Broadening understanding of accountability ecosystems in sexual and reproductive health and rights: A systematic review
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Date
2018
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
BACKGROUND
Accountability for ensuring sexual and reproductive health and rights is increasingly receiving
global attention. Less attention has been paid to accountability mechanisms for sexual
and reproductive health and rights at national and sub-national level, the focus of this systematic
review.
METHODS
We searched for peer-reviewed literature using accountability, sexual and reproductive
health, human rights and accountability instrument search terms across three electronic
databases, covering public health, social sciences and legal studies. The search yielded
1906 articles, 40 of which met the inclusion and exclusion criteria (articles on low and middle-
income countries in English, Spanish, French and Portuguese published from 1994 and
October 2016) defined by a peer reviewed protocol.
RESULTS
Studies were analyzed thematically and through frequencies where appropriate. They were
drawn from 41 low- and middle-income countries, with just over half of the publications from
the public health literature, 13 from legal studies and the remaining six from social science
literature. Accountability was discussed in five health areas: maternal, neonatal and child
health services, HIV services, gender-based violence, lesbian/gay/bisexual/transgender
access and access to reproductive health care in general. We identified three main groupings
of accountability strategies: performance, social and legal accountability.
CONCLUSION
The review identified an increasing trend in the publication of accountability initiatives
in Sexual and Reproductive Health and Rights (SRHR). The review points towards a complex `accountability ecosystem' with multiple actors with a range of roles, responsibilities
and interactions across levels from the transnational to the local. These accountability
strategies are not mutually exclusive, but they do change the terms of engagement
between the actors involved. The publications provide little insight on the connections
between these accountability strategies and on the contextual conditions for the successful
implementation of the accountability interventions. Obtaining a more nuanced understanding
of various underpinnings of a successful approach to accountability at national
and sub national levels is essential.
Description
Keywords
Sexual and reproductive health, Sexual health, Sexual and Reproductive Health and Rights (SRHR), Accountability ecosystem, Accountability
Citation
Van Belle, S. et al. (2018). Broadening understanding of accountability ecosystems in sexual and reproductive health and rights: A systematic review. PLoS ONE, 13(5): e0196788.