Health in conflict and post-conflict settings: reproductive, maternal and child health in Colombia

Abstract

Background: In conflict-afflicted areas, pregnant women and newborns often have higher rates of adverse health outcomes. Objective: To describe maternal and child health indicators and interventions between 1998 and 2016 comparing high and low conflict areas in Colombia. Methods: Mixed study of convergent triangulation. In the quantitative component, 16 indicators were calculated using official, secondary data sources. The victimization rate resulting from armed conflict was calculated by municipality and grouped into quintiles. In the qualitative component, a comparative case study was carried out in two municipalities of Antioquia: one with high rates of armed conflict and another with low rates. A total of 41 interviews and 8 focus groups were held with local and national government officials, health professionals, community informants, UN agencies and NGOs. Results: All of the indicators show improvement, however, four show statistically significant differences between municipalities with high victimization rates versus low ones. The maternal mortality ratio was higher in the municipalities with greater victimization in the periods 1998-2004, 2005-2011 and 2012-2016. The percentage of cesarean births and women who received four or more antenatal visits was lower among women who experienced the highest levels of victimization for the period 1998-2000, while the fertility rate for women between 15 and 19 years was higher in these municipalities between 2012 and 2016. In the context of the armed conflict in Colombia, maternal and child health was affected by the limited availability of interventions given the lack of human resources in health, supplies, geographical access difficulties and insecurity. The national government was the one that mostly provided the programs, with difficulties in continuity and quality. UN Agencies and NGOs accessed more easily remote and intense armed conflict areas. Few specific health interventions were identified in the postconflict context. Conclusions: In Colombia, maternal and child health indicators have improved since the conflict, however a pattern of inequality is observed in the municipalities most affected by the armed conflict.

Implications of armed conflict for maternal and child health: A regression analysis of data from 181 countries for 2000–2019

“…Research from Afghanistan showed that coverage of skilled birth attendants and institutional facility deliveries continued to increase linearly between 2003 (approximately 20%) and 2015 (approximately 50%), when the country experienced substantial national conflict, explained by early investment in maternal health programmes and a resilient health system [ 37 ]. A similar pattern was recently documented in Colombia [ 43 ]. The absence of a significant relationship between conflict and neonatal mortality indicates that mechanisms underlying the association between conflict and maternal and child health may be complex and may vary between outcome measures.…”

Factors impacting antenatal care utilization: a systematic review of 37 fragile and conflict-affected situations

“…We posit that while conflict was not a frequently cited barrier, it may largely explain women’s poor uptake of ANC. For example, in some FCAS, healthcare facilities are attacked, practitioners may be kidnapped, killed, or forced to flee to urban areas to ensure safety, and clinics often lack necessary resources [ 83 ]. These events may explain why women experience poor quality of ANC and cannot find care facilities in rural areas [ 6 , 84 , 85 ].…”

“…Women reported experiencing long wait times and receiving care from providers who were unfriendly and “inept” [ 30 ]. Conflict directly affects resource allocation and contributes to a lack of providers, equipment, and medical resources, which may explain the poor quality of care [ 83 ]. Pregnant women in FCAS are a vulnerable population who are often unaware of the benefits of ANC [ 38 ].…”

A social innovation model for equitable access to quality health services for rural populations: a case from Sumapaz, a rural district of Bogota, Colombia

“…In this paper, we present the findings of a social innovation case study developed and implemented in a rural post-conflict region in Colombia with the purpose of comprehensively addressing the health needs of the local population and enhancing health service access [ 24 ].. The social innovation - ‘ Model of Integral Health Care for Rural Areas, in the rural town of Sumapaz (Bogotá, Colombia)’ - has been implemented as a primary care initiative by the Subred Sur (the main public health institution of the district) for the past 20 years.…”