Ganle John Kuumuori, Baatiema Leonard, Ayamah Paul, Ofori Charlotte Abra Esime, Ameyaw Edward Kwabena, Seidu Abdul-Aziz, Ankomah Augustine
Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, P. O. Box LG 13 Legon, Accra, Ghana.
Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Accra, Ghana.
Int J Equity Health. 2021 Aug 19;20(1):186. doi: 10.1186/s12939-021-01518-y.
Although evidence suggest that many slum dwellers in low- and middle-income countries have the most difficulty accessing family planning (FP) services, there are limited workable interventions/models for reaching slum communities with FP services. This review aimed to identify existing interventions and service delivery models for providing FP services in slums, and as well examine potential impact of such interventions and service delivery models in low- and middle-income settings.
We searched and retrieved relevant published studies on the topic from 2000 to 2020 from e-journals, health sources and six electronic databases (MEDLINE, Global Health, EMBASE, CINAHL, PsycINFO and Web of Science). Grey and relevant unpublished literature (e.g., technical reports) were also included. For inclusion, studies should have been published in a low- and middle-income country between 2000 and 2020. All study designs were included. Review articles, protocols or opinion pieces were excluded. Search results were screened for eligible articles and reports using a pre-defined criterion. Descriptive statistics and narrative syntheses were produced to summarize and report findings.
The search of the e-journals, health sources and six electronic databases including grey literature and other unpublished materials produced 1,260 results. Following screening for title relevance, abstract and full text, nine eligible studies/reports remained. Six different types of FP service delivery models were identified: voucher schemes; married adolescent girls' club interventions; Willows home-based counselling and referral programme; static clinic and satellite clinics; franchised family planning clinics; and urban reproductive health initiatives. The urban reproductive health initiatives were the most dominant FP service delivery model targeting urban slums. As regards the impact of the service delivery models identified, the review showed that the identified interventions led to improved targeting of poor urban populations, improved efficiency in delivery of family planning service, high uptake or utilization of services, and improved quality of family planning services.
This review provides important insights into existing family planning service delivery models and their potential impact in improving access to FP services in poor urban slums. Further studies exploring the quality of care and associated sexual and reproductive health outcomes as a result of the uptake of these service delivery models are essential. Given that the studies were reported from only 9 countries, further studies are needed to advance knowledge on this topic in other low-middle income countries where slum populations continue to rise.
尽管有证据表明，低收入和中等收入国家的许多贫民窟居民在获得计划生育（FP）服务方面困难最大，但针对贫民窟社区提供计划生育服务的可行干预措施/模式却很有限。本综述旨在确定在贫民窟提供计划生育服务的现有干预措施和服务提供模式，并研究这些干预措施和服务提供模式在低收入和中等收入环境中的潜在影响。
我们从电子期刊、卫生资源以及六个电子数据库（MEDLINE、全球卫生、EMBASE、护理学与健康领域数据库、心理学文摘数据库和科学引文索引）中搜索并检索了2000年至2020年期间关于该主题的相关已发表研究。灰色文献和相关未发表文献（如技术报告）也被纳入。纳入的研究应于2000年至2020年期间在低收入和中等收入国家发表。所有研究设计均被纳入。综述文章、方案或观点文章被排除。使用预先定义的标准对搜索结果进行筛选以获取符合条件的文章和报告。进行描述性统计和叙述性综合分析以总结和报告研究结果。
对电子期刊、卫生资源以及包括灰色文献和其他未发表材料在内的六个电子数据库的搜索产生了1260条结果。经过标题相关性、摘要和全文筛选后，剩下9项符合条件的研究/报告。确定了六种不同类型的计划生育服务提供模式：代金券计划；已婚少女俱乐部干预措施；柳树家庭咨询和转诊计划；固定诊所和卫星诊所；特许计划生育诊所；以及城市生殖健康倡议。城市生殖健康倡议是针对城市贫民窟的最主要计划生育服务提供模式。关于所确定的服务提供模式的影响，综述表明，所确定的干预措施导致对城市贫困人口的针对性提高、计划生育服务提供效率提高、服务的高接受率或利用率以及计划生育服务质量提高。
本综述为现有的计划生育服务提供模式及其在改善贫困城市贫民窟获得计划生育服务方面的潜在影响提供了重要见解。进一步研究探索由于采用这些服务提供模式而产生的护理质量以及相关的性与生殖健康结果至关重要。鉴于仅9个国家报告了相关研究，需要进一步开展研究以增进其他低收入和中等收入国家（贫民窟人口持续增加）在该主题上的知识。
