Delivery of sexual and reproductive health interventions in conflict settings: a systematic review

Abstract

Background: It is essential to provide comprehensive sexual and reproductive health (SRH) interventions to women affected by armed conflict, but there is a lack of evidence on effective approaches to delivering such interventions in conflict settings. This review synthesised the available literature on SRH intervention delivery in conflict settings to inform potential priorities for further research and additional guidance development.

Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and SRH. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries and describing an SRH intervention delivered during or within 5 years after the end of a conflict were included. Information on population, intervention and delivery characteristics were extracted and narratively synthesised. Quantitative data on intervention coverage and effectiveness were tabulated, but no meta-analysis was undertaken.

Results: 110 publications met our eligibility criteria. Most focused on sub-Saharan Africa and displaced populations based in camps. Reported interventions targeted family planning, HIV/STIs, gender-based violence and general SRH. Most interventions were delivered in hospitals and clinics by doctors and nurses. Delivery barriers included security, population movement and lack of skilled health staff. Multistakeholder collaboration, community engagement and use of community and outreach workers were delivery facilitators. Reporting of intervention coverage or effectiveness data was limited.

Discussion: There is limited relevant literature on adolescents or out-of-camp populations and few publications reported on the use of existing guidance such as the Minimal Initial Services Package. More interventions for gender-based violence were reported in the grey than the indexed literature, suggesting limited formal research in this area. Engaging affected communities and using community-based sites and personnel are important, but more research is needed on how best to reach underserved populations and to implement community-based approaches.

Prospero registration number: CRD42019125221.

Keywords: child health; health systems evaluation; mental health & psychiatry; public health; systematic review.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram: publication selectionprocess for systematic review on the delivery of sexual and reproductive health interventions to women and children in conflictsettings.

Figure 2

Geographic distribution of included publications.

Figure 3

Publication count by publication year and intervention start year

Figure 4

SRH interventions delivered to women of reproductive age. GBV, gender-based violence; SRH, sexual and reproductive health.

Figure 5

SRH interventions delivered to displaced women of reproductive age living in and outside of camps. SRH, sexual and reproductive health.

Figure 6

Reported SRH interventions delivered to women of reproductive age, by delivery personnel and SRH domain. CHWs, community health workers; F, family planning (including abortion); G, gender-based violence; GBV, gender-based violence; H, HIV/STIs; O, general SRH; SRH, sexual and reproductive health; TBAs, traditional birth attendants.

Figure 7

Reported SRH interventions delivered to women of reproductive age, by delivery sites and SRH domain. F, family planning (including abortion); G, gender-based violence; GBV, gender-based violence; H, HIV/STIs; O, general reproductive health; SRH, sexual and reproductive health.