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How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps

• Miriam Hartmann,
• Rajat Khosla,
• Suneeta Krishnan,
• Asha George,
• Sofia Gruskin,
• Avni Amin

x

• Published: December 21, 2016
• https://doi.org/ten.1371/journal.pone.0167542

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Abstract

The importance of promoting gender equality and human rights in sexual and reproductive health (SRH) programmes and policies has been affirmed in numerous international and regional agreements, most recently the 2030 Agenda for Sustainable Development. Given the critical role of research to determine what works, we aimed to identify research gaps as part of a broader priority setting practise on integrating gender equality and human being rights approaches in SRH programmes and policies. A systematic literature review of reviews was conducted to examine the question: what do we know about how enquiry in the context of SRH programmes and policies has addressed gender equality and man rights and what are the electric current gaps in inquiry. We searched 3 databases for reviews that addressed the enquiry question, were published between 1994–2014, and met methodological standards for systematic reviews, qualitative meta-syntheses and other reviews of relevance to the research question. Additional grayness literature was identified based on skilful input. Articles were appraised past the primary author and examined by an practiced console. An abstraction and thematic assay process was used to synthesize findings. Of the 3,073 abstracts identified, 56 articles were reviewed in full and 23 were included along with x from the grey literature. The bulk focused on interventions addressing gender inequalities; very few reviews explicitly included homo rights based interventions. Across both topics, weak study designs and employ of intermediate upshot measures limited evidence quality. Farther, at that place was express evidence on interventions that addressed marginalized groups. Better quality studies, longer-term indicators, and measurement of unintended consequences are needed to meliorate understand the impact of these types of interventions on SRH outcomes. Further efforts are needed to cover inquiry on gender equality and human rights issues as they pertain to a broader set of SRH topics and populations.

Citation: Hartmann Yard, Khosla R, Krishnan S, George A, Gruskin S, Amin A (2016) How Are Gender Equality and Human Rights Interventions Included in Sexual and Reproductive Health Programmes and Policies: A Systematic Review of Existing Research Foci and Gaps. PLoS One eleven(12): e0167542. https://doi.org/ten.1371/periodical.pone.0167542

Editor: Benjamin Mason Meier, University of N Carolina at Chapel Colina, UNITED STATES

Received: September eight, 2016; Accepted: November fifteen, 2016; Published: December 21, 2016

Copyright: © 2016 Hartmann et al. This is an open up access commodity distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in whatsoever medium, provided the original author and source are credited.

Information Availability: All relevant data are within the paper and its Supporting Information files.

Funding: This review was supported past the Human Reproduction Programme, Earth Health Organization. The content is solely the responsibility of the authors and does non necessarily represent the official views of the authors' employers or funders. Asha George is supported by the South African Research Chair's Initiative of the Department of Scientific discipline and Technology and National Research Foundation of S Africa (Grant No 82769). Any opinion, finding and decision or recommendation expressed in this material is that of the author and the NRF does not accept any liability in this regard.

Competing interests: The authors declare that they take no competing interests.

Introduction

Sexual and reproductive wellness (SRH) affects, and is afflicted by the intersectionality of people's personal experiences and relationships and by the broader structural context of their lives which shapes their overall health and well-being. This context includes gender inequality equally a determinant on its own and in combination with other social and economic inequalities including: diff power dynamics in interpersonal relationships, harmful gender and other socio-cultural norms and practices, limited economic circumstances, lack of admission to educational activity, limited employment opportunities, poor living conditions, disability, ethnicity, as well as the challenging political and legal environments where they live[1]. Studies accept shown that harmful gender norms that promote male dominance over women prevent women from practicing safer sex, limit their use of contraceptives, and increment their risk of STIs, including HIV[2]. Similarly, research has also shown a relationship between violation and neglect of homo rights and negative health outcomes and emphasizes the need to meliorate integrate human being rights approaches into interventions, particularly with attention to provider training, service commitment, raising awareness and capacity edifice[3, iv].

