Sexual and Reproductive Health in Humanitarian Settings : an integrative literature review

Abstract

Sexual and reproductive health is a human right. A complex challenge is its availability in all circumstances and for all, including during humanitarian crises. The number of people that are displaced, refugees and asylum seekers around the world is increasing. Crisis, such as war, violence, natural disasters and epidemics are examples where daily life changes and healthcare service needs to expand, including sexual and reproductive health services.

Inter-Agency Working Group (2021a) states that research in sexual and reproductive health service delivery and access to services in humanitarian settings is a topic where more research is needed. The aim of this study was to increase awareness of sexual and reproductive health in humanitarian settings. The objectives of this study were to examine the barriers and facilitators for sexual and reproductive health service delivery and people in need of the services in humanitarian settings. The research questions of the study were: 1. What are the barriers and facilitators for sexual and reproductive health services delivery in humanitarian settings? 2. What are the barriers and facilitators for people seeking sexual and reproductive health services in humanitarian settings?

Integrative literature review was the used method in seeking answers to the research questions. The research process was followed and reflected by Whittemore and Knafl´s (2005) five stages of integrative literature review. Data search was conducted in May 2021 using five databases. Studies identified from databases were included according to criteria. Out of 175 studies, 20 research studies were included in the review. Data were assessed by using the STROBE quality assessment tool. Data analysis was done using data driven inductive thematic analysis. Thematic analysis was followed and reflected by the six phases of thematic analysis according to Nowell et al. (2017). Themes and subthemes emerged and two main factors, human related and institutional related, were identified addressing the research questions. A wide variety of results was discovered.

Extensive results on sexual and reproductive health service delivery in humanitarian settings were found in areas of strategies and funding, leadership and management, service provision, training, safety and attitudes of service providers. The identified results for people seeking sexual and reproductive health services were found in knowledge, behavioral and attitudinal factors. Also, outreach and health programs were discovered. Mistreatment, stigma, religious and socio-cultural, as well as service access and self-testing came across in the results. It was noticed that there was a lack of research data covering disaster risk reduction/mitigation and addressing vulnerable groups in humanitarian settings under the umbrella of sexual and reproductive health.

The result of data collection showed that facilitators to sexual and reproductive health service delivery were the most covered emphasis in research studies. The result of data collection showed that a small amount of research covered disaster risk reduction and the preparedness phase of a disaster.

Keywords: sexual and reproductive health, humanitarian settings, barriers and facilitators, integrative literature review