Support for sexual and reproductive health and rights in Sub-Saharan Africa: a new index based on World Values Survey data.

BACKGROUND: Addressing attitudes is central to achieving sexual and reproductive health and rights (SRHR) and Agenda 2030. We aimed to develop a comprehensive index to measure attitudinal support for SRHR, expanding opportunities for global trend analyses and tailored interventions. METHODS: We designed a new module capturing attitudes towards different dimensions of SRHR, collected via the nationally representative World Values Survey in Ethiopia, Kenya, and Zimbabwe during 2020-2021 (n = 3,711). We used exploratory factor analysis of 58 items to identify sub-scales and an overall index. Adjusted regression models were used to evaluate the index according to sociodemographic characteristics, stratified by country and sex. RESULTS: A 23-item, five-factor solution was identified and used to construct sub-indices reflecting support for: (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. These five sub-indices performed well across countries and socioeconomic subgroups and were combined into a comprehensive "SRHR Support Index", standardized on a 1-100 scale (mean = 39.19, SD = 15.27, Cronbach's alpha = 0.80) with higher values indicating more support for SRHR. Mean values were highest in Kenya (45.48, SD = 16.78) followed by Ethiopia (40.2, SD = 13.63), and lowest in Zimbabwe (32.65, SD = 13.77), with no differences by sex. Higher education and being single were associated with more support, except in Ethiopia. Younger age and urban residence correlated with more support among males only. CONCLUSION: The SRHR Support Index has the potential to broaden SRHR attitude research from a comprehensive perspective - addressing the need for a common measure to track progress over time.

Sexual and reproductive health and rights (SRHR) are becoming increasingly polarized worldwide, but researchers have previously not been able to fully measure what people think about SRHR. More research about this topic is needed to address discriminatory norms and advance SRHR for all. In this study, we added new questions to the World Values Survey collected in Ethiopia, Kenya, and Zimbabwe during 2020­2021. We used statistical methods to develop an index capturing to what extent individuals' attitudes were supportive of SRHR. This index, which we call the SRHR Support Index, included 23 survey questions reflecting support for five related dimensions of SRHR. Those dimensions were (1) sexual and reproductive rights, (2) neighborhood sexual safety, (3) gender-equitable relationships, (4) equitable masculinity norms, and (5) SRHR interventions. We found that individuals in Kenya were more supportive of SRHR, followed by Ethiopia and then Zimbabwe. There were no differences in support of SRHR between men and women, but individuals who were single and those with higher education were more supportive of SRHR, except in Ethiopia. Younger men living in urban areas were also more supportive. Our SRHR Support Index enables researchers, policymakers, and others to measure attitudes to SRHR in countries across the world and over time, based on new data from the World Values Survey that are readily available online. If combined with other sources of data, researchers can also investigate how people's support of SRHR is linked to, for example, health and policy.

Celebrating Africa's first endowed chair in sexual and reproductive health and rights.

This month, April 2024, the University of Benin, a federally-funded university in Southern Nigeria announced the first endowed professorial chair in sexual and reproductive health and rights (SRHR) in sub-Saharan Africa, and possibly the first such chair globally. This professorship is named in honour of Friday Okonofua1, the irrepressible champion who is a trailblazer in women's health, social advocate for women's social advancement, lead founder of the University's African Centre of Excellence in Reproductive Health, and founder of Nigeria's leading non-governmental organization, the Women's Health and Action Research Centre and the African Journal of Reproductive Health. The new professorship will be crucial in deepening and scaling up reproductive health curricula at the University of Benin, by drawing upon the principles and models of transparency, excellence, and accountability that Friday Okonofua has championed over several years. The University's Registrar alluded to this approach by explaining that the endowment "will strengthen the leadership of the University of Benin in Nigeria in this area of public health and educational delivery.

Ce mois-ci, en avril 2024, l'Université du Bénin, une université financée par le gouvernement fédéral dans le sud du Nigéria, a annoncé la création de la première chaire professorale dotée en santé et droits sexuels et reproductifs (SDSR) en Afrique subsaharienne, et peut-être la première chaire de ce type au monde. Cette chaire est nommée en l'honneur de Friday Okonofua1, champion irrépressible, pionnier de la santé des femmes, défenseur social de la promotion sociale des femmes, fondateur principal du Centre d'excellence africain en santé reproductive de l'université et fondateur de la principale organisation non gouvernementale du Nigeria, le Centre de recherche sur la santé et l'action des femmes et l'African Journal of Reproductive Health. La nouvelle chaire sera cruciale pour approfondir et élargir les programmes de santé reproductive à l'Université du Bénin, en s'appuyant sur les principes et les modèles de transparence, d'excellence et de responsabilité que Friday Okonofua défend depuis plusieurs années. Le registraire de l'Université a fait allusion à cette approche en expliquant que la dotation « renforcera le leadership de l'Université du Bénin au Nigeria dans ce domaine de la santé publique et de l'enseignement.