In the past two decades, nifty strides take been made in the development of norms and standards related to gender equality and human rights pertaining to SRH and the interpretation and application of existing standards to dissimilar areas of SRH programming and policy making. This is truthful at the level of international policy, as well as at policy and programmatic levels within countries. The axis of addressing interconnections between gender equality, human rights, and SRH, was recognized in the Cairo and Beijing agreements, the World Wellness Organisation'due south Reproductive Health Strategy[five], and virtually recently the 2030 Agenda for Sustainable Development and the accompanying Sustainable Development Goals (SDGs). Not simply is the achievement of gender equality a goal in itself (i.eastward. Goal 5), but there is a specific target inside that goal on universal access to SRH and rights (i.e. target 5.6), in addition to the target(i.e. target 3.7) on sexual and reproductive health in the health goal (i.east. Goal 3).[6]

The achievement of the highest accessible standard of SRH is thus closely linked with the extent to which gender equality and people'south homo rights–such equally the rights to not-bigotry, to privacy and confidentiality, to life, freedom, and security, likewise as the rights to educational activity, information and health–are respected, protected and fulfilled. In its recently adopted General Comment on the correct to sexual and reproductive wellness, the United nations Committee on Economical, Social and Cultural Rights, emphasizes that this includes, a "set of freedoms and entitlements". The freedoms, according to the Committee, include the right to brand free and responsible decisions and choices, free of violence, coercion and discrimination, over matters apropos one's body and sexual and reproductive health. The entitlements, the Committee explains, include unhindered admission to a whole range of health facilities, appurtenances, services and information, which ensure all people full enjoyment of sexual and reproductive health.[6]

While progress has been made in understanding how some dimensions of gender inequalities and violations of human rights shape SRH outcomes, too as in developing and evaluating interventions that promote gender equality in the context of some SRH programmes and policies, much remains to be done to address these bug systematically. Enquiry has a disquisitional role to play in finer identifying and addressing gender inequalities and human rights by developing an understanding of what's been washed and what remains to be done. As a first step to determine what is known, a systematic literature review of reviews was conducted to accost the following question: what do we know about how research in context of SRH programmes and policies has addressed gender equality and human rights and what are the current gaps in research? This review was conducted to inform a larger inquiry priority setting exercise that is being undertaken to identify what research should be prioritized to strengthen the integration of constructive gender equality interventions and human rights approaches in SRH programmes and policies. This newspaper summarizes the results of the review.

Methods

The systematic literature review of reviews was guided by a protocol (Encounter S1 Protocol) that identified the search strategy including search terms, inclusion and exclusion criteria, and a data abstraction process. The pick of conducting a review of reviews rather than master intervention studies was guided past the necessity of including the broad scope of topics covered inside the field of SRH.

Search strategy

An automatic search strategy was undertaken in 2014 to identify literature reviews, systematic reviews and meta-analyses. Three priority databases that typically alphabetize nigh systematic and other types of literature reviews were searched—Scopus, PubMed, and Cochrane—using a list of preliminary search terms related to gender equality, human rights, and SRH that included terms such every bit gender, gender norms, equality, disinterestedness, and sexual wellness. The preliminary search yielded a very large number of review articles). Therefore, some of the search terms were revised to minimize/remove duplicate terms (e.one thousand., empowerment vs. women's empowerment). Key words capturing important human rights concepts such equally human rights, reproductive rights, and accountability were retained. Table i, below, lists the initial terms used, too as the revised terms.

Finally, in addition to database searches, we consulted participants of an expert coming together that was convened in January 2015 to identify additional reviews from the gray literature that may have been missed in the databases[7].

Inclusion and exclusion criteria

Articles, both peer reviewed and from the grey literature, that met the post-obit criteria were included: (i) addressed the primary research question: what practice nosotros know about how research in context of SRH programmes and policies has addressed gender equality and homo rights and what are the current gaps in research; (ii) published between 1994 and 2014 –the catamenia between when ICPD raised global attending to the role of gender equality and human rights in SRH and when the search was conducted; and (3) classified equally reviews and met methodological standards (i.e. followed PRISMA guidelines) for systematic reviews, or qualitative meta-syntheses, or other reviews of relevance to the research question. For the purpose of this review, interventions were defined equally actions seeking to promote change in a directed manner. For example, a human rights intervention may exist an intervention aimed at empowering women and girls to know and claim their rights in context of sexual and reproductive health. Articles were selected if the part of gender or human rights was explicitly stated equally the focus of an intervention or if a gender equality or human being rights component was explicitly included within a broader SRH intervention. SRH outcomes of involvement were express to those included within the WHO Reproductive Health (RH) strategy. These include family planning (FP), unsafe abortion, sexually transmitted infections (STI) HIV, reproductive tract infections (RTIs), gender-based violence (GBV), menstrual conditions, urinary and fecal incontinence due to obstetric fistula, uterine prolapse, pregnancy loss, sexual dysfunction, female genital mutilation (FGM), antenatal, perinatal, postpartum and newborn intendance, cervical cancer, and infertility.[5]

