Background By 2030, the Sustainable Development Goals aim to achieve human rights for all. This involves empowering women and girls (Goal 5) and ensuring that everyone can access sexual and reproductive health rights (Goal 3). This is the first systematic review of the effectiveness of rights-based approaches to sexual and reproductive health including gender-based violence (GBV), maternity, HIV and sexually transmitted infections (STI).
Aim To determine the effectiveness of rights-based approaches to sexual and reproductive health in low and middle-income countries (LMICs).
Methods Search Strategy EMBASE, MEDLINE and Web of Science were searched until 9/1/2020. Inclusion criteria were:
Study design: any interventional study
Population: adolescent and adult females
Intervention: a ‘rights–based approach’ (defined by the author) and/or interventions that the author explicitly stated related to ‘rights’.
Study selection, data extraction and risk of bias assessment was undertaken independently by two authors.
Synthesis A narrative synthesis of included studies was undertaken, and outcomes mapped to identify evidence gaps.
Risk of bias The RoB-2 tool and the ROBINS-I tool were used to assess risk of bias of cluster-randomised studies and non-randomised studies respectively. Uncontrolled before-after studies based on two cross-sectional surveys were given an overall assessment of serious or critical risk of bias.
Results Of 17,212 records identified through database searching, 13,404 records remained after de-duplication. Sixty-nine studies remained following title and abstract screening, of which seven were included after full-text screening. Reference list screening identified seventeen studies.
Rights-based interventions were effective for most included outcomes, but evidence was of poor quality. Testing uptake for HIV and/or other STIs improved with intervention but all relevant studies were at critical or serious risk of bias. Condom use improved with intervention (although one study showed no change), but all relevant studies were at high, serious or critical risk of bias. Awareness of rights improved with intervention, but all four studies were at critical or serious risk of bias.
Conclusion This is the first systematic review to evaluate the effect of rights-based approaches to sexual and reproductive health including maternity, GBV and STIs/HIV. Considerable risk of bias in all studies means results must be interpreted with caution.
Priority and relevance Rights-based approaches are often recommended but high-quality controlled studies are needed urgently to determine if they are effective for sexual and reproductive health in LMICs.
This systematic review was written through a collaboration between the University of Warwick and the Center for Health Human Rights & Development (CEHURD), Uganda.
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