Use of digital media by adolescents for sexual and reproductive health and rights communication in sub-Saharan Africa: a protocol for systematic review.

BACKGROUND: Within the sub-Saharan African region, there is a growing concern for sexual and reproductive health and rights communication, and more particularly, for adolescents. Given the existing barriers associated with face-to-face access, the need to use digital media to access information and services has become desirable and imperative, especially so due to the COVID-19 pandemic. However, in sub-Saharan Africa, a synthesis of evidence that informs adolescents' digital media engagements for sexual and reproductive health and rights (SRHR) communication is limited. This systematic review therefore aims to examine and synthesize evidence on use of digital media for sexual and reproductive health and rights communication by adolescents in sub-Saharan Africa. METHODS: A search for peer-reviewed articles will be conducted in PubMed, ScienceDirect, Scopus, Embase, Web of Science, PsychINFO and Google Scholar with emphasis on those published between 2000 and 2023. Only observational and qualitative studies will be included. Quality assessment of included articles will be done using standardized checklists from the Joanna Briggs Institute. Both descriptive and narrative summaries will be used to appraise evidence from included studies. DISCUSSION: This review will be essential in providing information on the types of digital media adolescents use, the various SRHR issues they use this platform to address and their reasons for using it and associated challenges. It will also contribute to the advocacy for the inclusion of these technologies in the teaching and learning, provision of and access to SRHR information and services by teachers, public health providers and peer educators in the subregion. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020211491. This protocol follows the PRISMA-P guidelines for reporting systematic reviews.

Being both a grandmother and a health worker: experiences of community-based health workers in addressing adolescents' sexual and reproductive health needs in rural Zambia.

INTRODUCTION: Community-based health workers (CBHWs) possess great potential to be the missing link between the community and the formal health system for improving adolescents' access to sexual and reproductive health and rights (SRHR) information and services. Yet, their role in addressing adolescents' SRHR within the context of the community-based health system has received very little attention. This paper analyses how CBHWs experience and perceive their role in addressing adolescents' SRHR needs in rural Zambia, including the possible barriers, dilemmas, and opportunities that emerge as CBHWs work with adolescents. METHODS: Between July and September 2019, we conducted 14 in-depth interviews with 14 community-based health workers recruited across 14 different communities in the central province of Zambia. The interviews were focused on eliciting their experiences and perceptions of providing sexual and reproductive health services to adolescents. Charmaz's grounded theory approach was used for the analysis. RESULTS: We present the core category "being both a grandmother and a CBHW", which builds upon four categories: being educators about sexual and reproductive health; being service providers and a link to SRHR services; being advocates for adolescents' SRHR; and reporting sexual violence. These categories show that CBHWs adopt a dual role of being part of the community (as a grandmother) and part of the health system (as a professional CBHW), in order to create/maximise opportunities and navigate challenges. CONCLUSION: Community-based health workers could be key actors providing context-specific comprehensive SRHR information and services that could span all the boundaries in the community-based health system. When addressing adolescents SRHR, playing dual roles of being both a grandmother and a professional CBHW were sometimes complimentary and at other times conflicting. Additional research is required to understand how to improve the role of CBHWs in addressing adolescents and young people's sexual and reproductive health.

Refugee women's and providers' perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad.

BACKGROUND: Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. METHODS: We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. RESULTS: Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. CONCLUSIONS: Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.

The importance of insufficient national data on sexual and reproductive health and rights in international databases.

Looking at SRHR as an isolated set of elements, as is the current practice, does not do justice to the needs and rights of people and communities and may be one of the reasons why challenges remain in the attainment of SRHR for all. SRHR Infographic snapshots were developed for all 194 WHO Member States and included 120 indicators covering a broad range of policy, health systems and service delivery interventions. The snapshots were created using data less than 10 years old publicly available in data repositories maintained by international and global agencies. Data availability was not consistent across countries with low and lower-middle income countries having higher data availability (71%) compared to high income countries (40%). SRHR data that is easily accessible and consistently reported can improve accountability and opportunities for learning to improve people-centred approaches to accelerate the attainment of SRHR for all.

