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Abstract
Introduction Syria’s protracted conflict has devastated the health system reversing progress made on maternal health preconflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria.
Methods We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a microcontext in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean section and age at pregnancy.
Results Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean sections, maternal age and perinatal care. 12 studies reported caesarean section rates; these varied from 16% to 64% of all births: northern Syria (19%–45%,) Damascus (16%–54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77 746 births across 17 facilities, trend data for caesarean sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean section births. There was notable geographical and interfacility variation in the findings.
Conclusion The quality of available literature was poor with country-level generalisations. Research which explores microcontexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
- Maternal health
- Obstetrics
- Public Health
- Surgery
Data availability statement
Data are available on reasonable request. Data used in this study are anonymised, aggregated data on consultations relating to maternal health and the total number of monthly consultations from 17 of SAMS’ (Syrian American Medical Society) health facilities in northwest Syria. Data requests can be made to the corresponding author.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Data availability statement
Data are available on reasonable request. Data used in this study are anonymised, aggregated data on consultations relating to maternal health and the total number of monthly consultations from 17 of SAMS’ (Syrian American Medical Society) health facilities in northwest Syria. Data requests can be made to the corresponding author.
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Footnotes
Handling editor Seema Biswas
Twitter @fares_alahdab, @AulaAb
Contributors AAi, MoH and MWA conceptualised and designed the study. SB and AS analysed the data under the guidance of AAi, MoH and MWA. SB, AAi, MWA, AS and MoH wrote the first draft of the manuscript and AAb, IH, AT, MuH, RL, FA and MK all edited and inputted heavily into the writing and editing. AA takes overall responsibility for the work conducted in the study.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
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