World Bank Group, Washington, DC, 20433, USA.
Soc Sci Med. 2019 Apr;226:104-112. doi: 10.1016/j.socscimed.2019.02.055. Epub 2019 Mar 3.
Retention in maternal health care is essential to decreasing preventable mortality. By reducing access to care, armed conflicts such as the Boko Haram Insurgency (BHI), contribute to the high maternal mortality rates in Nigeria. While there is a rich literature describing the mechanisms through which conflict affects health care access, studies that estimate the impact of conflict on maternal health care use are sparse and report mixed findings. In this study, we examine the impact of the BHI on maternal care access in Nigeria. We spatially match 52,675 birth records from the Nigeria Demographic and Health Survey (NDHS) with attack locations in the Armed Conflict Location and Event Dataset (ACLED). We define BH conflict area as NDHS clusters with at least five attacks within 3000, 5000 and 10,000 m of BH activity during the study period and employ difference-in-differences methods to examine the effect of the BHI on antenatal care visits, delivery at the health center and delivery by a skilled professional. We find that the BHI reduced the probability of any antenatal care visits, delivery at a health center, and delivery by a skilled health professional. The negative effects of the BHI on maternal health care access extended beyond the Northeastern region, that is the current focus of humanitarian programs. Systematic efforts to identify and address the mechanisms underlying reductions in maternal health care use due to the BHI, and to target the affected populations, are essential to improving maternal health in Nigeria.
孕产妇保健服务的保留对于降低可预防的死亡率至关重要。武装冲突（如博科圣地叛乱）会限制孕产妇获得保健服务，从而导致尼日利亚孕产妇死亡率居高不下。虽然有大量文献描述了冲突影响医疗保健服务获取的机制，但估计冲突对孕产妇保健服务利用影响的研究却很少，且报告的结果存在差异。在这项研究中，我们研究了博科圣地叛乱对尼日利亚孕产妇保健服务获取的影响。我们将来自尼日利亚人口与健康调查（NDHS）的 52675 份生育记录与武装冲突地点和事件数据集（ACLED）中的袭击地点进行空间匹配。我们将博科圣地冲突地区定义为 NDHS 集群中，在研究期间有至少 5 次袭击事件发生在博科圣地活动的 3000、5000 和 10000 米范围内的地区，并采用差分法来研究博科圣地叛乱对产前护理就诊、在卫生中心分娩和由熟练专业人员分娩的影响。我们发现，博科圣地叛乱降低了任何产前护理就诊、在卫生中心分娩和由熟练卫生专业人员分娩的可能性。博科圣地叛乱对孕产妇保健服务获取的负面影响超出了东北部地区，而东北部地区正是当前人道主义项目的重点关注区域。为了改善尼日利亚的孕产妇健康，必须系统地努力查明和解决因博科圣地叛乱而导致孕产妇保健服务利用率降低的根本原因，并针对受影响的人群采取措施。
