Refugee Health Program, Global Health Institute, American University of Beirut, Beirut, Lebanon.
Alice Ramez Chagoury School of Nursing, Lebanese American University, Byblos, Lebanon.
Reprod Health. 2021 Mar 8;18(1):58. doi: 10.1186/s12978-021-01108-9.
Women and girls are disproportionately affected in times of conflict and forced displacement, with disturbance in access to healthcare services leading to poor sexual and reproductive health outcomes. The minimal initial service package (MISP) was created to mitigate the consequences of conflict and prevent poor sexual and reproductive health (SRH) outcomes, especially among women and girls. The aim of this narrative review was to explore the SRH response for Syrian refugee women and girls in Lebanon, with a focus on MISP implementation.
A comprehensive literature search was conducted for peer-reviewed articles in 8 electronic databases and multiple grey literature sites for articles published from March 2011 to May 2019. The target population was Syrian refugee women in Lebanon displaced from Syria as a result of the conflict that erupted in March 2011. The selected articles addressed MISP, SRH needs and services, and barriers to service access. A narrative synthesis was conducted, guided by the six main objectives of the MISP.
A total of 254 documents were retrieved, from which 12 peer-reviewed articles and 12 reports were included in the review. All identified articles were descriptive in nature and no studies evaluating MISP or other interventions or programs were found. The articles described the wide range of SRH services delivered in Lebanon to Syrian refugee women. However, access to and quality of these services remain a challenge. Multiple sources reported a lack of coordination, leading to fragmented service provision and duplication of effort. Studies reported a high level of sexual and gender-based violence, pregnancy complications and poor antenatal care compliance, and limited use of contraceptive methods. Very few studies reported on the prevalence of HIV and other STIs, reporting low levels of infection. Multiple barriers to healthcare access were identified, which included system-level, financial, informational and cultural factors, healthcare workers.
This study highlights the main SRH services provided, their use and access by Syrian refugee women in Lebanon. Despite the multitude of services provided, the humanitarian response remains decentralized with limited coordination and multiple barriers that limit the utilization of these services. A clear gap remains, with limited evaluation of SRH services that are pertinent to achieve the MISP objectives and the ability to transition into comprehensive services. Improving the coordination of services through a lead agency can address many of the identified barriers and allow the transition into comprehensive services.
在冲突和被迫流离失所时期，妇女和女孩受到的影响不成比例，获得医疗保健服务的机会受到干扰，导致性健康和生殖健康结果不佳。最小初始服务包（MISP）的创建是为了减轻冲突的后果，防止性健康和生殖健康（SRH）结果不佳，特别是妇女和女孩。本叙述性综述的目的是探讨在黎巴嫩的叙利亚难民妇女的 SRH 应对措施，重点是 MISP 的实施。
对 8 个电子数据库和多个灰色文献网站中的同行评审文章进行了全面的文献检索，这些文章的发表时间为 2011 年 3 月至 2019 年 5 月。目标人群是因 2011 年 3 月爆发的冲突而从叙利亚流离失所到黎巴嫩的叙利亚难民妇女。所选文章涉及 MISP、SRH 需求和服务以及服务获取障碍。根据 MISP 的六个主要目标进行了叙述性综合。
共检索到 254 份文件，其中包括 12 篇同行评审文章和 12 份报告。所有确定的文章均为描述性，没有发现评估 MISP 或其他干预措施或方案的研究。这些文章描述了在黎巴嫩向叙利亚难民妇女提供的广泛的 SRH 服务。然而，这些服务的获取和质量仍然是一个挑战。多个来源报告说协调不力，导致服务提供分散和工作重复。研究报告称存在高度的性暴力和基于性别的暴力、妊娠并发症和产前保健合规性差以及避孕方法的使用有限。很少有研究报告艾滋病毒和其他性传播感染的流行情况，报告感染率较低。确定了多种获取医疗保健的障碍，包括系统层面、财务层面、信息层面和文化层面以及医疗保健工作者。
本研究强调了在黎巴嫩的叙利亚难民妇女所提供的主要 SRH 服务、其使用和获取情况。尽管提供了众多服务，但人道主义反应仍然分散，协调有限，存在多种障碍，限制了这些服务的利用。一个明显的差距仍然存在，对与实现 MISP 目标相关的 SRH 服务的评估有限，并且无法过渡到综合服务。通过一个牵头机构改善服务协调，可以解决许多已确定的障碍，并允许过渡到综合服务。
