REVIEW PROTOCOL

Sexual and reproductive rights of homeless women: a scoping review protocol

Givânya Bezerra de Melo1, Aurélio Molina da Costa1

1 University of Pernambuco, Recife, PE, Brazil

ABSTRACT

Objective: To outline an overview for the exercise of sexual and reproductive rights of homeless girls and women in Brazil. Method: A scoping review to answer the following question: What is the overview for the exercise of sexual and reproductive rights of homeless girls and women in Brazil? Data collection will take place in PUBMED, SCOPUS, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Scientific Electronic Library Online (SciELO), Google Scholar, Directory of Open Access Journals (DOAJ), the Brazilian Publications Portal for scientific journals in open access (OasisBr) and the Brazilian Portal of Theses and Dissertations. The articles found will be grouped in the Mendeley software. Two independent reviewers will select the titles, abstracts and full articles regarding the eligibility criteria and will extract the data that answer the research question. The data will be submitted to descriptive and narrative analysis and the IRAMUTEQ software will assist in their analysis and presentation.

Descriptors: Sexual and Reproductive Rights; Homeless People; Women.

INTRODUCTION

Progress in sexual and reproductive rights in recent decades has not been uniform across countries, regions and population groups. Intersecting economic, gender, cultural, ethnic and political variables are barriers to guaranteeing these human rights. Achieving the global goals of accelerating progress and sustainable development requires focusing on the sexual and reproductive rights of marginalized groups, including homeless people(1,2).

The term “homeless situation” describes a social group that suffers violations of the rights to adequate housing, life, security, health, and protection of the home and the family(3). Homeless girls and women are in extreme deprivation of their sexual and reproductive rights, facing gender inequalities, patriarchal domination, prejudice and violence, in a context of extreme psychosocial vulnerability and denial of rights(4–6).

They are frequently faced with lack of infrastructure to meet their basic needs and those inherent to the female universe; expose themselves to abusive use of alcohol and other drugs, trafficking and prostitution in exchange for financial and protection resources(7,8). They are also exposed to multiple forms of violence, especially sexual violence by an intimate partner while living on the street(8).

In 2018, a case of judicialization of the sterilization of a homeless woman, in the inland of São Paulo, drew the attention of the United Nations (UN), UN Women and the Regional Office for South America of the High Commissioner of the United Nations for Human Rights, which repudiated State interference in a decision that would fall on the woman, violating international agreements on sexual and reproductive rights of which Brazil is a signatory(9).

In the United States, homeless women lack access to prenatal care, which leads to increased rates of unwanted pregnancies and adverse postpartum outcomes(10). In the United Kingdom, primary care services had deficits in the medical records about contraceptive methods and approaches to unwanted pregnancies in these women(11).

In practice, the universal prerogative of availability and qualification of services, goods and facilities for the full exercise of sexual and reproductive rights(2) seems not to include women in street situations. They are on the sidelines of fundamental achievements in this field, compromising access to and achievement of the highest standard of sexual and reproductive health, including sexual and reproductive autonomy(1,12).

Primary studies on sexual and reproductive rights of homeless girls and women have been published. However, a preliminary search conducted in July 2021 in in PubMed, the Cochrane Library, the Joanna Briggs Institute (JBI), the International Prospective Register of Systematic Reviews (PROSPERO) and the Open Science Framework (OSF) did not identify scoping or systematic review protocol studies focusing on homeless women's sexual and reproductive rights. A recent systematic review briefly addressed these women's experiences in accessing health care. However, the studies included mostly portrayed the American reality, which limits generalization to other countries(6).

The absence of a universal concept to define the homeless population is a limitation in the consolidation of scientific knowledge about this population, including the issue of the exercise of sexual and reproductive rights. In this sense, the proposal of scoping analyses in different countries makes it possible to investigate with greater reliability the characteristics of this exercise, allowing for the exploration of regional data sources. In the last ten years, the homeless population in Brazil has grown by around 595%(13,14), which further highlights the importance of discussing this phenomenon.

The implementation and proposal of more effective public policies require the identification and consolidation of the knowledge produced, including aspects related to access to the services for the full exercise of sexual and reproductive rights, the needs of these women and girls and the health professionals' perceptions and attitudes in guaranteeing these rights.

The current study aims at outlining an overview of the exercise of sexual and reproductive rights of homeless girls and women in Brazil.

METHOD

The Scoping Review proposed in this protocol will be developed according to the JBI ‒ Joanna Briggs Institute – methodology for scoping analyses. The protocol is registered with the OSF, with access via following link: osf.io/khby6/.

Review question

What is the overview for the exercise of sexual and reproductive rights of homeless girls and women in Brazil?

Inclusion criteria

Participants

Studies that have included homeless girls and women or that deal with this context will be eligible. The minimum age of nine years old was adopted as an inclusion criterion in the study, which is conventional for the initiation of vaccination against Human Papillomavirus (HPV) and due to early sexual initiation(15).

To avoid a generalized understanding of cisgender and transgender women, only the context of cisgender women will be explored, to investigate their specificities. Cisgender women identify with the female gender they were assigned at birth(16). Future studies on transgender women are needed.