Articles that were considered secondary analyses, discussions of literature, editorial discussions, or which did not provide sufficient detail regarding their review methodology were excluded. Articles were too excluded if: (i) they were published in a linguistic communication other than English or Spanish (the languages accessible past the principal authors), or (ii) homo rights, gender equality, or SRH outcomes were not explicitly discussed.

Title, abstruse, and article screening

Search results from each of the iii priority databases were exported into Excel and titles and abstracts were reviewed past the primary author (MH) to identify articles that merited full text review. Articles were delineated into those that met review criteria based on the abstract (Y), may meet review criteria (Chiliad), or did not meet review criteria (Due north). Those articles identified as meeting (Y) or may run across (M) the review criteria were reviewed in full text. Findings were reviewed with other authors (SK, AA, RK) and decisions discussed.

Study appraisal and synthesis

Selected reviews that still met the inclusion criteria, after full text evaluation, were abstracted for the following information: authors, year, title, journal, type of review, population focus, geographic focus, gender/human rights interventions covered, SRH topics covered, outcomes assessed, and research gaps/limitations. Reviews identified in the grey literature by the expert meeting participants in January 2015 were subjected to the same brainchild process.

Results

Literature Review and Search Process

In total, nosotros reviewed three,073 abstracts from our peer-review literature search. Nosotros shortlisted 42 abstracts as either meeting (Y) or possibly meeting (M) the inclusion criteria for the review. These articles were retrieved for a full text review. Following a full text review 19 of the 42 articles were excluded as they did not run into the inclusion criteria. The 23 remaining articles were bathetic as per the process outlined in a higher place. In addition, ten reviews from the grey literature were reviewed and bathetic. Fig 1, below, outlines the search and screening process and reasons for article exclusion.

Characteristics of Included Reviews

Ten out of the thirty-three publications (i.e. 23 peer reviewed articles and 10 reports from greyness literature) were classified equally systematic reviews, all the peer-reviewed manufactures were published in health-related journals, and the majority of articles either took a global perspective or focused on depression and center-income countries. Despite the broad time range specified for inclusion (1994–2014), the oldest gender focused review selected was published in 2003 and the oldest human rights focused review article was published in 2011. More than specific characteristics of the included review articles are presented below and outlined in tables that are available every bit supporting information to this manuscript (S1 and S2 Tables).

What'due south the state of the enquiry?

Based on the findings of the review the post-obit section identifies research foci and gaps in gild to inform enquiry priority setting in relation to developing effective interventions and approaches to address gender equality and human rights within sexual and reproductive health programmes and policies. Results are broken down by fundamental themes, such every bit research topic, location, target population, outcomes, and other methodological issues.

Research Topics.

Human Rights: Merely v review manufactures specifically assessed the bear on of human rights interventions on SRH outcomes. These included interventions targeted at the wellness facility[8–10], customs[10, 11], and policy[12] levels. Given this dearth of information, the main topical gap is a lack of explicit focus on human rights interventions in SRH research. Furthermore, the reviews that did exist tended to focus on one or two homo rights principles (eastward.m. participation, empowerment) every bit against a comprehensive inclusion of human rights interventions in relation to SRH. Furthermore, the review highlights the need to look across traditional 'outcomes' and to focus more on processes and staggered effects over time. [8]

