A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises

Abstract

IntroductionWomen and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries.MethodsWe searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach.ResultsOf the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers.ConclusionsDespite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.

The Rohingya Refugee Crisis of Bangladesh: Gender Based Violence and the Humanitarian Response

“…In addition, there has been potential and actualization of continuing sexual abuse of both women and children within the refugee camps. Additionally, there continues to be limited reproductive health care in the camps (Singh et al, 2018).…”

Self care interventions could advance sexual and reproductive health in humanitarian settings

“…A recent review of uptake of sexual and reproductive services in humanitarian crises identified gaps in knowledge in several key areas. 2 For example, scant research has examined prevention of vertical HIV transmission, prevention and treatment of sexually transmitted infections, abortion and post-abortion care, or clinical management of rape. 2 The Inter-Agency Working Group on Reproductive Health in Crises 12 is a coalition of 20 steering committee member agencies.…”

“…1 Humanitarian crises disrupt communities to such an extent that they require national or international resources and help. 1 2 Forcibly displaced people include those who have left their home but have not crossed an international border (internally displaced people); those who have left their country because of persecution, war, and violence (refugees); and people who have applied for sanctuary in another country (asylum seekers). 1…”

“… 7 This may result in inadequate or interrupted access to sexual and reproductive health services and rights. 2 8 9 10 Uganda, a low income country, provides an example of one such humanitarian crisis. Over a million refugees are now in Uganda.…”

“…3 4 Information about strategies to increase the use of sexual and reproductive health services in humanitarian situations is limited. 2 5 6 Innovative delivery models and research are needed. 6 Self care interventions show great promise in these challenging conditions.…”