The Urban Environment and Disparities in Sexual and Reproductive Health Outcomes in the Global South: a Scoping Review.

By 2050, the Global South will contain three-quarters of the world's urban inhabitants, yet no standardized categorizations of urban areas exist. This makes it challenging to compare sub-groups within cities. Sexual and reproductive health and rights (SRHR) are a critical component of ensuring that populations are healthy and productive, yet SRHR outcomes within and across urban settings vary significantly. A scoping review of the literature (2010-2022) was conducted to describe the current body of evidence on SRHR in urban settings in the Global South, understand disparities, and highlight promising approaches to improving urban SRHR outcomes. A total of 115 studies were identified, most from Kenya (30 articles; 26%), Nigeria (15; 13%), and India (16; 14%), focusing on family planning (56; 49%) and HIV/STIs (43; 37%). Findings suggest significant variation in access to services, and challenges such as gender inequality, safety, and precarious circumstances in employment and housing. Many of the studies (n = 84; 80%) focus on individual-level risks and do not consider how neighborhood environments, concentrated poverty, and social exclusion shape behaviors and norms related to SRHR. Research gaps in uniformly categorizing urban areas and key aspects of the urban environment make it challenging to understand the heterogeneity of urban environments, populations, and SRHR outcomes and compare across studies. Findings from this review may inform the development of holistic programs and policies targeting structural barriers to SRHR in urban environments to ensure services are inclusive, equitably available and accessible, and direct future research to fill identified gaps.

From commitment to implementation: lessons learnt from the first National Strategy for the Reduction of Teenage Pregnancy in Sierra Leone.

This study provides insight into the extent to which public commitment to reduce teenage pregnancy made by the President of Sierra Leone made the issue a political priority and the factors that facilitated and hindered this. Using historical observations from government and civil society actors who were involved in the formulation and implementation of the country's National Strategy for the Reduction of Teenage Pregnancy (NSRTP), the study presents lessons learnt, with a particular focus on advocacy. It does not examine the extent to which the NSRTP was operationalised and its objectives fulfilled. Findings indicate that the availability of locally relevant data as well as advocacy from international and national NGOs were factors that led to the President's commitment and the development of a national strategy. Whilst continued verbal support from political leaders and administrative mechanisms for implementation assured that teenage pregnancy reduction stayed on the political agenda, the scarcity of resources as well as the necessary diversion of efforts and resources to the Ebola epidemic impeded implementation. Overall, the findings demonstrate that public commitments made by political leaders - starting with President Ernest Bai Koroma's public declaration in 2012 - kick-started efforts to reduce teenage pregnancy in Sierra Leone; and that despite inadequate human and financial resources for the implementation of the NSRTP, actions taken by both the government and partners over time have contributed to tangible progress.