An overview of the sexual and reproductive health status and service delivery among Syrian refugees in Jordan, nine years since the crisis: a systematic literature review

Abstract

Background The Syrian refugee crisis has led to massive displacement into neighboring countries including Jordan. This crisis has caused a significant strain on the sexual and reproductive health (SRH) services to the host communities and Syrian refugees. The Minimum Initial Service Package (MISP) is a standard package of services that should be implemented at the onset of an emergency. Due to their importance in protracted humanitarian crisis, this systematic review aimed to assess the utilization of SRH and MISP after 9 years of the crisis. Methods We searched PubMed, Medline/Ovid and Scopus for both quantitative and qualitative studies from 1 January 2011 to 30 November 2019. Our search included both free text key words and Medical Subject Headings (MeSH) for various forms and acronmym of the following terms: (Sexual and) Reproductive Health, Sexual/Gender-based/Family/Intimate partner violence, Minimum Initial Service Package, MISP, Women, Girls, Adolescents, Syrian, Refugee, Jordan, Humanitarian crisis, War, (armed) conflict, and Disaster. Boolean operators and star truncation (*) were used as needed. We further conducted an in-depth review of the available grey literature published during the same timeframe. Using a narrative synthesis approach, two authors independently extracted and analyzed data from published papers. After removal of duplicates, screening, and assessing for eligibility of 161 initially identified citations, 19 papers were selected for review. Results Findings from this review indicated a number of barriers to access, utilization, and implementation of SRH services, including lack of reliable information on sexual and gender-based violence (SGBV), aggravation of early marriages by crisis setting, gaps in the knowledge and use of family planning services, inadequate STIs and HIV coverage, and some issues around the provision of maternal health services. Conclusion The findings from this review are suggestive of a number of barriers pertaining to access, utilization, and implementation of SRH services. This is especially true for transitioning from MISP to comprehensive SRH services, and particularly for refugees outside camps. Following are needed to address identified barriers: improved inter-agency coordination, better inclusion/engagement of local initiatives and civil societies in SRH services delivery, improved quality of SRH services, adequate and regular training of healthcare providers, and increased awareness of Syrian women and adolescent girls. Also, more implementing research is required to identify ways to transition SRH provision from the MISP to comprehensive care for the Syrian refugee population in Jordan.

A Cross-Sectional Quantitative Study on Sexual and Reproductive Health Knowledge and Access to Services of Arab and Kurdish Syrian Refugee Young Women Living in an Urban Setting in Lebanon

“…Mistreatment by staff, high cost, poor quality of services, long waiting times, far distances, and unaffordable means of transport were the obstacles mentioned by participants. Comparable barriers are observed in Syrian refugee populations in Jordan and Turkey [ 51 , 52 ], in addition to other displaced populations such as refugee adolescent girls in the Nakivale refugee settlement in Uganda [ 44 ]. Surprisingly, and in contrary to other studies on Syrian refugee women in Jordan and Turkey [ 35 , 53 , 54 ], the sex of the healthcare provider was not named as a barrier to SRH services access.…”

Access to preventive sexual and reproductive health care for women from refugee-like backgrounds: a systematic review

“…By contrast, most women in high-income countries have free or low cost universal SRH access in primary health care including screening for reproductive cancers [ 24 ]. The poor quality of SRH care but also a lack of available services, leads to low utilisation of these services [ 25 ] further contributing to barriers refugee and displaced women may experience in accessing care [ 26 ]. In 2004, a global evaluation of reproductive health services for refugees and internally displaced people concluded that most people affected by conflict lack adequate SRH care.…”

Measuring sexual violence stigma in humanitarian contexts: assessment of scale psychometric properties and validity with female sexual violence survivors from Somalia and Syria

“…More than a million Syrians are estimated as being displaced in Jordan on account of the war that began in 2011, with the vast majority of the more than 600,000 refugees registered with UNHCR living outside of camp settings [ 38 ]. A recent systematic review found that while the exact prevalence of sexual violence among displaced Syrian women is unclear, they are at risk for multiple forms of violence including early and/or forced marriage, and approximately one third of Syrian refugees surveyed in Lebanon reported exposure to conflict-related violence [ 39 , 40 ]. Since the early 1990s when the Dadaab camp was established, Somali refugees have fled to Kenya on account of civil war, drought, and famine [ 41 ].…”