"Even when you write with a pencil there is an eraser to clean it": Examining men's conceptualisations of and involvement in emergency contraceptive use in Accra, Ghana.

Emergency contraceptive pills are an essential and unique post-coital method to avoid a pregnancy, with evidence showing the significant role men can have in procurement and decisions to use. Global Health recommendations specify that emergency contraceptive pills be used sparingly and under specific conditions. This increasingly misaligns with the myriad conceptualisations and rationales among the public for why they choose to use emergency contraceptive pills. There has been a paucity of research aiming to understanding men's involvement and how they shape women's access, choice, and autonomy. This study interrogates how emergency contraceptive pills are conceptualised by men in James Town, Ghana, and how this intersects with their motivations to be involved in its use. Mixed method data from a survey (n = 270) and in-depth interviews (n = 37) were collected between July 2020 and January 2021. The analysis examines men's framings of emergency contraceptive pills and how these shape their involvement in its use. Men's knowledge of post-coital contraceptives was high, while knowledge of the specific term 'emergency contraception' was lower. While some men understood the pills in ways that aligned to Global Health framings, many more men saw emergency contraceptive pills as another means of pregnancy prevention in line with other contraceptives. This included its conceptualisation as a contraceptive that facilitates pleasurable (condomless) and spontaneous sex. Gendered perceptions of women who use emergency contraceptive pills were bound in sexual stigma, and men indicated that emergency contraceptive pills were a directly observable form of contraception that they could pressure their partner into using. Understanding plural conceptualisations away from 'emergency' are necessary to create policies and programmes that account for men's involvement. This includes understanding how emergency contraceptive pills are located within people's sexual and reproductive lives and gendered power dynamics, to reflect the public's own rationales for and experiences using post-coital contraceptives.

Integrating Mental Health Management into Empowerment Group Sessions for Out-of-School Adolescents in Kenyan Informal Settlements: A Process Paper.

This article presents processes for developing contextualized training procedures to better appreciate partnership, capacity-building experiences, and specific implementation challenges and opportunities for mental and public health teams. The program enrolled 469 out-of-school adolescents to participate in the integration of youth mental health into health and life-skill safe spaces. The teams utilized various methods to achieve process outcomes of restructuring and adapting curricula, training youth mentors, and assessing their self-efficacy before integrating the intervention for 18 months. The Coronavirus (COVID-19) pandemic became an additional unique concern in the preliminary and the 18-month implementation period of the program. This necessitated innovation around hybrid training and asynchronous modalities as program teams navigated the two study locations for prompt training, supervision, evaluation, and feedback. In conclusion, out-of-school adolescents face a myriad of challenges, and a safe space program led by youth mentors can help promote mental health. Our study demonstrated how best this can be achieved. We point to lessons such as the importance of adapting the intervention and working cohesively in teams, building strong and trusting partnerships, learning how to carry out multidisciplinary dialogues, and continuous supervision and capacity building. This article aimed to document the processes around the design and implementation of this innovative intervention and present a summary of lessons learned.

Sexual and reproductive health and rights of migrant women attending primary care in England: A population-based cohort study of 1.2 million individuals of reproductive age (2009-2018).

Background: Evidence on the sexual and reproductive health and rights (SRHR) of migrants is lacking globally. We describe SRHR healthcare resource use and long-acting reversible contraceptives (LARCs) prescriptions for migrant versus non-migrant women attending primary care in England (2009-2018). Methods: This population-based observational cohort study, using Clinical Practice Research Datalink (CPRD) GOLD, included females living in England aged 15 to 49. Migration was defined using a validated codelist. Rates per 100 person years at risk (pyar) and adjusted rate ratios (RRs) were measured in migrants versus non-migrants for consultations related to all-causes, six exemplar SRHR outcomes, and LARC prescriptions. Proportions of migrants and non-migrants ever prescribed LARC were calculated. Findings: There were 25,112,116 consultations across 1,246,353 eligible individuals. 98,214 (7.9 %) individuals were migrants. All-cause consultation rates were lower in migrants versus non-migrants (509 vs 583/100pyar;RR 0.9;95 %CI 0.9-0.9), as were consultations rates for emergency contraception (RR 0.7;95 %CI 0.7-0.7) and cervical screening (RR 0.96;95 %CI 0.95-0.97). Higher rates of consultations were found in migrants for abortion (RR 1.2;95 %CI 1.1-1.2) and management of fertility problems (RR 1.39;95 %CI 1.08-1.79). No significant difference was observed for chlamydia testing and domestic violence. Of 1,205,258 individuals eligible for contraception, the proportion of non-migrants ever prescribed LARC (12.2 %;135,047/1,107,894) was almost double that of migrants (6.91 %;6,728/97,364). Higher copper intrauterine devices prescription rates were found in migrants (RR 1.53;95 %CI 1.45-1.61), whilst hormonal LARC rates were lower for migrants: levonorgestrel intrauterine device (RR 0.63;95 %CI 0.60-0.66), subdermal implant (RR 0.72;95 %CI 0.69-0.75), and progesterone-only injection (RR 0.35;95 %CI 0.34-0.36). Interpretation: Healthcare resource use differs between migrant and non-migrant women of reproductive age. Opportunities identified for tailored interventions include access to primary care, LARCs, emergency contraception and cervical screening. An inclusive approach to examining health needs is essential to actualise sexual and reproductive health as a human right.

