A systematic review published in Conflict and Health has found substantial gaps and wide variability in the delivery of sexual and reproductive health services for refugees across the Eastern Mediterranean Region (EMR). The review assessed the implementation of the Minimum Initial Service Package (MISP), a set of priority interventions designed to deliver life-saving sexual and reproductive health care during humanitarian emergencies.
The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The researchers searched multiple electronic databases as well as reports from United Nations agencies, covering material published between 2013 and December 31, 2024. The risk of bias in the included studies was assessed using the Newcastle–Ottawa Scale.
In total, eleven peer-reviewed studies and one report met the inclusion criteria. The review focused on female refugees aged 15 to 49 years in the EMR, synthesizing evidence on MISP-related service utilization indicators alongside maternal and reproductive health outcomes.
The findings revealed considerable variation across refugee populations. Unplanned pregnancy rates ranged from 26 percent to 70 percent, while contraceptive prevalence ranged from 35 percent to 54 percent. Antenatal care coverage showed an equally broad spread, from 30 percent to 100 percent across the included studies.
Birth-related indicators presented a mixed picture. The proportion of births attended by skilled health personnel ranged from 72 percent to nearly 100 percent, and cesarean section rates varied from 5 percent to 35 percent. According to the review, indicators such as skilled birth attendance and cesarean section rates were generally within acceptable ranges in several settings.
Other outcomes raised more concern. Reported rates of sexual violence ranged from 3 percent to 68 percent, and neonatal mortality varied considerably across the included studies. The review also identified substantial gaps in family planning services and in the prevention of unplanned pregnancy, alongside a lack of available evidence for several core MISP components.
The authors concluded that the available evidence indicates important gaps and considerable variability in the implementation of MISP-related sexual and reproductive health services, and in the associated maternal and reproductive health outcomes, across the EMR.
The review underscores the need to strengthen MISP implementation, improve monitoring of key indicators, and expand high-quality research on sexual and reproductive health services for refugee populations in the region.
As a systematic review, the study synthesizes previously published research rather than collecting new data from refugee populations, and its conclusions are bounded by the quality and coverage of the underlying studies.
Subject of Research: Implementation of the Minimum Initial Service Package for sexual and reproductive health among refugees in the Eastern Mediterranean Region
Article Title: Assessing the implementation of the minimum initial service package for sexual and reproductive health (MISP) among refugees in the Eastern Mediterranean region: a systematic review
Article References: Hakimi, S., Alizadeh, S., Esmaeili, E. D., Allahqoli, L., Turfan, E. C., Sogukpinar, N., Etrusco, A. L., & Alkatout, I. (2026). Assessing the implementation of the minimum initial service package for sexual and reproductive health (MISP) among refugees in the Eastern Mediterranean region: a systematic review. Conflict and Health. https://doi.org/10.1186/s13031-026-00856-4
Image Credits: AI Generated
DOI: 10.1186/s13031-026-00856-4
Keywords: refugee health, sexual and reproductive health, MISP, humanitarian emergencies, Eastern Mediterranean, systematic review, maternal health, family planning, antenatal care, skilled birth attendance, sexual violence, neonatal mortality
News Source: Harold Sullivan. (October 27, 2026). Systematic review finds wide gaps in reproductive health services for refugees in the Eastern Mediterranean. Scienmag.
