Evaluating the effectiveness of sexual and reproductive health services during humanitarian crises: A systematic review

Abstract

BackgroundAn estimated 32 million women and girls of reproductive age living in emergency situations, all of whom require sexual and reproductive health (SRH) information and services. This systematic review assessed the effect of SRH interventions, including the Minimum Initial Service Package (MISP) on a range of health outcomes from the onset of emergencies.Methods and findingsWe searched EMBASE, Global Health, MEDLINE and PsychINFO databases from January 1, 1980 to April 10, 2017. This review was registered with the PROSPERO database with identifier number CRD42017082102. We found 29 studies meet the inclusion criteria. We found high quality evidence to support the effectiveness of specific SRH interventions, such as home visits and peer-led educational and counselling, training of lower-level health care providers, community health workers (CHWs) to promote SRH services, a three-tiered network of health workers providing reproductive and maternal health services, integration of HIV and SRH services, and men’s discussion groups for reducing intimate partner violence. We found moderate quality evidence to support transport-based referral systems, community-based SRH education, CHW delivery of injectable contraceptives, wider literacy programmes, and birth preparedness interventions. No studies reported interventions related to fistulae, and only one study focused on abortion services.ConclusionsDespite increased attention to SRH in humanitarian crises, the sector has made little progress in advancing the evidence base for the effectiveness of SRH interventions, including the MISP, in crisis settings. A greater quantity and quality of more timely research is needed to ascertain the effectiveness of delivering SRH interventions in a variety of humanitarian crises.

Intersectionality as a lens to the COVID-19 pandemic: implications for sexual and reproductive health in development and humanitarian contexts

“…A recent systematic review on SRH interventions in humanitarian crises did not find any studies focusing on people with disabilities, adolescents or LGBTQ populations. [6] While "women and girls" are acknowledged as facing limited SRH access, analysis tends to take a one-dimensional, horizontal lens.…”

Protecting women and children in conflict settings

“…Existing handbooks and manuals are constrained by a general focus on broader humanitarian settings or by a paucity of evidence to underpin or inform maternal and child health recommendations 13. Armed conflict poses specific difficulties for implementation of health interventions, especially the complex and dynamic challenges to security and governance.…”

Delivering infectious disease interventions to women and children in conflict settings: a systematic review

“…11 12 Though there has been increased international focus to produce and disseminate systematic and comprehensive guidelines for the delivery of infectious disease services in conflict settings, significant challenges remain in terms of provision and utilisation of critical health interventions. 13 This paper is part of a set of eight systematic reviews using a common protocol to examine the delivery of reproductive, maternal, newborn, child and adolescent health and nutrition interventions in conflict settings, motivated by the urgent need to better address the vulnerabilities of women and children in humanitarian crises generally and in conflict settings particularly. 14 15 Here we aimed to systematically characterise the literature on the delivery of infectious disease interventions to women, children and adolescents and identify key gaps in that literature; and to synthesise reported information on intervention delivery characteristics, including how they may vary by setting and by population displacement status.…”