Reproductive, maternal, neonatal and child health in conflict: a case study on Syria using Countdown indicators

Abstract

IntroductionWomen and children account for a disproportionate morbidity burden among conflict-affected populations, and yet they are not included in global accountability frameworks for women’s and children’s health. We use Countdown to 2015 (Millennium Development Goals) health indicators to provide an up-to-date review and analysis of the best available data on Syrian refugees in Jordan, Lebanon and Turkey and internally displaced within Syria and explore data challenges in this conflict setting.MethodsWe searched Medline, PubMed, Scopus, Popline and Index Medicus for WHO Eastern Mediterranean Region Office and relevant development/humanitarian databases in all languages from January 2011 until December 2015. We met in person or emailed relevant key stakeholders in Lebanon, Jordan, Syria and Turkey to obtain any unpublished or missing data. We convened a meeting of experts working with these populations to discuss the results.ResultsThe following trends were found based on available data for these populations as compared with preconflict Syria. Birth registration in Syria and in host neighbouring countries decreased and was very low in Lebanon. In Syria, the infant mortality rate and under-five mortality rate increased, and coverage of antenatal care (one visit with a skilled attendant), skilled birth attendance and vaccination (except for DTP3 vaccine) declined. The number of Syrian refugee women attending more than four antenatal care visits was low in Lebanon and in non-camp settings in Jordan. Few data were available on these indicators among the internally displaced. In conflict settings such as that of Syria, coverage rates of interventions are often unknown or difficult to ascertain because of measurement challenges in accessing conflict-affected populations or to the inability to determine relevant denominators in this dynamic setting.ConclusionResearch, monitoring and evaluation in humanitarian settings could better inform public health interventions if findings were more widely shared, methodologies were more explicit and globally agreed definitions and indicators were used consistently.

Voices from the frontline: findings from a thematic analysis of a rapid online global survey of maternal and newborn health professionals facing the COVID-19 pandemic

“…[50][51][52][53] Displaced women and their newborns face sub-optimal access to ANC, skilled attendance at birth, PNC, and vaccination, and subsequently experienced poor health outcomes even prior to the pandemic-induced disruptions of essential services. [54][55][56][57] Global and local efforts must be established to ensure that displaced populations have access to appropriate infection prevention measures, testing and treatment, and to quality maternal and newborn services to halt anticipated exacerbations of negative health outcomes. 29,52 Personal Experiences.…”

Accountability strategies for sexual and reproductive health and reproductive rights in humanitarian settings: a scoping review

“…Monitoring and measurementkey tools for accountabilitycan be especially challenging in humanitarian contexts. For example, one paper assessed to what extent global level reproductive, maternal, newborn, and child health indicators are being met for Syrian IDPs and refugees in Jordan, Lebanon, Turkey and Syria [101]. The researchers were able to gather some data on some populations, but were stymied by lack of data about denominators given the dynamic setting, inconsistencies in definitions used, lack of data sharing, and lack of data collection [101].…”

A Qualitative Analysis of Knowledge, Attitudes, and Perceptions of Family Planning Among Syrian Refugees in Lebanon

“…Existing studies also show that pre-conflict awareness/ use of contraception, prevailing beliefs from the host country, and access to SRH services all influence women's perceptions of contraception [8]. In pre-conflict Syria, most primary care and SRH services were free [24] and estimates of contraception use ranged between 54% and 60% with approximately 84% of FP needs being met [25][26][27]. Among displaced Syrian families, on the other hand, cost and access have been identified as important barriers to SRH care.…”

“…Even when Syrian girls and women do access services, they often perceive that they are judged and mistreated [29] as well as viewed negatively by Lebanese health care providers [8]. Misinformation about harmful side effects as well as banning of contraception by husbands and family members were identified as barriers to FP uptake in pre-conflict Syria and continue to be cited by some refugees after displacement [25][26][27].…”