Alibhai Kameela Miriam, Ziegler Bianca R, Meddings Louise, Batung Evans, Luginaah Isaac
Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
DeGroote School of Medicine, McMaster University, 1280 Main Street W, Hamilton, ON, L8S 4L8, Canada.
Confl Health. 2022 Jun 11;16(1):33. doi: 10.1186/s13031-022-00459-9.
It is estimated that over 930 million people live in fragile and conflict-affected situations (FCAS) worldwide. These regions, characterized by violence, civil unrest, and war, are often governed by corrupt administrations who are unwilling to provide their citizens with basic human rights. Individuals living in FCAS face health inequities; however, women are disproportionally affected and face additional barriers to accessing sexual and reproductive services, including antenatal care (ANC). This systematic review aims to identify the factors that impact ANC usage in the 37 countries or regions classified as FCAS in 2020 by The World Bank.
Using the PRISMA guidelines, a systematic search of five databases (SCOPUS, Web of Science, PubMed, EMBASE, and CINAHL) was conducted. Results were limited to human studies, written in English, and published between January 2002 and January 2022. Studies that identified factors affecting utilization of ANC or maternal health services were included for review and critically appraised using the National Institute of Health's Quality Assessment Tools. Findings were summarized using a narrative synthesis approach.
The database search yielded 26,527 studies. After title, abstract and full-text review, and exclusion of duplicate articles, 121 studies remained. Twenty-eight of the 37 FCAS were represented in the included studies. The studies highlighted that women in FCAS' are still not meeting the World Health Organization's 2002 recommendation of four ANC visits during pregnancy, a recommendation which has since been increased to eight visits. The most cited factors impacting ANC were socioeconomic status, education, and poor quality of ANC. Despite all studies being conducted in conflict-affected regions, only nine studies explicitly identified conflict as a direct barrier to accessing ANC.
This review demonstrated that there is a paucity in the literature examining the direct and indirect impacts of conflict on ANC utilization. Specifically, research should be conducted in the nine FCAS that are not currently represented in the literature. To mitigate the barriers that prevent utilization of maternal health services identified in this review, policy makers, women utilizing ANC, and global organizations should attempt to collaborate to enact policy change at the local level.
据估计，全球有超过9.3亿人生活在脆弱和受冲突影响的地区（FCAS）。这些地区的特点是暴力、内乱和战争，往往由腐败的政府治理，这些政府不愿为其公民提供基本人权。生活在FCAS地区的个人面临健康不平等；然而，女性受到的影响尤为严重，在获得性健康和生殖服务（包括产前护理，ANC）方面面临额外障碍。本系统综述旨在确定影响2020年世界银行归类为FCAS的37个国家或地区中ANC使用情况的因素。
按照PRISMA指南，对五个数据库（SCOPUS、科学网、PubMed、EMBASE和CINAHL）进行了系统检索。结果仅限于英文撰写的、2002年1月至2022年1月发表的人体研究。纳入那些确定影响ANC利用或孕产妇保健服务利用因素的研究进行综述，并使用美国国立卫生研究院的质量评估工具进行严格评估。研究结果采用叙述性综合方法进行总结。
数据库检索产生了26527项研究。经过标题、摘要和全文审查，并排除重复文章后，剩下121项研究。纳入研究涵盖了37个FCAS地区中的28个。这些研究强调，FCAS地区的女性仍未达到世界卫生组织2002年关于孕期进行四次ANC检查的建议，该建议后来已增加到八次。影响ANC的最常被提及的因素是社会经济地位、教育程度和ANC质量差。尽管所有研究都是在受冲突影响地区进行的，但只有九项研究明确将冲突确定为获得ANC的直接障碍。
本综述表明，关于冲突对ANC利用的直接和间接影响的文献很少。具体而言，应在目前文献中未涉及的九个FCAS地区开展研究。为了减轻本综述中确定的阻碍孕产妇保健服务利用的障碍，政策制定者、使用ANC的女性和全球组织应尝试合作，在地方层面实施政策变革。
