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A long way to go: a systematic review to assess the utilisation of sexual and reproductive health services during humanitarian crises
  1. Neha S Singh1,2,
  2. Sarindi Aryasinghe2,
  3. James Smith1,
  4. Rajat Khosla3,
  5. Lale Say3,
  6. Karl Blanchet1
  1. 1Health in Humanitarian Crises Centre, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene and Tropical Medicine, London, UK
  3. 3Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
  1. Correspondence to Dr Neha S Singh; neha.singh{at}


Introduction Women and girls are affected significantly in both sudden and slow-onset emergencies, and face multiple sexual and reproductive health (SRH) challenges in humanitarian crises contexts. There are an estimated 26 million women and girls of reproductive age living in humanitarian crises settings, all of whom need access to SRH information and services. This systematic review aimed to assess the utilisation of services of SRH interventions from the onset of emergencies in low- and middle-income countries.

Methods We searched for both quantitative and qualitative studies in peer-reviewed journals across the following four databases: EMBASE, Global Health, MEDLINE and PsychINFO from 1 January 1980 to 10 April 2017. Primary outcomes of interest included self-reported use and/or confirmed use of the Minimum Initial Service Package services and abortion services. Two authors independently extracted and analysed data from published papers on the effect of SRH interventions on a range of SRH care utilisation outcomes from the onset of emergencies, and used a narrative synthesis approach.

Results Of the 2404 identified citations, 23 studies met the inclusion criteria. 52.1% of the studies (n=12) used quasi-experimental study designs, which provided some statistical measure of difference between intervention and outcome. 39.1% of the studies (n=9) selected were graded as high quality, 39.1% moderate quality (n=9) and 17.4% low quality (n=4). Evidence of effectiveness in increasing service utilisation was available for the following interventions: peer-led and interpersonal education and mass media campaigns, community-based programming and three-tiered network of community-based reproductive and maternal health providers.

Conclusions Despite increased attention to SRH service provision in humanitarian crises settings, the evidence base is still very limited. More implementation research is required to identify interventions to increase utilisation of SRH services in diverse humanitarian crises settings and populations.

  • systematic review
  • health services research
  • maternal health
  • Hiv
  • other infection, disease, disorder, or injury

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  • Handling editor Soumitra Bhuyan

  • Twitter neha_s_singh

  • Contributors NSS and KB led the study. NSS, SA and JS participated in data searching and data analysis. NSS led the writing up of the paper with SA. RK and LS participated in development of the study protocol and reviewed drafts of the paper. All authors contributed to the paper.

  • Funding This work was funded with support from the Department of Reproductive Health and Research, WHO.

  • Disclaimer The authors alone are responsible for the views expressed in this publication, and they do not necessarily represent the decisions, policy or views of WHO.

  • Competing interests All authors declare support from WHO for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous 3 years, no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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