI methodology for scoping reviews. Databases to be searched will include PubMed (Ovid), Scopus, PsycINFO (EBSCOhost), CINAHL(EBSCO), Web of Science, Cochrane CENTRAL, ProQuest Dissertations and Theses, and Google Scholar (first 10 pages of the search). We will also search for grey literature and screen reference lists of relevant reviews. Two independent reviewers will screen the titles and abstracts, followed by full-text screening. Data will be extracted using a predefined form. The findings will be descriptively presented with supporting tables and diagrams, accompanied by a narrative summary.\u003c/p\u003e","manuscriptTitle":"Social norms, culture, and religious factors influencing sexual and reproductive health in low -middle-income countries: A scoping review protocol","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-17 08:37:57","doi":"10.21203/rs.3.rs-6896809/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"82d1a84c-9c23-4859-b87c-3b6e3d85bfb5","owner":[],"postedDate":"June 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":50061793,"name":"Sexual \u0026 Reproductive Medicine"}],"tags":[],"updatedAt":"2025-06-17T08:37:57+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-17 08:37:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6896809","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6896809","identity":"rs-6896809","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}