Rights based approaches to sexual and reproductive health in low and middle-income countries: A systematic review

Abstract

Introduction The Sustainable Development Goals, which are grounded in human rights, involve empowering women and girls and ensuring that everyone can access sexual and reproductive health and rights (Goal 5). This is the first systematic review reporting interventions involving rights-based approaches for sexual and reproductive health issues including gender-based violence, maternity, HIV and sexually transmitted infections in low and middle-income countries. Aims To describe the evidence on rights-based approaches to sexual and reproductive health in low and middle-income countries. Methods EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were: Study design: any interventional study. Population: females aged over 15 living in low and middle-income countries. Intervention: a “rights-based approach” (defined by the author) and/or interventions that the author explicitly stated related to "rights". Comparator: clusters in which no intervention or fewer components of an intervention were in place, or individuals not exposed to interventions, or exposed to fewer intervention components. Outcome: Sexual and reproductive health related outcomes. A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps. The systematic review protocol was registered on PROSPERO (CRD42019158950). Results Database searching identified 17,212 records, and 13,404 studies remained after de-duplication. Twenty-four studies were included after title and abstract, full-text and reference-list screening by two authors independently. Rights-based interventions were effective for some included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other sexually transmitted infections, condom use, and awareness of rights improved with intervention, but all relevant studies were at high, critical or serious risk of bias. No study included gender-based violence outcomes. Conclusion Considerable risk of bias in all studies means results must be interpreted with caution. High-quality controlled studies are needed urgently in this area.

Knowledge of Sexual and Reproductive Health Rights Among University Students: A Cross-Sectional Study in Southeast Ethiopia

“…10 Evidence suggests that most young people are not even aware of the extent to which their sexual rights are being violated; worse yet, they continue to be unaware of where they can turn for legal or social advice; 5 and the poor quality of rights-based interventions for sexual and reproductive health rights reported in low and middle-income countries like Ethiopia. 11 As a result, the issue continues to be a major concern for university students, with limited studies indicating that their knowledge of sexual and reproductive health rights is grossly inadequate. In Nepal, for example, the mean level of knowledge about reproductive and sexual health rights was barely more than fifty percent (51.12%).…”

“… 10 Evidence suggests that most young people are not even aware of the extent to which their sexual rights are being violated; worse yet, they continue to be unaware of where they can turn for legal or social advice; 5 and the poor quality of rights-based interventions for sexual and reproductive health rights reported in low and middle-income countries like Ethiopia. 11 …”

Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation

“…Most reviews of structural interventions have focused on other aspects of sexual and reproductive health, particularly HIV prevention [ 8 , 43 , 44 , 45 , 46 , 47 ], as well as violence prevention [ 48 , 49 ] and child marriage prevention [ 50 ]. Reviews that focused on particular types of structural interventions tended to include only a minority or no studies measuring or focusing on contraceptive use [ 51 , 52 , 53 , 54 ] or did not focus on adolescents [ 11 , 55 , 56 , 57 ] or LMICs [ 58 ].…”

“…That there are methodological challenges in this field is not news. The need for consistent outcome measures and empowerment indicators [ 4 , 55 , 57 , 59 ], issues of the conceptualisations and terminology relating to structural interventions or empowerment [ 46 , 53 , 60 ] and study design challenges [ 4 , 43 , 61 ] have all been identified previously.…”

A realist review of interventions targeting maternal health in low- and middle-income countries

“…Educational intervention strategies for pregnant women, family members and HCPs to improve their clinical skills were a common intervention component. 32,[44][45][46]53,54 Lack of knowledge of the importance of seeking medical care during pregnancy and labour hinders women's health behaviours and the decision-making process. 84 However, an international survey of maternal health researchers suggests that the major challenge for improving maternal care is access to healthcare rather than women's knowledge of the importance for healthcare.…”