Domestication of the Maputo Protocol in the Democratic Republic of Congo: Leveraging regional human rights commitments for abortion decriminalization and access.

The Maputo Protocol, adopted over 20 years ago, is a promising regional treaty for advancing gender equity and sexual and reproductive health and rights. This instrument has driven progress in women's health and rights across Africa, with much remaining to achieve to realize its full potential for women and girls, including access to safe abortion. The present paper shares the strategies and lessons from the Democratic Republic of Congo's (DRC) reform centered on the domestication of the Protocol, specifically applying its commitments on abortion decriminalization and access. With a vision of addressing maternal mortality and rectifying the impacts of widespread sexual violence against women during war, abortion as a human right and health imperative was at the heart of the DRC's reform. Governmental commitment, broad coalition building, evidence generation, and an intersectional advocacy agenda were critical to overcoming opposition, stigma, and other challenges. This paper shares key learnings from the DRC's complex yet collaborative reform strategies and its processes. The strategy prioritized domestication of the Protocol for numerous reforms, including paving the path to legal abortion on the broad grounds of rape or incest, and saving women's health and/or life. With a commitment to maximizing quality, access, task sharing, and equity, progressive national comprehensive abortion guidelines were created alongside an implementation roadmap for accountability. The DRC's experience leveraging the Maputo Protocol's obligations to advance abortion rights and access offers valuable insights for consideration globally.

Professional societies of obstetrics and gynecology as agents of change in sexual and reproductive health: FIGO's 10-country safe abortion advocacy project in Africa and Latin America.

In 2019, FIGO started implementing its abortion project focusing on advocacy. The Advocacy for Safe Abortion (ASA) Project was conducted in partnership with 10 national professional societies of obstetrics and gynecology in Latin America and Africa. The project aimed to strengthen national societies, support them to be leaders in sexual and reproductive health, and enable them to obtain context-specific advocacy goals that improve access to safe abortion. Innovative monitoring and evaluation methodology enabled tracking of outcomes, consideration of their contribution to success, and cross-country evaluation. The project saw success through some key strategies: institutional capacity strengthening; enhanced work through collaborations; training to increase knowledge and reduce abortion-related stigma with a broad array of stakeholders; and generation and use of evidence to influence decision-makers. This article describes the project and methodology used and provides tangible examples of how societies have been agents of change in their countries and of the need for such important work to continue.

Improving access to family planning for women with disabilities in Kaduna city, Nigeria: study protocol for a pragmatic cluster-randomized controlled trial with integrated process evaluation.

BACKGROUND: Globally, women with disabilities are less likely to have access to family planning services compared to their peers without disabilities. However, evidence of effective interventions for promoting their sexual and reproductive health and rights remains limited, particularly in low- and middle-income settings. To help address disparities, an inclusive sexual and reproductive health project was developed to increase access to modern contraceptive methods and reduce unmet need for family planning for women of reproductive age with disabilities in Kaduna city, Nigeria. The project uses demand-side, supply-side and contextual interventions, with an adaptive management approach. This protocol presents a study to evaluate the project's impact. METHODS: A pragmatic cluster-randomized controlled trial design with surveys at baseline and endline will be used to evaluate interventions delivered for at least 1 year at health facility and community levels in comparison to 'standard' state provision of family planning services, in the context of state-wide and national broadcast media and advocacy. Randomization will be conducted based on the health facility catchment area, with 19 clusters in the intervention arm and 18 in the control arm. The primary outcome measure will be access to family planning. It was calculated that at least 950 women aged 18 to 49 years with disabilities (475 in each arm) will be recruited to detect a 50% increase in access compared to the control arm. For each woman with disabilities enrolled, a neighbouring woman without disabilities in the same cluster and age group will be recruited to assess whether the intervention has a specific effect amongst women with disabilities. The trial will be complemented by an integrated process evaluation. Ethical approval for the study has been given by the National Health Research Ethics Committee of Nigeria and London School of Hygiene & Tropical Medicine. DISCUSSION: Defining access to services is complex, as it is not a single variable that can be measured directly and need for family planning is subjectively defined. Consequently, we have conceptualized 'access to family planning' based on a composite of beliefs about using services if needed. TRIAL REGISTRATION: ISRCTN registry ISRCTN12671153. Retrospectively registered on 17/04/2023.