Concept

The review will consider studies with primary data that portray the experiences or characteristics of the exercise of sexual and reproductive rights of homeless girls and women. Studies with secondary data that resorted to the following data sources will also be considered in the same circumstances: records in information systems, official databases, documents with registration and monitoring record information, and legal databases. Sexual and reproductive rights include the right to attain the highest standard of sexual and reproductive health(17,18). The studies included will be those that allow assessing the following: access to sexual and reproductive health services and information on sexuality and sexual education(17); respect for bodily integrity, choice of a partner and desire to be sexually active or not; autonomy in engaging in consensual sexual relationships and choosing a spouse; pursuit and guarantee of a satisfying, safe and pleasurable sex life, free from stigma and discrimination(2); free, informed and voluntary decision-making about sexuality, sexual orientation and gender identity(18); reproductive autonomy in terms of number, spacing and timing for having children and access to information and the means to do so; respect for reproduction free from discrimination, coercion and violence(2); right to privacy, confidentiality, respect and informed consent and to respectful and equitable gender relations(2).

Context

Studies with data collection carried out in Brazil, both in institutional and non-institutional environments, including health and social assistance services, the street and support houses, among others, will be eligible, in view of the multiplicity of environments in which these girls and women can transit(13).

Types of sources

Articles with primary data and qualitative, quantitative or mixed designs will be considered; among them, experimental and non-experimental studies. Observational studies, including cohort, case-control and cross-sectional studies, will also be considered. Case series and case reports/studies will also be included, as well as articles from theses and dissertations, although the latter two will not be part of the sample.

The data will be collected from PUBMED, SCOPUS, LILACS, SciELO, Google Scholar, DOAJ, OasisBr from the Brazilian Institute of Information in Science and Technology (Instituto Brasileiro de Informações em Ciências e Tecnologia, IBICT), and from the Theses and Dissertations Catalog of the Coordination for the Improvement of Higher Level Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, CAPES).

Studies in any language published between January 1st, 1994 (year of the International Conference on Population and Development, held in Cairo, Egypt) and November 30th, 2022, will be eligible. The period comprises important milestones in the field of sexual and reproductive rights in Brazil and in the world, as well as the consolidation of public policies for the homeless population in the country.

Exclusion criteria

Articles that do not explain the context or the study design will be excluded. In studies that include other groups or men and women living on the streets, only the data referring to homeless women and girls will be used. Abstracts of congresses, undergraduate and lato sensu course conclusion papers, proceedings of events, editorials, letters, technical notes, review studies, policies or legislation will be excluded.

Research strategy

A three-stage search strategy will be outlined. The first consists in performing searches in PUBMED and LILACS. Subsequently, the words/Descriptors in Health Sciences (Descritores em Ciências da Saúde, DeCS) and Medical Subject Headings (MeSH) relevant to the review objective will be extracted from the titles, abstracts and index terms. Figure 1 shows three complete search strategies for PubMed, LILACS and Google Scholar, carried out on July 31st, 2021, using the DeCs and MeSH terms, combined by the Boolean operators AND and OR.

Source: Prepared by the authors, 2021.

Figure 1 ‒ Search strategies in PUBMED, LILACS and Google Scholar. Recife, PE, Brazil, 2021

In the second stage, a secondary and more sensitive search will be carried out in all databases, with the inclusion of all keywords/descriptors.

In the third stage, after reading the studies selected at the end of the second stage, the reference lists of these studies will be examined to assist in the identification of additional studies that may comprise the final sample of this scoping review. Additional searches will also be carried out for articles from theses and dissertations that were identified during the search stages, including the reference list examination stage. The reviewers may contact the authors of the studies to solve doubts and obtain additional information.

Selection of the studies

All data collection articles will be uploaded and grouped in Mendeley (Elsevier, Amsterdam, Netherlands) and duplicates will be removed. The remaining references will be exported to the Rayann application (Qatar Foundation, Qatar). Two independent (blind) reviewers will conduct the three-stage selection process. In the first, they will read the titles, following the pre-established eligibility criteria. Subsequently, they will review the abstracts of the remaining studies, and any and all disagreement in the selection of studies will be resolved through a consensus meeting. In the last stage, the potentially relevant studies will be retrieved in full to the Trello@ software (project manager) and evaluated against the inclusion and exclusion criteria by the same independent reviewers. An independent researcher will be called upon to make the decision if there are disagreements in the selection of studies in this last stage. The reasons for the sources excluded in the full-text review will be reported in the scoping review. The main results obtained will be reported in the final scoping review and presented in a flowchart in the Reporting Items for Systematic Reviews and Meta-analyses for Scoping Review – PRISMA/ScR format(19).

Data extraction

A standardized data extraction form was developed by the study authors (Figure 2) to assist in extracting the data from the studies of the final sample. The form will be submitted to a pre-test stage, with the prior evaluation of five articles and may undergo modifications to meet the study objective.

Source: Prepared by the authors, 2021.

Figure 2 – Standardized data extraction form. Recife, PE, Brazil, 2021

The data from the final sample studies will be extracted by the independent reviewers with the aid of an Excel® spreadsheet on the data extraction form questions. To fully answer the research question, the form may be updated during the extraction process. At the end, the two reviewers will discuss the data extracted to reach a consensus. Possible discrepancies will be resolved by a third independent researcher.

Data analysis and presentation

The main data extracted will be presented in synoptic charts and tabular diagrams in order to meet the objectives of this scoping review. In addition, they will be subjected to a descriptive and narrative analysis to explore and detail the synthesis of the diverse evidence that answers the research questions. The IRAMUTEQ software will be used to assist in data analysis and presentation.

CONFLICT OF INTEREST

The authors have declared that there is no conflict of interest.

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Submission: 09/01/2021

Approved: 02/18/2022