Gender equality: The bulk of manufactures (Northward = 29) represented reviews of gender-equality focused interventions. These reviews most ofttimes assessed impact of gender equality or human rights on HIV outcomes (N = 18), followed by other SRH outcomes such as FP (N = 7), gender-based violence (N = 8), and maternal health (Northward = half-dozen). The gender equality interventions focused on male person involvement, women's empowerment, addressing gender roles—such every bit those relating to communication and decision-making, and biomedical interventions addressing gender-based barriers to SRH (e.g. female-controlled HIV prevention methods). Several reviews examined whether strategies reinforced (i.e. perpetuated unequal gender relations), accommodated (i.e. took into account men and women'southward diff roles and power simply did non change them) or were transformative (i.e. attempted to modify diff gender ability relations and norms)[thirteen–15]. Reviews as well indicated that gender-equality interventions in this area have ranged from those that focused on structural factors such as customs gender norms to others that focused on interpersonal gender power relations reflected in couple's communication.

Intersection of Gender and Human Rights: While it is assumed that implicitly, interventions that address gender inequalities de facto are addressing some human rights concerns and vice versa, few reviews explicitly addressed both gender inequalities and human rights. One of the v human rights focused reviews examined interventions specifically designed to promote FP demand and access using rights-based approaches, and also included an intervention to accost inequitable gender norms[10]. Similarly, three reviews of gender-equality focused interventions were explicitly stated to be addressing human rights past framing interventions to accost gender-based violence (GBV) or gender-barriers to FP as human rights issues[16–18].

SRH: Across both gender equality and human rights reviews, a comparison between the SRH topics addressed in the reviews and those included in the WHO RH strategy identified several gaps. The primary SRH topics covered past reviews of human rights interventions have been GBV and FP. Gender equality interventions included in the reviews have looked at a broader range of SRH topics (e.grand., maternal wellness, FP/contraception, HIV/STIs). Nevertheless, even within maternal health and FP, specific topics such as safety motherhood, salubrious timing and spacing of pregnancy, and neonatal, child wellness and nutrition have received less attention. Other topics such equally menstrual conditions, urinary and fecal incontinence due to obstetric fistula, uterine prolapse, infertility, and cervical cancer were relatively limited in their inclusion in the reviews. Similarly abortion and FGM, both topics that have clear gender equality and homo rights associations, were rarely covered.

Laws and Policies: The reviews did not include many studies or interventions that examined the potential positive impacts of laws and policies promoting gender equality or human rights on SRH. One review focused on the negative impact of discriminatory laws around sexual activity work, including their affect on voluntariness of medical intendance and admission to health services; yet the review itself establish limited data regarding the positive bear on of changes in policies on SRH outcomes (e.g. how police influences sex workers ability to avoid STIs or to access SRH services equally opposed to measuring levels of HIV infection)[12]. Another included some review of how changes in policies positively affect homo rights related outcomes such as access to FP, participation of diverse stakeholders, or disinterestedness, nondiscrimination, and quality of SRH care. This latter review found that most policy level intervention studies were not true evaluations, but rather documentation of FP policy implementation and subsequent changes in FP admission and uptake. It also institute that while policies exist to support FP access and uptake, a human rights perspective to doing and so is often not included. Some identification of factors necessary to ensure the fulfillment of individuals' rights to FP, divers as availability, accessibility, acceptability and quality of contraceptives, and participation in determination-making, were establish in this literature. However a demand to improve empathize the association between homo rights and SRH was acknowledged in many of the reviews, as was the demand for meliorate tools to monitor both health and human rights concerns.[10, 19] This was especially noted for topic areas that are difficult to measure (east.1000. abortion)[20].

Geographical Focus.

Although several reviews attempted to include data on either global level or low- and middle-income state interventions, they constitute gaps in the geographical focus of the research studies they identified. For case, within depression- and middle-income countries there was a dearth of testify from the Centre East and North Africa with more research occurring in sub-Saharan Africa[21]. Humanitarian or conflict-affected countries were often cited as missing from the testify-base of operations as well, specially in relation to violence confronting women, an issue that can be exacerbated in these settings[17, 22]. When interventions have been conducted in these settings, the reviews noted they are frequently not rigorously evaluated and thus their effectiveness is unclear[17]. Finally, one review found that within Due south Asia, the bulk of gender equality interventions across several SRH topics (i.e. RMNCH, HIV, GBV, and universal wellness care) took place in India[23].

