Department of Economics, University of New Mexico, Albuquerque, NM 87131-0001, USA.
Health Policy Plan. 2013 May;28(3):309-19. doi: 10.1093/heapol/czs062. Epub 2012 Jul 6.
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.
武装冲突主要发生在中低收入国家，对受影响人群的健康造成了深远影响，其中包括孕产妇保健服务利用率的下降。武装冲突与孕产妇保健服务利用之间的定量关系在公共卫生文献中受到的关注有限。我们在尼泊尔评估了一种特定类型的医疗服务，即产前护理，与这种关系。使用计数回归技术、家庭调查数据和次国家冲突数据，我们发现受访者所在的村发展委员会内发生的与冲突相关的暴力事件数量与接受产前护理的次数之间存在负相关关系。具体来说，我们发现，在高强度冲突情况下，妇女接受的产前护理检查次数减少了 0.3 到 1.5 次。这些发现意味着孕产妇保健服务的利用部分取决于社会环境的特征（例如政治不稳定），并表明医疗服务提供者需要在受冲突影响的地区修改孕产妇保健策略。策略可能包括服务的去中心化、在各派之间保持中立、加强基于社区的卫生服务和发展流动诊所。
