University of Warwick Medical School, Coventry, West Midlands, United Kingdom.
Center for Health, Human Rights and Development (CEHURD), Kampala, Uganda.
PLoS One. 2021 Apr 29;16(4):e0250976. doi: 10.1371/journal.pone.0250976. eCollection 2021.
The Sustainable Development Goals, which are grounded in human rights, involve empowering women and girls and ensuring that everyone can access sexual and reproductive health and rights (Goal 5). This is the first systematic review reporting interventions involving rights-based approaches for sexual and reproductive health issues including gender-based violence, maternity, HIV and sexually transmitted infections in low and middle-income countries.
To describe the evidence on rights-based approaches to sexual and reproductive health in low and middle-income countries.
EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were: Study design: any interventional study.Population: females aged over 15 living in low and middle-income countries.Intervention: a "rights-based approach" (defined by the author) and/or interventions that the author explicitly stated related to "rights".Comparator: clusters in which no intervention or fewer components of an intervention were in place, or individuals not exposed to interventions, or exposed to fewer intervention components.Outcome: Sexual and reproductive health related outcomes. A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps. The systematic review protocol was registered on PROSPERO (CRD42019158950).
Database searching identified 17,212 records, and 13,404 studies remained after de-duplication. Twenty-four studies were included after title and abstract, full-text and reference-list screening by two authors independently. Rights-based interventions were effective for some included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other sexually transmitted infections, condom use, and awareness of rights improved with intervention, but all relevant studies were at high, critical or serious risk of bias. No study included gender-based violence outcomes.
Considerable risk of bias in all studies means results must be interpreted with caution. High-quality controlled studies are needed urgently in this area.
可持续发展目标以人权为基础，涉及赋予妇女和女孩权力，确保人人都能获得性健康和生殖健康及权利（目标 5）。这是第一项系统评价报告，涉及在中低收入国家实施基于权利的方法干预性健康和生殖健康问题，包括基于性别的暴力、孕产妇、艾滋病毒和性传播感染。
描述中低收入国家基于权利的性健康和生殖健康方法的证据。
直到 2020 年 9 月 1 日，我们检索了 EMBASE、MEDLINE 和 Web of Science。纳入标准为：研究设计：任何干预性研究。人群：年龄在 15 岁以上的中低收入国家的女性。干预措施：一种“基于权利的方法”（由作者定义）和/或作者明确表示与“权利”相关的干预措施。对照：没有干预措施或干预措施较少的集群，或者没有暴露于干预措施的个体，或者暴露于较少干预措施的个体。结局：性健康和生殖健康相关结局。对纳入的研究进行了叙述性综合，并将结局映射出来以确定证据差距。系统评价方案已在 PROSPERO（CRD42019158950）上注册。
数据库搜索确定了 17212 条记录，在去重后有 13404 项研究。经过两位作者独立进行标题和摘要、全文和参考文献筛选后，纳入了 24 项研究。基于权利的干预措施对一些纳入的结局有效，但证据质量较差。艾滋病毒和/或其他性传播感染的检测率、避孕套使用率和权利意识随着干预而提高，但所有相关研究都存在高、关键或严重的偏倚风险。没有研究包括基于性别的暴力结局。
所有研究中都存在相当大的偏倚风险，这意味着结果必须谨慎解释。该领域急需高质量的对照研究。
