背景:大多数被迫流离失所者居住在低收入和中等收入国家(LMIC)。被迫流离失所者日益城市化,大多数难民和近一半的国内流离失所者生活在城市地区。这项范围审查评估了性健康和生殖健康(SRH)需求,结果,以及生活在城市LMIC的被迫流离失所者的优先事项。
方法:遵循JoannaBriggs研究所的范围审查方法,我们搜索了八个数据库,以获取1998年至2023年之间发表的有关LMIC城市难民SRH需求的文献。SHR作为性健康的任何方面(全面的性教育[CSE];性暴力和基于性别的暴力[GBV];艾滋病毒和性传播感染预防和控制;性功能和性心理咨询)和/或生殖健康(antental,产时,和产后护理;避孕;生育护理;安全堕胎护理)。搜索包括跨定量的同行评审和灰色文献研究,定性,或混合方法设计。
结果:该综述包括100个国家的92项研究:55篇同行评审出版物和37篇灰色文献报告。大多数同行评审的文章(n=38)讨论了性健康领域,包括:GBV(n=23);HIV/STI(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);生育能力(n=1);和安全流产(n=1)。八个包括生殖健康和性健康。大多数灰色文献(n=29)研究了GBV漏洞。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,包括跨越结构的因素(例如,生计损失),卫生机构(例如,缺乏健康保险),社区(例如,减少社会支持),人际关系(例如,性别不平等的关系),和内心(例如,低识字率)水平。
结论:这篇综述确定了位移过程,资源不安全,以及多种形式的污名作为导致不良SRH结果的因素,以及为城市LMIC中被迫流离失所的个人提供SRH准入障碍。研究结果对动员创新方法如SRH的自我护理策略有影响(例如,艾滋病毒自我检测)解决这些差距。非洲等地区,拉丁美洲,在这篇综述中,加勒比地区在研究中的代表性不足。我们的发现可以指导SRH提供商,政策制定者,和研究人员制定方案,以满足LMIC城市被迫流离失所者的不同SRH需求。大多数被迫流离失所的人生活在低收入和中等收入国家(LMICs),大量居住在城市地区。本范围审查审查了城市LMIC中被迫流离失所者的性健康和生殖健康(SRH)结果。我们检索了8个数据库,查找1998年至2023年之间发表的相关文献。纳入标准包括同行评审的文章和灰色文献。SRH的定义包括性健康的各个方面(全面性教育;性暴力和基于性别的暴力;艾滋病毒/性传播感染预防;性功能,和性心理咨询)和生殖健康(产前,产时,和产后护理;避孕;生育护理;和安全堕胎护理)。我们包括90份文件(53篇同行评审的文章,37份灰色文献报告)跨越100个国家。大多数同行评审的文章都涉及性健康和大约三分之一的生殖健康。灰色文献主要探讨性暴力和基于性别的暴力脆弱性。确定的SRH障碍包括结构性挑战(生计损失),医疗机构(缺乏保险),社区(减少社会支持),人际关系(性别不平等),和个人(低识字率)水平。调查结果强调了在解决低收入国家城市难民的性健康需求方面存在的差距,特别是在性功能方面,生育保健,和安全堕胎,以及关于非洲城市难民的区域知识差距,拉丁美洲,和加勒比海。SRH的自我护理策略(例如,艾滋病毒自我检测,长效自我注射避孕,堕胎自我管理)对解决城市难民经历的SRH障碍具有重要意义,并值得对该人群进行进一步探索。需要紧急的研究努力来弥合这些知识差距,并制定旨在支持低收入国家城市难民的针对性干预措施。
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.
RESULTS: 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.