Target Populations.

The ways in which population of focus were defined in gender equality and human being rights reviews differed. Gender equality reviews oftentimes included generic categories of women and/or men whereas reviews of homo rights interventions tended to focus more on people who were marginalized such as female person sex activity workers or women living with HIV. For example, two reviews of human being rights interventions focused on sex workers, ane of which reviewed policy and advancement interventions to promote female sex activity workers' rights and the other reviewed customs empowerment initiatives designed to overcome barriers to female sex workers' health and homo rights[11, 12]. A third review focused on the pregnancy-related rights of HIV-positive women[9]. The final ii, which focused on women and children and women and men broadly speaking–reviewed elements of healthcare according to human rights principles such as availability, accessibility, acceptability, and quality of care[viii, 10]. Despite the more articulate focus on marginalized populations within human rights reviews, reviews with a focus on lesbian, gay, bi-sexual, or transgender individuals were not found suggesting both a heteronormative lens to the existing enquiry base of operations and the invisibility of gender expressions that differ from the cultural norm. Additionally, while four reviews addressed adolescents, two of which focused exclusively on this population (ane on African American youth and another on Latino youth in the US and Mexico)[14, fifteen, 17, 24], concentration on this population, which often faces stigma and discrimination in SRH service provision, was withal relatively rare.

Outcomes.

Gender, Human being Rights, and SRH outcomes: Cogitating of the range of topics and foci addressed across the reviews, outcome measures ranged accordingly. Gender related measures often included gender norms, partner communication, male involvement levels, decision-making or power dynamics, but also measurement of harmful outcomes, such as incidence of FGM, violence, or early union. The use of longer term outcomes like female life expectancy were rare, just were used on occasion, such as in one review examining outcomes of gender equitable policies[19]. While harmful SRH outcomes that were the intended focus of interventions were at times included, such as incidence of FGM, information technology was not common for interventions to measure out unintended harm resulting from intervention efforts[22, 25, 26]. Furthermore, some reviews noted that male person appointment approaches, in particular, suffer from greater inconsistences in measurement and in impact on SRH behaviours and health outcomes and thus, in understanding how male person engagement might help or mayhap hinder women'south empowerment.[21, 27, 28]

The framing of human rights measures similarly varied according to intervention goals. These ranged from exposure to empowerment interventions, to access to care, to longer term impacts, such equally decriminalization of sex piece of work. Accessibility and quality of services were commonly measured in areas such as FP to sexual activity work[8–10, 12], whereas measures of stigma or voluntariness were used less consistently[ix, 12]. This was the example even when the review included studies that explicitly included interventions promoting voluntary rights-based FP[10].

Beyond the reviews, the bulk of SRH outcomes were related to changes in noesis, attitude, or behaviors, and not clinical outcomes (e.g. STI or HIV prevalence). Related to this, self-report was ordinarily used to measure out outcomes such as STI symptoms or male perpetration of VAW highlighting the methodological limitations of studies in the reviews.[22]

Price, replicability, and calibration: A bulk of the studies or interventions covered in the reviews bespeak to research on new innovations or minor-scale interventions addressing gender equality in single settings. Simply ane review focused on examining the implementation of an intervention found to exist effective in 1 setting, 'Stepping Stones', across multiple settings[29]. Therefore, more than research is needed on replicability of pilot gender equality (and human rights) interventions beyond different settings and their scale up. In addition, but two of the reviews provided data on the costs, cost-effectiveness, and sustainability of gender equality and human rights-based interventions in SRH programmes and policies[15, 30]. 1 review, which focused exclusively on cost and cost-effectiveness, plant as well that nearly toll-related data comes from pilot and unmarried-site studies, again pointing towards a research gap around intervention calibration[thirty].

Other Methodological Gaps.

