Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W, Toronto, M5S 1V4, Canada.
Centre for Gender and Sexual Health Equity, Vancouver, Canada.
Reprod Health. 2024 Apr 12;21(1):51. doi: 10.1186/s12978-024-01780-7.
BACKGROUND: Most forcibly displaced persons are hosted in low- and middle-income countries (LMIC). There is a growing urbanization of forcibly displaced persons, whereby most refugees and nearly half of internally displaced persons live in urban areas. This scoping review assesses the sexual and reproductive health (SRH) needs, outcomes, and priorities among forcibly displaced persons living in urban LMIC. METHODS: Following The Joanna Briggs Institute scoping review methodology we searched eight databases for literature published between 1998 and 2023 on SRH needs among urban refugees in LMIC. SHR was operationalized as any dimension of sexual health (comprehensive sexuality education [CSE]; sexual and gender based violence [GBV]; HIV and STI prevention and control; sexual function and psychosexual counseling) and/or reproductive health (antental, intrapartum, and postnatal care; contraception; fertility care; safe abortion care). Searches included peer-reviewed and grey literature studies across quantitative, qualitative, or mixed-methods designs. FINDINGS: The review included 92 studies spanning 100 countries: 55 peer-reviewed publications and 37 grey literature reports. Most peer-reviewed articles (n = 38) discussed sexual health domains including: GBV (n = 23); HIV/STI (n = 19); and CSE (n = 12). Over one-third (n = 20) discussed reproductive health, including: antenatal, intrapartum and postnatal care (n = 13); contraception (n = 13); fertility (n = 1); and safe abortion (n = 1). Eight included both reproductive and sexual health. Most grey literature (n = 29) examined GBV vulnerabilities. Themes across studies revealed social-ecological barriers to realizing optimal SRH and accessing SRH services, including factors spanning structural (e.g., livelihood loss), health institution (e.g., lack of health insurance), community (e.g., reduced social support), interpersonal (e.g., gender inequitable relationships), and intrapersonal (e.g., low literacy) levels. CONCLUSIONS: This review identified displacement processes, resource insecurities, and multiple forms of stigma as factors contributing to poor SRH outcomes, as well as producing SRH access barriers for forcibly displaced individuals in urban LMIC. Findings have implications for mobilizing innovative approaches such as self-care strategies for SRH (e.g., HIV self-testing) to address these gaps. Regions such as Africa, Latin America, and the Caribbean are underrepresented in research in this review. Our findings can guide SRH providers, policymakers, and researchers to develop programming to address the diverse SRH needs of urban forcibly displaced persons in LMIC. Most forcibly displaced individuals live in low- and middle-income countries (LMICs), with a significant number residing in urban areas. This scoping review examines the sexual and reproductive health (SRH) outcomes of forcibly displaced individuals in urban LMICs. We searched eight databases for relevant literature published between 1998 and 2023. Inclusion criteria encompassed peer-reviewed articles and grey literature. SRH was defined to include various dimensions of sexual health (comprehensive sexuality education; sexual and gender-based violence; HIV/ STI prevention; sexual function, and psychosexual counseling) and reproductive health (antenatal, intrapartum, and postnatal care; contraception; fertility care; and safe abortion care). We included 90 documents (53 peer-reviewed articles, 37 grey literature reports) spanning 100 countries. Most peer-reviewed articles addressed sexual health and approximately one-third centered reproductive health. The grey literature primarily explored sexual and gender-based violence vulnerabilities. Identified SRH barriers encompassed challenges across structural (livelihood loss), health institution (lack of insurance), community (reduced social support), interpersonal (gender inequities), and individual (low literacy) levels. Findings underscore gaps in addressing SRH needs among urban refugees in LMICs specifically regarding sexual function, fertility care, and safe abortion, as well as regional knowledge gaps regarding urban refugees in Africa, Latin America, and the Caribbean. Self-care strategies for SRH (e.g., HIV self-testing, long-acting self-injectable contraception, abortion self-management) hold significant promise to address SRH barriers experienced by urban refugees and warrant further exploration with this population. Urgent research efforts are necessary to bridge these knowledge gaps and develop tailored interventions aimed at supporting urban refugees in LMICs.
背景:大多数被迫流离失所者都在中低收入国家(LMIC)。被迫流离失所者正在城市化,大多数难民和近一半的国内流离失所者生活在城市地区。本范围审查评估了居住在 LMIC 城市地区的被迫流离失所者的性和生殖健康(SRH)需求、结果和优先事项。
方法:我们遵循乔安娜布里格斯研究所的范围审查方法,在 1998 年至 2023 年期间在八个数据库中搜索关于 LMIC 城市难民的 SRH 需求的文献。SRH 被定义为任何性健康方面(全面性教育[CSE];性和性别暴力[GBV];艾滋病毒和性传播感染预防和控制;性功能和心理性咨询)和/或生殖健康(产前、产时和产后护理;避孕;生育保健;安全堕胎护理)。搜索包括定量、定性或混合方法设计的同行评审和灰色文献研究。
结果:该审查包括来自 100 个国家的 92 项研究:55 项同行评审出版物和 37 项灰色文献报告。大多数同行评审文章(n=38)讨论了性健康领域,包括:GBV(n=23);艾滋病毒/性传播感染(n=19);和 CSE(n=12)。超过三分之一(n=20)讨论了生殖健康,包括:产前、产时和产后护理(n=13);避孕(n=13);生育(n=1);和安全堕胎(n=1)。八项研究同时包括生殖和性健康。大多数灰色文献(n=29)研究了 GBV 脆弱性。研究中的主题揭示了实现最佳 SRH 和获得 SRH 服务的社会生态障碍,包括跨越结构(例如,生计丧失)、卫生机构(例如,缺乏健康保险)、社区(例如,社会支持减少)、人际关系(例如,性别不平等关系)和个人内部(例如,低识字率)层面的因素。
结论:本审查确定了流离失所过程、资源不安全以及多种形式的污名化是导致 SRH 结果不佳的因素,并为城市 LMIC 中的被迫流离失所者获得 SRH 服务造成了障碍。研究结果对动员创新方法(例如,艾滋病毒自我检测)来解决这些差距具有重要意义。非洲、拉丁美洲和加勒比地区在本审查中的研究代表性不足。我们的研究结果可以为 SRH 提供者、政策制定者和研究人员提供指导,制定计划以满足 LMIC 城市中被迫流离失所者的多样化 SRH 需求。
Arch Public Health. 2025-4-9