Submission ID 131986
| Issue/Objective | Background Conflict-affected and fragile settings are increasing globally, disrupting health systems and exacerbating inequities in access to care. Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services are particularly vulnerable to these disruptions, with significant implications for morbidity and mortality. Understanding the barriers and facilitators influencing service delivery and utilization is critical to advancing equitable, context-driven health system responses. This review synthesizes existing evidence to inform policy and practice in low- and middle-income countries (LMICs) affected by conflict . Objective To identify and synthesize barriers and facilitators affecting the delivery, uptake, and utilization of RMNCAH services in conflict-affected settings. |
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| Methodology/Approach | Methodology The systematic review was conducted following PRISMA guidelines and MEDLINE, EMBASE, the Cochrane Library, and ProQuest Social Sciences were searched, along with grey literature sources (including WHO, UNICEF, MSF, USAID, IFRC, ICRC, IRC, Save the Children, and World Vision) from 2010 to 2025. Keywords related to factors affecting delivery, uptake and utilization of RMNCAH services in conflict-affected low- and middle-income countries (LMICs) were used. Studies were included if they examined determinants of access and/or utilization of RMNCAH services in conflict-affected LMIC settings. Two reviewers independently screened studies, assessed eligibility, and conducted risk of bias and quality appraisal using the Critical Appraisal Skills Programme (CASP) tool and associated checklists. The review protocol was registered with PROSPERO. |
| Results | Results Barriers to RMNCAH service delivery and utilization were multifactorial, spanning contextual (insecurity, displacement), organizational (health workforce shortages, infrastructure gaps), financial (user costs, funding instability), and sociocultural (gender norms, trust) domains. Provider training, attitudes, and community engagement approaches significantly influenced care uptake. Facilitators included investment in primary health care, strengthening local health systems, and partnerships with community actors, which improved trust, continuity, and perceived quality of care. |
| Discussion/Conclusion | Conclusion Delivering RMNCAH services in conflict settings requires integrated, equity-focused approaches that address both health system constraints and community-level determinants. Strengthening local systems, investing in community health workers, and fostering trust between providers and communities are critical to improve access. Innovative delivery models (i.e. mobile and remote care) can support continuity in insecure environments. Integrating these strategies can better strengthen access to RMNCAH services in conflict settings. |
| Presenters and Affiliations | Donya Razavi York University Dina Idriss-Wheeler University of Ottawa Julia Hajjar Canadian Red Cross Akalewold Gebremeskel University of Ottawa Rajalakshmi Ravikumar Canadian Red Cross Mekdes Assefa Canadian Red Cross Christina Angelakis Canadian Red Cross Faiza Rab Canadian Red Cross Ilja Ormel Canadian Red Cross Salim Sohani Canadian Red Cross Areej Amjad Canadian Red Cross |
