Protracted armed conflict and maternal health: a scoping review of literature and a retrospective analysis of primary data from northwest Syria
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Published version
Author(s)
Type
Journal Article
Abstract
Introduction: Syria’s protracted conflict has devastated the health system reversing progress made on maternal health pre-conflict. Our aim is to understand the state of maternal health in Syria focused on underage pregnancy and caesarean-sections using a scoping review and quantitative analysis; the latter draws on data from the Syrian American Medical Society’s (SAMS) maternal health facilities in northwest Syria.
Methods: We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a micro-context in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean-section and age at pregnancy.
Results: Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean-sections, maternal age and perinatal care. 12 studies reported caesarean-section rates; these varied from 16 to 64% of all births: northern Syria (19-45%,) Damascus (16-54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77,746 births across 17 facilities, trend data for caesarean-sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean-section births. There was notable geographical and inter-facility variation in the findings.
Conclusion: The quality of available literature was poor with country level generalisations. Research which explores micro-contexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean-section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
Methods: We performed a scoping review of academic and grey literature on the state of maternal health across Syria since the onset of conflict (taken as March 2011). Identified articles were screened using pre-established criteria and themes identified. We also performed a retrospective quantitative analysis of maternal health data from SAMS’ facilities in a micro-context in north-west Syria between March 2017 and July 2020, analysing the trends in the proportion of births by caesarean-section and age at pregnancy.
Results: Scoping review: of 2824 articles, 21 remained after screening. Main themes related to maternal mortality rates, caesarean-sections, maternal age and perinatal care. 12 studies reported caesarean-section rates; these varied from 16 to 64% of all births: northern Syria (19-45%,) Damascus (16-54%,) Lattakia (64%) and Tartous (59%.) Quantitative analysis: Of 77,746 births across 17 facilities, trend data for caesarean-sections showed a decrease from 35% in March 2017 to 23% in July 2020 across SAMS facilities. Girls under 18 years accounted for 10% of births and had a lower proportion of caesarean-section births. There was notable geographical and inter-facility variation in the findings.
Conclusion: The quality of available literature was poor with country level generalisations. Research which explores micro-contexts in Syria is important given the different effects of conflict across the country and the fragmented health system. Our quantitative analysis provides some evidence around the changes to caesarean-section rates in northwest Syria. Despite limitations, this study adds to sparse literature on this important topic.
Date Issued
2022-08-30
Date Acceptance
2022-07-12
Citation
BMJ Global Health, 2022, 7 (8)
ISSN
2059-7908
Publisher
BMJ Publishing Group
Journal / Book Title
BMJ Global Health
Volume
7
Issue
8
Copyright Statement
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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Subjects
Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Maternal health
Obstetrics
Public Health
Surgery
WOMEN
CARE
Maternal health
Obstetrics
Public Health
Surgery
Adolescent
Armed Conflicts
Cesarean Section
Female
Humans
Maternal Health
Pregnancy
Retrospective Studies
Syria
Humans
Cesarean Section
Retrospective Studies
Pregnancy
Adolescent
Syria
Female
Maternal Health
Armed Conflicts
Publication Status
Published
Article Number
ARTN e008001
Date Publish Online
2022-08-30