Neal Sarah, Stone Nicole, Ingham Roger
Department of Social Statistics and Demography, Social Sciences, University of Southampton, Southampton, S017 1BJ, UK.
Centre for Sexual Health Research, Department of Psychology, University of Southampton, Southampton, S017 1BJ, UK.
BMC Public Health. 2016 Mar 4;16:225. doi: 10.1186/s12889-016-2868-5.
Young women in conflict-affected regions are at risk of a number of adverse outcomes as a result of violence, economic deterioration and the breakdown of community structures and services. This paper presents the findings of a systematic review of quantitative literature reporting how key sexual and reproductive health (SRH) outcomes among young women under the age of 20 years are affected by exposure to armed conflict; namely, sexual debut, first marriage and first birth. Increases in these outcomes among young women are all associated with potential negative public health consequences. It also examines and documents possible causal pathways for any changes seen.
To fit with our inclusion criteria, all reviewed studies included outcomes for comparable populations not exposed to conflict either temporally or spatially. A total of 19 studies with results from 21 countries or territories met our inclusion criteria; seven presented findings on marriage, four on fertility and eight on both of these outcomes. Only one study reporting on sexual debut met our criteria.
Findings show clear evidence of both declines and increases in marriage and childbirth among young women in a range of conflict-affected settings. Several studies that showed increases in marriage below the age of 20 years reported that such increases were concentrated in the younger teenagers. Trends in fertility were predominantly driven by marriage patterns. Suggested causal pathways for the changes observed could be grouped into three categories: involuntary, gender and psycho-social and economic and material factors.
The review reveals a paucity of literature on the impact of conflict on SRH outcomes of young women. Further quantitative and qualitative studies are needed to explore how conflict influences SRH events in young women over both the short- and longer-term.
受冲突影响地区的年轻女性因暴力、经济恶化以及社区结构和服务的崩溃而面临一系列不良后果的风险。本文介绍了一项对定量文献的系统综述结果，该综述报告了20岁以下年轻女性的主要性与生殖健康（SRH）结果如何受到武装冲突的影响；即首次性行为、初婚和首次生育。年轻女性中这些结果的增加都与潜在的负面公共卫生后果相关。它还研究并记录了所观察到的任何变化可能的因果途径。
为符合我们的纳入标准，所有纳入综述的研究都纳入了在时间或空间上未接触冲突的可比人群的结果。共有19项来自21个国家或地区的研究结果符合我们的纳入标准；7项研究呈现了关于婚姻的结果，4项关于生育，8项关于这两个结果。只有一项关于首次性行为的研究符合我们的标准。
研究结果表明，在一系列受冲突影响的环境中，年轻女性的婚姻和生育既有下降也有上升的明显证据。几项显示20岁以下婚姻增加的研究报告称，这种增加集中在青少年早期。生育趋势主要由婚姻模式驱动。观察到的变化的建议因果途径可分为三类：非自愿、性别和心理社会以及经济和物质因素。
该综述揭示了关于冲突对年轻女性性与生殖健康结果影响的文献匮乏。需要进一步开展定量和定性研究，以探索冲突如何在短期和长期内影响年轻女性的性与生殖健康事件。