A number of methodological limitations of existing research on gender equality and human rights-based interventions and SRH emerged. The bulk of identified reviews included studies using either qualitative or quantitative methods but non both, and none of the reviews undertook a qualitative meta-ethnographic or meta-synthesis/analysis procedure. Methodological rigor may also vary according to intervention approach and region of implementation. Ane review, which examined research design according to gender accommodating versus transformative interventions, found that all-around interventions less normally used a mixed methods approach and those attempting to transform gender norms tended to utilise qualitative only designs. The review also identified less use of randomized controlled trials in Due south Asia every bit compared to other regions of the world.[23] Reviews also identified studies with poor quality design highlighting the demand for improve quality research studies that not only rely on randomized controlled trials, but too case serial, cohort studies and use qualitative research methodologies that are well recognized in order to instill reasonable confidence in the findings. Variety in outcome measures (equally reported in the department on outcomes) highlight the need for a validated and consequent range of event measures of gender equality and human being rights interventions[11, 21, 22, 25–27, 31–36]. Consideration for a longer timeframe of measurement in society to assess whether positive outcomes are sustained over fourth dimension was often highlighted[15, 17, 21, 23, 25, 26, 29, 33, 34]. The reviews of gender equality interventions (e.g. social norm change) tended to have express fourth dimension frames making information technology difficult to mensurate beliefs alter or the impact on health outcomes.

Word

Nearly 20 years later ICPD Programme of Activity (1994) and the Beijing Platform for Action (1995) highlighted the importance of addressing gender equality and homo rights in health and specifically SRH programmes, there has been an aggregating of interventions, programming and evaluations that take enabled researchers to review bodies of evidence. This review of reviews provides an overview of that trunk of evidence, highlighting what the focus and subsequent gaps accept been across topics, population and geographic focus, and methodological approaches.

While interventions addressing gender equality and man rights were recognized equally important more than a decade ago, our review found that research on gender equality has received more than attention than man rights. This is reflected in the relative paucity of peer reviewed reviews on human rights, particularly in the public health literature. A myriad of factors, including limited funding and limited agreement of man rights, may contribute to this finding. Every bit a result, this body of evidence suffers from additional challenges including selective or ad hoc awarding of some elements (east.yard. non-bigotry, participation) of a human rights based arroyo as confronting a comprehensive awarding; data considerations; and lastly implicit integration of what are called man rights considerations, instead of explicit and comprehensive integration of man rights equally internationally understood which impairs report design and evaluations.[1, 8]

Although the reviews on gender equality provide a much wider body of evidence than human rights, information technology'due south still challenged past gaps that impede our ability to empathize the effectiveness of these interventions. Not surprisingly, given women's ofttimes socially prescribed lower status in communities worldwide, the interventions included in the reviews primarily focused on women and women'south SRH outcomes. While interventions have clearly targeted gender equality for women from multiple levels ranging from the interpersonal to the structural, agreement and measuring change from both women and men'southward perspectives is notwithstanding inadequately done. Specifically, in line with recent ethical and safe recommendations on VAW intervention research[37], evaluations of interventions should measure potential harms or unintended consequences, likewise as outcomes in terms of the individual and in relation to social norms. Moreover, there is a need to better understand whether and what types of interventions atomic number 82 to resistance to prevailing caitiff gender norms among men and how resistance to norms impacts men for the sake of their ain SRH (equally partners, fathers, and community members). The latter is of item importance given both, the challenge of engaging men in these issues and the need to engage them to address their contribution to maintaining existing gender inequalities that inhibit women's health. While much remains to exist learned on effective male engagement, motivating men based on the contributions they can make, also as their own benefits has been highlighted as an important approach and as such, reliable and valid measurement of these outcomes needs to be incorporated.[21, 28, 32]

Finally, several gaps identified past this review, including the brusk timeframes of inquiry studies, the express geographical spread of inquiry, the minimal inclusion of a wider variety of populations, and the missing focus on policy research and on cost, replicability and scale of interventions hinder the field'south ability to progress in integrating gender equality and equal human rights in SRH programmes and policies. For example, shorter timeframes for measuring research outcomes inhibit our ability to understand longer term alter–a challenge of great importance for issues such equally these, where interventions must back up intensive changes in social norms and sustain changes in SRH behaviours. Without longer term research frameworks and funding support to mensurate and evaluate bear on of gender equality and homo rights interventions in SRH programmes and policies, we will proceed to rely on shorter term outcome measures that can merely capture shifts in more proximate knowledge and attitudes, rather than truly understanding what is required to change social, cultural and other norms and behaviours. As another case, the limited attending to replicability of interventions included in the reviews prevent us from agreement how different socio-cultural and economic context would affect whether or not a particular gender equality intervention or man rights approach would work beyond settings. Similarly, the pilot nature of interventions or studies included in the reviews makes it difficult to know and sympathize whether these would work or not if implemented on a larger scale. Funding agencies accept an important role to play in shaping where, how, and for how long enquiry projects occur in order to permit for measuring longer term, community-wide and larger scale impacts beyond different settings