Policy change to improve access to safe abortion care in federal Nepal.

In Nepal's constitution, safe abortion care is recognized as an essential component of a comprehensive approach to fulfill individuals' sexual and reproductive health and rights. In the current context of transition to a three-level governance (federal, provincial, and local), there are opportunities to accelerate decentralization and devolution of decision-making power, increase access to and coverage of safe abortion services, and improve health outcomes. This article documents the processes and results of the policy change undertaken by the Ministry of Health and Population in collaboration with development partners to decentralize the approval process of safe abortion sites and providers with the objective to increase access to and coverage of safe abortion services. With the decentralization of certification, the approval process for safe abortion service sites and providers has become simpler, less time consuming, and less expensive by reducing cost of traveling to Kathmandu or approaching authorities at the federal level. This has resulted in expanding safe abortion services across the country including remote areas with marginalized populations. Evidence-based advocacy enabled policy change for decentralization of the approval process. Collaboration among stakeholders has been vital for implementing the policy change, including issuing directives from the federal to provincial levels and capacity strengthening of provincial level officials in understanding the requirements for approval of sites and providers.

Community bylaws concerning sexual and reproductive health and rights in Machinga District, Malawi: to what extent are they responsive to young people's needs?

BACKGROUND: Community bylaws are commonly accepted mechanisms to influence behaviour change to achieve better health and development outcomes in sub-Saharan Africa. However, the uses, benefits, and potential downsides of community bylaws are largely unclear, especially regarding sexual and reproductive health and rights (SRHR) of young people. The objective of this study was to determine the extent to which community bylaws in Machinga District in southern Malawi are responsive to young people's realities and SRHR needs. METHODS: In Phase 1 of this qualitative study, 35 community members were interviewed, including 14 young people (15-24 years), five parents, five traditional leaders, and eleven key informants. Based on findings from Phase 1, eleven members from local youth groups co-created a drama performance that covered issues concerning bylaws and young people's SRHR (Phase 2). The drama was performed in the community, after which young women (18-24 years), young men (17-24 years), female and male parents discussed on what they saw in the drama, focusing on young people's SRHR, in four focus group discussions (Phase 3). All transcripts were coded and thematically analysed and narratives were written on main themes. RESULTS: Three community SRHR bylaws, related to teenage pregnancy, child marriage, and sexual harassment and rape were identified and commonly accepted in the community. While these bylaws intend to reduce SRHR-related issues among young people, they are often not involved in bylaw formulation. The bylaws were associated with protection of girls, and a good reputation for boys, young men and traditional leaders. Bylaw enforcement faced problems, as fines were not in line with national laws, and wealthy offenders could avoid them through bribes. Effects of bylaws on teenage pregnancy rates seemed limited, while some positive effects on school readmission, prevention of child marriage, and reporting sexual harassment were reported. CONCLUSIONS: The study revealed that community bylaws were accepted but not owned by young people, and had different effects on the rich versus the poor, and girls versus young men. Bylaws were associated with punishment in terms of money, which seemed to overpower their potential to promote rights and address social norms underlying SRHR issues of the youth.

Power and poverty: A participatory study on the complexities of HIV and intimate partner violence in an informal urban settlement in Nairobi, Kenya.

