George, A. S., Branchini, C., & Portela, A. (2015). Do interventions that promote awareness of rights increase use of maternity care services? A systematic review. PloS one, 10(10), e0138116.Link to Source
Headline Findings: a summary statement
The evidence base on raising awareness of women’s rights relating to maternal and newborn health is limited to just four studies in Low-and Middle Income countries and new studies are urgently needed.
The authors identified only four studies that were eligible for inclusion in the review. The studies examined varied interventions, however, all intended to raise awareness of the right to quality maternity care services. Three studies took place in India while one study took place in Uganda. Two studies were RCTs and were deemed to be of strong quality, while two were deemed to be of weak quality.
Implications for policy and practice
Because of the lack of evidence in this area, the authors do not draw conclusions across their included studies about the effectiveness of these interventions.
Implications for further research
The authors highlight the urgent need for evaluations using robust methodology in other regions and settings than Uganda and India, including of programmes in urban areas and those that work with discriminated against populations including migrants, nomadic groups, young people, institutionalised populations, and disabled women. They also suggest that future systematic reviews should look at the larger body of research on promotion of rights around other sexual and reproductive health areas to inform work in this area. Existing studies should be better indexed and labelled so that review authors can identify these easily.
The right to safe pregnancy and childbirth for women was first agreed in the Program of Action for the International Conference on Population and Development in 1994 and has since been reaffirmed by the United Nations in its ‘Global Strategy on Women and Children’. International human rights law also includes commitments for states to enable women to survive pregnancy and childbirth as part of both their enjoyment of sexual and reproductive health rights and right to live a life of dignity. To date, there has been no systematic review of interventions to improve awareness among women of their rights around pregnancy and childbirth and the impact that this has on use of maternity care services or maternal and newborn health more broadly.
This review aims to systematically assess the evidence on interventions promoting awareness of rights in order to increase use of maternity care services. Specifically, the review seeks to answer the question: what interventions which aim to promote awareness of human rights relating to maternal and newborn health are effective in increasing demand for and use of health care to improve maternal and newborn health outcomes?
The authors included published and unpublished studies assessing the impact of interventions to promote awareness of human rights/sexual and reproductive rights or rights to access quality care on outcomes related to health and rights awareness, including birth with a skilled attendant or in a facility, use of antenatal care, use of postnatal care for the infant and mothers. They included studies that reported on desired outcomes, as long as the study outcomes were compared with control groups or with data collection prior and post the intervention. They searched for studies in the MASCOT database, which was developed by systematically mapping maternal health studies and systematic reviews focused on health system and community-based interventions for improving maternal health and for reducing maternal health inequities in low and middle-income countries. In addition, the authors’ searched PubMed, a general iterative internet search with Google/Google Scholar to help identify additional studies including grey literature and a large number of institutional websites.
Two reviewers independently screened titles and carried out data extraction. Key variables extracted from included studies included intervention description, target populations, elements of rights awareness promotion, facilitators and barriers to implementation, study design and care seeking outcomes. Due to the small number of heterogenous studies, the authors carried out a narrative synthesis rather than undertaking a meta-analysis. The quality of the studies was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool.
The authors undertake an extensive search for papers and reduce bias in selection of studies through independent double screening. The characteristics and results of the included studies appear to be reported reliably with data extraction being carried out by two reviewers, with a summary of participants, interventions, outcomes and quality of included studies provided. The authors present the PRISMA reporting checklist for systematic reviews which makes it easy to track the methods. Limitations include not having the full risk of bias assessment presented and a lack of clarity around the publication cut off dates for the searches.