Armed Conflict and Maternal Health in Sub-Saharan Africa

A midway review of the UN Millennium Development Goals concluded that maternal health remains a regional and global scandal. One of the targets of the Sustainable Development Goals is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. Recent years have seen some improvements, but progress is still slow, particularly in Sub-Saharan Africa (SSA). The odds that a woman in SSA will die from complications related to pregnancy and childbirth is one in 20 compared to one in 6,250 in the developed world. In a region where the majority of countries have experienced armed conflict since the end of the Cold War, the poor performance may in part be due to detrimental effects of armed conflicts. This is supported by recent global studies reporting high female excess mortality during and immediately after conflict. The primary objective of this project is to improve our understanding of how conflict affects maternal health and how to improve maternal health in post-conflict societies, which is crucial for formulating humanitarian policies to improve women's health after conflict. We use subnational conflict data to investigate local effects of civil war on various maternal health indicators, such as e.g. the use of life-saving maternal health care services like antenatal care and professional assistance during birth. Finally, we study determinants of maternal health in post-conflict societies to identify the most effective intervention strategies, and we study the effectiveness of development aid. We combine statistical analysis of existing data, such as national surveys and geographical conflict data. We have conducted fieldwork in Burundi, DR Congo, and Liberia, where we i.a. have interviewed women in fertile ages and medical personnel about barriers with regard to access to maternal health services. While many studies focus exclusively on the direct effects of specific interventions to improve maternal health such as family planning services and the provision of obstetrical care, we broaden the scope and also consider the more distant impact of political, socioeconomic, and cultural factors. Furthermore, this project is the first systematic attempt to study determinants of maternal health in post-conflict societies at the local (subnational) level. The project has hosted/co-hosted two workshops in Oslo, one in Addis Ababa, one in Kampala and one in Washington DC - including both researchers and policy-makers. In addition we have hold one public dissemination event at the Wilson Center in Washington DC. We have given several conference presentations and talks in e.g. Australia, Belgium, DR Congo, Germany, Norway, Sweden, Uganda, UK, and the USA. We have also written several academic articles, of which 14 are so-far published in scholarly peer-reviewed journals (such as e.g. BMC Pregnancy and Childbirth, Conflict Management and Peace Science, Demography, Political Geography, and World Development), and a handful more are under review. While the majority of our studies within this project focus on how armed conflict, crises, and development aid affects the access to- and the use of maternal health services, we have now also started to use a large amount of survey data to conduct a more direct test of local conflict exposure with regard to the risk of maternal mortality, based on information on the respondent's sisters. One of our main findings is that there seems to be a strong reinforcing effect of local armed conflict exposure on the risk of maternal deaths in sub-Saharan Africa.

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A midway review of the UN Millennium Development Goals concluded that maternal health remains a regional and global scandal. The most recent years have seen some improvements, but progress is still slow, particularly in Sub-Saharan Africa (SSA). The odds that a woman in SSA will die from complications related to pregnancy and childbirth is one in 20 compared to one in 6,250 in the developed world, resulting both from high fertility and maternal mortality rates. In a region where the majority of countries have experienced armed conflict since the end of the Cold War, the poor performance may in part be due to detrimental effects of armed conflicts on maternal health. This is supported by recent global studies reporting high female excess mortality during a nd immediately after conflict. This project aims to increase our knowledge of how armed conflict impacts maternal health, and how to improve maternal health in post-conflict societies, which is crucial for formulating humanitarian policies to improve wome n's health after conflict. We use disaggregated conflict data to investigate local effects of civil war on health indicators. This allows us to assess various measures of maternal health, account for contextual factors, and consider potential diffusion ef fects of poor maternal health into neighboring regions. Finally, we study the determinants of maternal health in post-conflict societies to identify the most effective intervention strategies. Attempting to ameliorate conflict-related biases in health dat a, we use methodological triangulation combining statistical analysis of secondary data from sources such as national survey data with qualitative analysis through fieldwork. While many studies focus on direct effects of interventions, like the provision of obstetrical care, we also consider political, socioeconomic, and cultural factors. This is the first systematic attempt to study how interventions affect maternal health post conflict at the subnational level.