This review of reviews has several limitations. One limitation was the search focused on databases that primarily capture the public health literature. Although we did identify articles from disciplines other than public wellness (e.g. legal, policy), all articles meeting review criteria ultimately came from public health journals. This may have somewhat limited the scope of which gender and homo rights interventions were considered. Yet, given the need to place manufactures measuring SRH outcomes, nosotros expect that this limitation should be minimized. Another limitation was the restriction of inclusion criteria of reviews published in English and Spanish. This was due to the language capabilities of the authors; yet, given that the inclusion of Spanish reviews identified no boosted reviews meeting criteria, it's likely that the addition of other languages would accept yielded similarly low returns. Additionally, although a large number of potential search terms (central words) were initially identified, nosotros were compelled to revise the search strategy due to the volume of results. This, in add-on to our focus on review of reviews, contributed to the varied nature of interventions captured nether the broad categories of gender equality and human rights and every bit such, our inability to make nuanced observations about the enquiry gaps inside specific gender equality or human rights intervention approaches. For instance, among human being rights interventions, we were unable to review interventions at the individual, customs, health intendance, or national level or across identified principles such as non-discrimination, availability, accessibility, acceptability, quality of care, decision-making, or participation[4]. Without explicit search terms reflecting the many levels of intervention, we cannot be certain that the exclusion of certain topics is reflective of an bodily lack of inquiry across these many areas. On the other mitt, the broad search terms used should have captured inquiry framed as gender equality or homo rights, thus pointing again to a lack of conceptualization of principles of non-discrimination, availability, participation etc., as part of a human rights framework.

Conclusion

This review highlights that progress has been made over the last fifteen years on research related to inclusion of gender equality and human rights interventions in SRH policies and programming, but fundamental gaps remain. Much more has been published on gender equality interventions than man rights-based interventions in the SRH literature. Inquiry relating to both gender equality and human being rights based interventions has been published on topics such as HIV/AIDS, SRH, more broadly, and to a limited extent on FP. There is a need to strengthen research methods and measurement of outcomes to capture long-term sustained changes in SRH behaviours and biological health outcomes[21, 22]. Attending to human being rights in intervention research although express and advertising hoc in nature is increasing, although here too publication has been greatest in relation to HIV and FP. Further investment, documentation, research and development of methodologies is needed in order to capture a) the pathways past which gender equality and human rights interventions can improve SRH outcomes; and b) how nosotros accost intersecting forms of inequalities and bigotry along with gender and human rights concerns faced by specific sub-populations and marginalized groups in relation to their SRH. Increased coordination between gender and man rights focused actors could improve their ability to more than holistically contain human rights and gender into intervention design, implementation, and evaluation thereby strengthening the evidence base of operations.

Supporting Information

Acknowledgments

The authors would similar to acknowledge participants of the expert review meeting who provided feedback on the initial results of the review search and who aided in the identification of relevant greyness literature. The review was conceptualized by RK, AA, and SK. All authors (MH, SK, RK, AA, SG, AG) provided inputs into the telescopic of the review and the search strategy. MH conducted the search, screened citations, read and appraised the literature, and summarized findings. MH and SK led the content analysis and wrote the first draft of the manuscript. MH constructed the figures and tables. All authors participated in revision, including the present manuscript version. All authors read and approved the concluding manuscript.

Author Contributions

1. Conceptualization: RK AA SK.
2. Information curation: MH.
3. Formal assay: MH SK.
4. Funding acquisition: RK AA.
5. Investigation: MH.
6. Methodology: MH SK RK AA SG AG.
7. Project administration: RK.
8. Visualization: MH RK.
9. Writing – original draft: MH RK.
10. Writing – review & editing: MH SK RK AA SG AG.

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Source: https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0167542

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