Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal

Abstract

Armed conflicts, which primarily occur in low- and middle-income countries, have profound consequences for the health of affected populations, among them a decrease in the utilization of maternal health care services. The quantitative relationship between armed conflict and maternal health care utilization has received limited attention in the public health literature. We evaluate this relationship for a particular type of health care service, antenatal care, in Nepal. Using count regression techniques, household survey data and sub-national conflict data, we find a negative correlation between the number of antenatal care visits and incidents of conflict-related violence within a respondent's village development committee. Specifically, we find that under high-intensity conflict conditions women receive between 0.3 and 1.5 fewer antenatal care check-ups. These findings imply that maternal health care utilization is partially determined by characteristics of the social environment (e.g. political instability) and suggest health care providers need to revise maternal health strategies in conflict-affected areas. Strategies may include decentralization of services, maintaining neutrality among factions, strengthening community-based health services and developing mobile clinics.

Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015

“…Obesity prevalence was added to help to reflect the added complexity of care and heightened risk of maternal complications in those who are obese 29,30. Mortality death rate from fatal discontinuities, a covariate that aggregates the effects of war, famine, and natural disaster, was introduced to help to inform maternal mortality estimates in geographies where demographic shocks have led to interruption of vital statistics and where health systems are also hypothesised to have deteriorated 31,32. Hospital beds per 1000 population was added based on the hypothesis that it might be a proxy for the availability of basic EmOC 33.…”

Factors influencing maternal health care in Nepal: The role of socioeconomic interaction

“…As such, it was not at all clear whether government programmes alone could have brought about such a significant drop in maternal mortality, nor is it even clear that the programmes had achieved their full potential. Finally, estimates of maternal mortality rates in data from smaller regions in Nepal were much higher (Prize and Bohara, 2013).…”

Conflict and Disease: A Complex Relationship

“…Depending on the extent of conflict, physical barriers, such as transportation blockades, may explicitly prevent individuals from accessing any available healthcare that remains. Even in the absence of such barriers, fear for personal safety may result in a negative correlation between healthcare seeking and the amount of conflict-related violence (Price & Bohara, 2012). In extreme cases, violent unrest can result in destruction of health posts, as well as kidnapping and torture of healthcare providers (Devkota & Teijlingen, 2010;Collins, 2006).…”