Climate change and sexual and reproductive health: A mixed methods scoping review of possible mechanisms

This scoping review synthesized empirical evidence on the relationships and possible pathways through which climate change could impact sexual and reproductive health and rights (SRHR) in low- and middle-income countries (LMICs). Eligible sources had to investigate climate change and SRHR using any study design. Two independent reviewers conducted screening; data extraction captured exposures, outcomes, associations/relationships, and possible mediators and contextual moderators. From 40,503 database-identified sources, we included 256 peer-reviewed publications across 108 LMICs. We identified 14 potential pathways and developed a typology of mediators and contextual moderators to inform the mechanisms. Five mediator domains were identified: (1) systems and infrastructure, (2) demographic shifts, (3) socioeconomic resources, and (4) behavioral and (5) biological. Six contextual moderator types were isolated: (1) patriarchal norms, (2) cultural power structures, (3) socioeconomic realities, (4) gender-inequitable climate governance, (5) place-based factors, and (6) pre-existing systems/infrastructure. As climate shocks intensify, advancing a mechanistic understanding will be critical to designing responsive, inclusive, and sustainable systems of protection.