03112nas a2200253   4500000000100000008004100001260000800042653004600050653001500096653001400111653001800125100001300143700001400156700001100170700001300181700001300194700001800207245016900225856005900394300000900453490000600462520237600468022001402844       2020                            d  bBMJ10aSexual and Reproductive Health and Rights10aDisability10aInclusion10aInterventions1 aHameed S1 aMaddams A1 aLowe H1 aDavies L1 aKhosla R1 aShakespeare T00aFrom words to actions: systematic review of interventions to promote sexual and reproductive health of persons with disabilities in low- and middle-income countries  uhttps://gh.bmj.com/content/bmjgh/5/10/e002903.full.pdf  a1-140 v53 a<p><strong>Introduction:</strong> Persons with disabilities have the same sexual and reproductive health and rights (SRHR) as non-disabled persons. Yet they face numerous barriers in their access to sexual and reproductive health services and their rights are often not met. Evidence on SRHR for persons with disabilities is sparse, particularly evaluations of interventions demonstrating ‘what works.’ This systematic review assessed interventions to promote SRHR for persons with disabilities in low- and middle-income countries.</p>

<p><strong>Methods: </strong>We searched for qualitative, quantitative or mixed method observational studies representing primary research, published between 2010 and 2019, using MEDLINE, Embase, PubMed, Global Health and CINAHL Plus. Search strings were compiled for different elements of SRHR and for all forms of disability. 24,919 records were screened, leading to over 380 relevant papers, most of which were descriptive, focussing on needs and barriers to SRHR needs being fulfilled. Of the 33 full-text articles assessed for eligibility, 18 were included in the synthesis. All included studies were assessed for bias and quality of evidence, using STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) and RATS (relevance, appropriateness, transparency andsoundness) tools. Among the 16 interventions (from 18 articles), 25% had low risk of bias, 31% had moderate risk of bias and 44% had high risk of bias. Data analysis used narrative synthesis; a method suited for systematic reviews with heterogeneous studies. We used Levesque healthcare access model to analyse the focus of interventions.</p>

<p><strong>Results: </strong>11 interventions were from upper middle-income settings; two from lower-income settings; only one operated in rural areas. Interventions addressed intellectual impairment (6), visual impairment (6), hearing impairment (4), mental health conditions (2) and physical impairments (2). Most interventions (15/16) focus on information provision and awareness raising. We could not identify any intervention promoting access to maternal health, family planning and contraception, or safe abortion for people with disabilities.</p>

<p><strong>Conclusion: </strong>This systematic review has highlighted stark gaps in evidence. More rigorous evaluations are needed.</p>
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