The impact of disaster events on sexual and reproductive health service provision and outcomes in low- and middle-income countries: A systematic review of the literature

Acute events, including natural disasters and epidemics, can strain the already-fragile health systems in many low- and middle-income countries (LMICs). Disasters introduce unique circumstances in which resources may be diverted away from essential sexual and reproductive health (SRH) services, disruptions to the supply chain may occur, and individuals may have limited access to or fear of health facilities. Disruptions to service delivery can disproportionately affect women and girls who faced existing structural barriers and inequalities before the disaster occurred. We will conduct a systematic review of the peer-reviewed literature to better understand the effects of disasters on SRH services and related outcomes in LMICs. We will review both quantitative and qualitative research papers published in the last 15 years, with a focus on the quality and rigor of each study. Documents from the grey literature may be included if too few articles are identified. We aim to produce a narrative synthesis to holistically describe what has been experienced, reported variation across disaster contexts, and any key lessons for how to lessen the impact on vulnerable individuals and communities. Evidence from this review can serve as a learning opportunity for the COVID-19 pandemic that already threatens SRH outcomes. Findings may inform interventions and policies that aim to build more resilient health systems in the face of acute disasters, including pandemics.