Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

Singh, Neha; Ataullahjan, Anushka; Ndiaye, Khadidiatou; Das, Jai K; Altare, Chiara; Ahmed, Zahra; Sami, Samira; Akik, Chaza; Tappis, Hannah; Mirzazada, Shafiq; Garcés-Palacio, Isabel C.; Ghattas, Hala; Langer, Ana; Spiegel, Paul; Blanchet, Karl; Bhutta, Zulfiqar Ahmed; Black, Robert E.; Boerma, Ties; Gaffey, Michelle F; Waldman, Ronald J.; Wise, Paul H.

doi:10.1016/s0140-6736(21)00132-x

Cited by 67 publications

(75 citation statements)

References 21 publications

(23 reference statements)

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“…For example, a case study from Afghanistan noted that comprehensive emergency obstetric and newborn care is inaccessible in most provinces. 67 A common thread in this review was the need to strengthen the support systems for midwives to enable them to provide quality services. Additionally, evidence suggests that lifesaving reproductive, maternal, newborn, child and adolescent health services frequently become disrupted in HFS.…”

Section: Bmj Global Healthmentioning

confidence: 99%

“…Additionally, evidence suggests that lifesaving reproductive, maternal, newborn, child and adolescent health services frequently become disrupted in HFS. 67 A paper synthesising findings from 10 case studies from conflict settings found that essential maternal and newborn health interventions were not clearly prioritised. Also, predefined packages of priority services were commonly not agreed on or implemented.…”

Section: Bmj Global Healthmentioning

confidence: 99%

“…Also, predefined packages of priority services were commonly not agreed on or implemented. 67 The studies included in our review identify a number of specific measures to support midwives in providing midwifery services including access to, and availability of, emergency obstetric and newborn care and midwife-led services. These measures are needed in all settings but there are additional challenges in HFS, especially due to safety and security concerns.…”

Section: Bmj Global Healthmentioning

confidence: 99%

“…Health workforce solutions include task shifting and task sharing; rotation of senior staff to remote areas; hiring local staff to nurture trust with local communities and value the sense of duty of local staff in their own country. 67 A focus on midwives is needed in HFS as midwifedelivered interventions have an important impact on maternal and newborn health outcomes. 12 These interventions are critically needed in all populations, especially in HFS, to reach those who are hardest to reach.…”

Section: Bmj Global Healthmentioning

confidence: 99%

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Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

et al. 2022

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IntroductionWomen and children bear a substantial burden of the impact of conflict and instability. The number of people living in humanitarian and fragile settings (HFS) has increased significantly over the last decade. The provision of essential maternal and newborn healthcare by midwives is crucial everywhere, especially in HFS. There is limited knowledge about the interventions, support systems and enabling environments that enhance midwifery care in these settings. The aim of this paper is to identify the factors affecting an enabling environment for midwives in HFS and to explore the availability and effectiveness of support systems for midwives.MethodsA structured systematic review was undertaken to identify peer-reviewed primary research articles published between 1995 and 2020.ResultsIn total, 24 papers were included from Afghanistan, Bangladesh, Nigeria, Democratic Republic of Congo, South Sudan and Sudan, Ethiopia, Pakistan, Uganda and Liberia. There were two broad themes: (1) the facilitators of, and barriers to, an enabling environment, and (2) the importance of effective support systems for midwives. Facilitators were: community involvement and engagement and an adequate salary, incentives or benefits. Barriers included: security and safety concerns, culture and gender norms and a lack of infrastructure and supplies. Support systems were: education, professional development, supportive supervision, mentorship and workforce planning.ConclusionMore efforts are needed to develop and implement quality midwifery services in HFS. There is an urgent need for more action and financing to ensure better outcomes and experiences for all women, girls and families living in these settings.PROSPERO registration numberCRD42021226323.

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Section: Bmj Global Healthmentioning

confidence: 99%

Section: Bmj Global Healthmentioning

confidence: 99%

Section: Bmj Global Healthmentioning

confidence: 99%

Section: Bmj Global Healthmentioning

confidence: 99%

See 2 more Smart Citations

Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

et al. 2022

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“…The above issue of insecurity and its implications on women or even health workers was described and discussed in a recent article on delivering health interventions for women in conflict settings. Syria was one of 10 case studies that were described in that article ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

Childbirth Experiences and Delivery Care During Times of War: Testimonies of Syrian Women and Doctors

Bashour

Kharouf

DeJong

2021

Front. Glob. Womens Health

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Background: Until the eruption of violence in 2011, Syria made good progress in improving maternal health indicators including reducing the maternal mortality ratio and increasing the level of skilled birth attendance. The war in Syria has been described as one of the worst humanitarian crises in recent times. Damascus Maternity Teaching Hospital is the largest maternity public hospital in the country that survived the war and continued to provide its services even during periods of pronounced instability. The main aim of this paper is to highlight the experience of childbirth and delivery care as described by women and doctors at times of severe violence affecting Damascus.Methods: This paper is based on secondary analysis of qualitative data collected between 2012 and 2014 for a WHO-funded implementation research project introducing clinical audits for maternal near-misses. This analysis specifically looked at the effects of violence on the childbirth experience and delivery care from the perspective of both women and physicians. A total of 13 in-depth interviews with women who had recently delivered and survived a complication and 13 in-depth interviews with consultant obstetricians were reviewed and analyzed, in addition to three focus group discussions with 31 junior care providers.Results: Three themes emerged concerning the experiences of women and doctors in these times of war. First, both women and doctors experienced difficulty reaching the hospital and accessing and providing the services, respectively; second, quality of care was challenged at that time as perceived by both women and doctors; and third, women and doctors expressed their psychological suffering in times of hardship and uncertainty and how this affected them.Conclusions: Efforts to safeguard the safety of delivery and prevent maternal mortality in Syria continued despite very violent and stressful conditions. Both women and providers developed strategies to navigate the challenges posed by conflict to the provision of delivery care. Lessons learned from the experiences of both women and doctors should be considered in any plans to improve maternal healthcare in a country like Syria that remains committed to achieving the Sustainable Development Goals in 2030 in the aftermath of nearly 10 years of war.

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Conflict's impacts on food systems: Mapping available evidence of interactions

Dowd,

Polzin,

Gleason

et al. 2024

J of Intl Development

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This scoping study maps the conflict and food systems nexus to identify broad themes, specific components and remaining gaps in research. Applying systems thinking and network analysis, the analysis points to three trends. First, studies are heavily focused on production, with relatively less attention to aspects including transport, trade and household utilisation. Second, geographically, food systems within Africa and at country‐level are well‐represented in existing research, at the expense of other regions and scales. Third, specific modalities of violence are often omitted, and we observe a tendency to aggregate discrete forms of insecurity. The study has implications for scholars and practitioners seeking to better understand and respond to conflict's impacts on food systems and suggests avenues for further research.

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Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies?

Cited by 67 publications

References 21 publications

Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

Childbirth Experiences and Delivery Care During Times of War: Testimonies of Syrian Women and Doctors

Conflict's impacts on food systems: Mapping available evidence of interactions

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