Citizen engagement in public services in low‐ and middle‐income countries: A mixed‐methods systematic review of participation, inclusion, transparency and accountability (PITA) initiatives

IntroductionGlobally, about half of all pregnancies are unintended and/or unwanted and three-fifths of these end in induced abortion. When faced with a choice to terminate pregnancy, women’s abortion decision-making processes are often complex and multiphasic and maybe amplified in low- and middle-income countries (LMICs) which bear the major burden of abortion-related morbidity and mortality. Our review aims to (1) describe abortion decision-making trajectories for women in LMICs and (2) investigate factors influencing the choice of abortion decision-making trajectories in LMICs.Methods and analysisWe will search and retrieve published and unpublished qualitative, quantitative and mixed-methods, community and/or hospital-based studies conducted in LMICs from 1 January 2000 up to 16 February 2021. We will search Ovid Medline, Ovid EMBASE, Ovid PsycInfo, Ovid Global Health, Web of Science (including Social Science Citation Index), Scopus, IBSS, CINAHL via EBSCO, WHO Global Index Medicus, the Cochrane Library, WHO website, ProQuest and Google Scholar. We will search reference lists of eligible studies and contact experts for additional data/information, if required. We will extract all relevant data to answer our research questions and assess study quality using the appropriate appraisal tools. Depending on the extracted data, our analysis will use sequential or convergent synthesis methods proposed by Hong et al. For qualitative studies, we will synthesise evidence using thematic synthesis, meta-ethnography or ‘best-fit’ framework synthesis; and for quantitative findings, we will provide a narrative synthesis and/or meta-analysis. We will do sensitivity analyses and assess confidence in our findings using Grades of Recommendation, Assessment, and Evaluation –Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQUal) for qualitative findings and Grades of Recommednation, Assessment, and Evaluation (GRADE) for quantitative findings.Ethics and disseminationWe did not require ethics approval for this systematic review. We will publish our findings in an open-access peer-reviewed journal with global and maternal health readership. We will also present our findings at national and international scientific conferences.

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Interventions in sexual and reproductive health services addressing violence against women in low- and middle- income countries: a mixed-methods systematic review

10.1101/2021.11.18.21266456 ◽

2021 ◽

Author(s):

Natalia V Lewis ◽

Muzrif Munas ◽

Manuela Colombini ◽

Ana Flavia Oliveira ◽

Stephanie Pereira ◽

...

Keyword(s):

Systematic Review ◽

Mixed Methods ◽

Cost Effectiveness ◽

Reproductive Health ◽

Health Systems ◽

Violence Against Women ◽

Sexual And Reproductive Health ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Objectives. To synthesise evidence on the effectiveness, cost-effectiveness, and barriers to responding to violence against women (VAW) in sexual and reproductive health (SRH) services in low- and middle-income countries (LMICs). Design. Mixed-methods systematic review. Data sources. Medline, Embase, Psycinfo, Cochrane, Cinahl, IMEMR, Web of Science, Popline, Lilacs, WHO RHL, ClinicalTrials.gov, Google, Google Scholar, websites of key organisations through December 2019. Eligibility criteria. Studies of any design that evaluated VAW interventions in SRH services in LMICs. Data extraction and synthesis. Concurrent narrative quantitative and thematic qualitative syntheses, integration through line of argument and mapping onto a logic model. Two reviewers extracted data and appraised quality. Results. 26 studies of varied interventions using heterogeneous outcomes. Of ten interventions that strengthened health systems capacity to respond to VAW during routine SRH consultation, three reported no harm and reduction in some types of violence. Of nine interventions that strengthened health systems and communities capacity to respond to VAW, three reported conflicting effects on re-exposure to some types of VAW and mixed effect on SRH. The interventions increased identification of VAW but had no effect on the provision (75-100%) and uptake (0.6-53%) of referrals to VAW services. Of seven psychosocial interventions in addition to SRH consultation that strengthened women readiness to address VAW, four reduced re-exposure to some types of VAW and improved health. Factors that disrupted the pathway to better outcomes included accepting attitudes towards VAW, fear of consequences, and limited readiness of the society, health systems, and individuals. No study evaluated cost-effectiveness. Conclusions. Some VAW interventions in SRH services reduced re-exposure to some types of VAW and improved some health outcomes in single studies. Future interventions should strengthen capacity to address VAW across health systems, communities, and individual women. First-line support should be better tailored to women needs and expectations. PROSPERO protocol CRD42019137167.

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