Evidence base of sexual and reproductive health and rights interventions growing, but gaps remain
Ahead of World Contraception Day (26 September) and International Safe Abortion Day (28 September), UN experts called for states, especially those in emergency, humanitarian and crisis situations, to promote, protect and respect sexual and reproductive health and all related rights. To do this, the experts underscored the need to establish inclusive policies, evidence-informed services, and leadership rooted in international human rights conventions. In our latest evidence gap map (EGM) on sexual and reproductive health and rights (SRHR), we have curated the best existing evidence in this area to make it more accessible and identified gaps where more research is needed. Here are key highlights from what we have found. (view the map here)
Growing body of evidence
3ie’s SRHR map aims to inform policy and practice in a domain that has witnessed an increasing body of evidence – but which remains scattered across different databases, websites and journals. Commissioned by the German Institute for Development Evaluation (DEval), the map pulls together more than 1,000 studies, including impact evaluations, systematic reviews and selected qualitative methods studies, looking at a broad range of SRHR interventions and outcomes across multiple populations in low- and middle-income countries(L&MICs) and regions.
The EGM will directly inform DEval’s upcoming strategic evaluation of the German SRHR field of action. Findings from the EGM will feed into the definition of evaluation questions and help integrate scientific evidence into the evaluation’s programme theories. According to Dr Tobias Polak, DEval's Senior Evaluator: "When we prepare an evaluation we try to systematically consider scientific evidence. This EGM gives us the opportunity to better understand what is the combined scientific knowledge for what the German Federal Ministry for Economic Cooperation and Development (BMZ) intends to do in this field".
Mapping evidence clusters and gaps
There is a significant and growing evidence base for decision-makers to draw from. For example, there are 249 studies with interventions or outcomes related to contraception and family planning, a sizeable number of counselling (e.g., in maternal and newborn care), provider capacity building (e.g., training of health workers), and multicomponent interventions.
However, the scope of the field is broad and there are still gaps. We find little evidence for health systems interventions, including civil registration and vital statistics systems, supply chain and logistics activities, policy advocacy, and social accountability; and other intervention categories such as safe abortion services and in-kind transfers.
Of particular concern is the lack of studies focused on populations in vulnerable and marginalized situations and in emergency, humanitarian and crisis settings. For example, only five studies were found for sexual minorities and two for persons with disabilities. There is also limited evidence about SRHR interventions in some countries where women may be more vulnerable to reduced sexual and reproductive choices or health options, including Central African Republic, Sao Tome and Principe, Papua New Guinea, Yemen, and other low-income countries that are largely in fragile or conflict-affected settings in Sub-Saharan Africa.
Innovative approaches and methodological limitations
We include a range of innovative approaches appropriate in settings when the intervention units are too small for statistical analysis. Designs such as realist evaluation shed some light on interventions and outcomes for which quantitative evidence gaps exist, most notably for policy advocacy interventions and legislative environment outcomes.
There is a relatively large number of systematic reviews (SRs) available, but many of them suffer from methodological limitations. Of the 141 completed systematic reviews we identified in this EGM, a majority have important limitations. Nevertheless, there is a sizeable number (23) of medium- or high-confidence SRs across all intervention domains, with a primary focus on SRHR services. In the full report, we will be summarizing their findings which span multiple topics such as comparing provider or self-administered contraceptives, abortion services or HPV screening; maternal and newborn care-related mHealth, education, health systems, clinical and other interventions; counselling interventions to address gender-based violence or female genital mutilation, and interventions in humanitarian contexts.