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

Natalia V Lewis; Muzrif Munas; Manuela Colombini; Ana Flavia d'Oliveira; Stephanie Pereira; Satya Shrestha; Thilini Rajapakse; Amira Shaheen; Poonam Rishal; Abdulsalam Alkaiyat; Alison Richards; Claudia M Garcia-Moreno; Gene S Feder; Loraine J Bacchus

doi:10.1136/bmjopen-2021-051924

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

Natalia V Lewis^*, Muzrif Munas, Manuela Colombini, Ana Flavia d'Oliveira, Stephanie Pereira, Satya Shrestha, Thilini Rajapakse, Amira Shaheen, Poonam Rishal, Abdulsalam Alkaiyat, Alison Richards, Claudia M Garcia-Moreno, Gene S Feder, Loraine J Bacchus

^*Corresponding author for this work

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Abstract

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/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's 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's needs and expectations.

PROSPERO REGISTRATION NUMBER: CRD42019137167.

Original language	English
Article number	e051924
Number of pages	15
Journal	BMJ Open
Volume	12
Issue number	2
DOIs	https://doi.org/10.1136/bmjopen-2021-051924
Publication status	Published - 22 Feb 2022

Bibliographical note

Funding Information:
Funding This research was funded by the National Institute for Health Research (NIHR) (17/63/125) using UK aid from the UK Government to support global health research. AR was funded by the NIHR Applied Research Collaboration West (NIHR ARC West).

Publisher Copyright:
© Authors 2022

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HERA: HERA - Healthcare Responding to Violence and Abuse
Feder, G. S. (Principal Investigator), Bacchus, L. J. (Co-Investigator), Lambert, H. S. (Co-Investigator), Colombini, M. (Co-Investigator), Evans, M. A. (Co-Investigator), Lewis, N. (Co-Investigator), Lewis, N. (Co-Investigator), Knipe, D. (Co-Investigator), Dheensa, S. (Co-Investigator), Capelas Barbosa, E. (Researcher), Hawcroft, C. S. (Manager), Martens, P. (Administrator), D'Oliveira, A. F. P. L. (Principal Investigator), Schraiber, L. (Co-Investigator), Aguiar, J. (Researcher), Guida, C. (Researcher), Pereira, S. (Researcher), Azeredo, Y. (Researcher), dos Reis, M. (Researcher), Kalichman, B. (Researcher), Portilho, N. (Researcher), Shaheen, A. (Principal Investigator), Alkaiyat, A. S. (Co-Investigator), Hashaloom, R. (Researcher), Alkhayyat, A. (Researcher), Halaseh, R. (Researcher), Odeh, H. (Researcher), Jerries, I. (Researcher), Eshtayeh, S. (Researcher), Khanfer, H. (Researcher), Amer, M. (Researcher), Nazzal, Z. (Researcher), Devi Pun, K. (Principal Investigator), Koju, R. (Co-Investigator), Rishal, P. (Co-Investigator), Raj Bhatta, P. (Researcher), Tiwari, S. (Researcher), Shrestha, S. (Researcher), Rajapakse, T. N. (Principal Investigator), Dass, G. C. (Researcher), Mohamed Munas, M. (Researcher), Siriwardhana, P. (Researcher), De Silva, L. (Researcher), Silva, T. (Researcher), Aroos, A. (Researcher) & Garcia Moreno, C. (Co-Investigator)
1/04/17 → 1/11/21
Project: Research

Cite this

Lewis, N. V., Munas, M., Colombini, M., d'Oliveira, A. F., Pereira, S., Shrestha, S., Rajapakse, T., Shaheen, A., Rishal, P., Alkaiyat, A., Richards, A., Garcia-Moreno, C. M., Feder, G. S., & Bacchus, L. J. (2022). Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries: a mixed-methods systematic review. BMJ Open, 12(2), Article e051924. https://doi.org/10.1136/bmjopen-2021-051924

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

abstract = "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/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's 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's needs and expectations.PROSPERO REGISTRATION NUMBER: CRD42019137167.",

author = "Lewis, {Natalia V} and Muzrif Munas and Manuela Colombini and d'Oliveira, {Ana Flavia} and Stephanie Pereira and Satya Shrestha and Thilini Rajapakse and Amira Shaheen and Poonam Rishal and Abdulsalam Alkaiyat and Alison Richards and Garcia-Moreno, {Claudia M} and Feder, {Gene S} and Bacchus, {Loraine J}",

note = "Funding Information: Funding This research was funded by the National Institute for Health Research (NIHR) (17/63/125) using UK aid from the UK Government to support global health research. AR was funded by the NIHR Applied Research Collaboration West (NIHR ARC West). Publisher Copyright: {\textcopyright} Authors 2022",

year = "2022",

month = feb,

day = "22",

doi = "10.1136/bmjopen-2021-051924",

language = "English",

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Lewis, NV, Munas, M, Colombini, M, d'Oliveira, AF, Pereira, S, Shrestha, S, Rajapakse, T, Shaheen, A, Rishal, P, Alkaiyat, A, Richards, A, Garcia-Moreno, CM, Feder, GS & Bacchus, LJ 2022, 'Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries: a mixed-methods systematic review', BMJ Open, vol. 12, no. 2, e051924. https://doi.org/10.1136/bmjopen-2021-051924

TY - JOUR

T1 - Interventions in sexual and reproductive health services addressing violence against women in low-income and middle-income countries

T2 - a mixed-methods systematic review

AU - Lewis, Natalia V

AU - Munas, Muzrif

AU - Colombini, Manuela

AU - d'Oliveira, Ana Flavia

AU - Pereira, Stephanie

AU - Shrestha, Satya

AU - Rajapakse, Thilini

AU - Shaheen, Amira

AU - Rishal, Poonam

AU - Alkaiyat, Abdulsalam

AU - Richards, Alison

AU - Garcia-Moreno, Claudia M

AU - Feder, Gene S

AU - Bacchus, Loraine J

N1 - Funding Information: Funding This research was funded by the National Institute for Health Research (NIHR) (17/63/125) using UK aid from the UK Government to support global health research. AR was funded by the NIHR Applied Research Collaboration West (NIHR ARC West). Publisher Copyright: © Authors 2022

PY - 2022/2/22

Y1 - 2022/2/22

N2 - 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/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's 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's needs and expectations.PROSPERO REGISTRATION NUMBER: CRD42019137167.

AB - 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/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's 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's needs and expectations.PROSPERO REGISTRATION NUMBER: CRD42019137167.

U2 - 10.1136/bmjopen-2021-051924

DO - 10.1136/bmjopen-2021-051924

M3 - Article (Academic Journal)

C2 - 35193906

SN - 2044-6055

VL - 12

JO - BMJ Open

JF - BMJ Open

IS - 2

M1 - e051924

ER -

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

Abstract

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