People in informal urban settlements in Kenya face multiple inequalities, yet researchers investigate issues such as HIV or intimate partner violence (IPV) in isolation, targeting single populations and focusing on individual behaviour, without involving informal settlement dwellers. We formed a study team of researchers (n = 4) and lay investigators (n = 11) from an informal settlement in Nairobi, Kenya to understand the power dynamics in the informal urban settlement that influence vulnerability to IPV and HIV among women and men from key populations in this context. We facilitated participatory workshops with 56 women and 32 men from different marginalised groups and interviewed 10 key informants. We used a participatory data analysis approach. Our findings suggest the IPV and HIV nexus is rooted in the daily struggle for cash and survival in the informal urban settlement where lucrative livelihoods are scarce and a few gatekeepers regulate access to opportunities. Power is gendered and used to exercise control over people and resources. Common coping strategies applied to mitigate against the effects of poverty and powerlessness amplify vulnerabilities to HIV and IPV. These complex power relations create and sustain an environment conducive to IPV and HIV. Prevention interventions thus need to address underlying structural drivers, uphold human rights, create safe environments, and promote participation to maximise and sustain the positive effects of biomedical, behavioural, and empowerment strategies.

Negative consequences of conflict-related sexual violence on survivors: a systematic review of qualitative evidence.

BACKGROUND: Conflicts exacerbate dynamics of power and inequalities through violence normalization, which acts as a facilitator for conflict-related sexual violence. Literature addressing its negative outcomes on survivors is scant. The aim of this systematic review was to analyze the qualitative evidence reported in scientific literature and focusing on the negative consequences of conflict-related sexual violence on victims' physical, psychological, and social dimensions of health in a gender-inclusive and disaggregated form. METHODS: A literature search was conducted on January 13, 2023 on Pubmed, Scopus, and PsychArticles. The search strings combined two blocks of terms related to sexual violence and conflict. A time filter was applied, limiting the search to studies published in the last ten years. Information regarding the main characteristics and design of the study, survivors and their experience, and about conflict-related sexual violence was collected. The negative consequences of conflict-related sexual violence on the physical, psychological, and social dimension of victims were extracted according to the Biopsychosocial model of health. The review followed the Joanna Briggs Institute methodology for systematic reviews and relied on the Preferred Reporting Items for Systematic reviews and Meta-Analyses. RESULTS: After full text review, 23 articles met the inclusion criteria, with 18 of them reporting negative repercussions on physical health, all of them highlighting adverse psychological outcomes, and 21 disclosing unfavorable social consequences. The negative outcomes described in multiple studies were sexual and reproductive health issues, the most mentioned being pregnancy, manifestations of symptoms attributable to post-traumatic stress disorder, and stigma. A number of barriers to access to care were presented as emerging findings. CONCLUSIONS: This review provided an analysis of the negative consequences of conflict-related sexual violence on survivors, thus highlighting the importance of qualitative evidence in understanding these outcomes and addressing barriers to access to care. Conflict-related sexual violence is a sexual and reproductive health issue. Sexuality education is needed at individual, community, and provider level, challenging gender norms and roles and encompassing gender-based violence. Gender-inclusive protocols and services need to be implemented to address the specific needs of all victims. Governments should advocate for SRHRs and translate health policies into services targeting survivors of CRSV.

Remote training for strengthening capacity in sexual and reproductive health and rights research: a systematic review.

BACKGROUND: Training has been used to develop research skills among sexual and reproductive health and rights (SRHR) researchers. Remote education may accelerate transfer of skills and reduce barriers to strengthening research capacity. This systematic review aimed to assess the effectiveness of remote training on SRHR research and describe enablers and barriers of effective remote training. METHODS: PubMed, Embase, and Scielo were searched up to December 2022 for studies that evaluated in any language online research training programmes either on a SRHR topic or tailored for professionals working in SRHR published since 1990. Characteristics of included studies, the programmes they evaluated, the programme's effectiveness, and reported barriers and enablers to remote learning were extracted. Three researchers synthesized and described findings on effectiveness, impact and outcomes mapping them against the Kirkpatrick model. Additionally, thematic analysis from qualitative data was conducted to identify themes relating to the barriers and enablers of remote learning. RESULTS: Of 1,510 articles retrieved, six studies that included 2,058 remote learners met the inclusion criteria. Five out of six studies described empirical improvements in participant research knowledge/skills and three studies reported improvements in attitudes/self-efficacy towards research. Follow-up surveys from four studies revealed frequent application of new research skills and improved opportunities for career advancement and publication following online trainings. Cited barriers to effective online SRHR research training included time management challenges and participants' competing professional obligations; limited opportunities for interaction; and lack of support from home institutions. Cited enablers included well-structured and clear courses, learning objectives and expectations with participants; ensuring a manageable workload; facilitating interactions with mentors and hands-on experience; and selecting programme topics relevant to participants' jobs. CONCLUSION: Remote SRHR training can lead to improvements in research knowledge, skills, and attitudes, particularly when course learning objectives, structure, and expectations are outlined clearly, and ongoing mentorship is provided.