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Armed conflict and maternal health care utilization: Evidence from the Boko Haram Insurgency in Nigeria

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  • Chukwuma, Adanna
  • Ekhator-Mobayode, Uche Eseosa

Abstract

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.

Suggested Citation

  • Chukwuma, Adanna & Ekhator-Mobayode, Uche Eseosa, 2019. "Armed conflict and maternal health care utilization: Evidence from the Boko Haram Insurgency in Nigeria," Social Science & Medicine, Elsevier, vol. 226(C), pages 104-112.
    • Handle: RePEc:eee:socmed:v:226:y:2019:i:c:p:104-112
    DOI: 10.1016/j.socscimed.2019.02.055
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    References listed on IDEAS

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    1. Uche Eseosa Ekhator-Mobayode & Abraham Abebe Asfaw, 2019. "The child health effects of terrorism: evidence from the Boko Haram Insurgency in Nigeria," Applied Economics, Taylor & Francis Journals, vol. 51(6), pages 624-638, February.
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    1. Vesco, P. & Baliki, G. & Brück, T. & Döring, S. & Eriksson, A. & Fjelde, H. & Guha-Sapir, D. & Hall, J. & Knutsen, C. H. & Leis, M. R. & Mueller, H. & Rauh, C. & Rudolfsen, I. & Swain, A., 2024. "The Impacts of Armed Conflict on Human Development," Cambridge Working Papers in Economics 2462, Faculty of Economics, University of Cambridge.
    2. Svallfors, Signe & Båge, Karin & Ekström, Anna Mia & Elimian, Kelly & Gayawan, Ezra & Litorp, Helena & Kågesten, Anna, 2024. "Armed conflict, insecurity, and attitudes toward women's and girls' reproductive autonomy in Nigeria," Social Science & Medicine, Elsevier, vol. 348(C).
    3. Ekhator-Mobayode,Uche Eseosa & Hanmer,Lucia C. & Rubiano Matulevich,Eliana Carolina & Arango,Diana Jimena, 2020. "Effect of Armed Conflict on Intimate Partner Violence : Evidence from the Boko Haram Insurgency in Nigeria," Policy Research Working Paper Series 9168, The World Bank.
    4. Torrisi, Orsola, 2024. "Violent instability and modern contraception: Evidence from Mali," World Development, Elsevier, vol. 177(C).
    5. Guerra-Cújar, María Elvira & Prem, Mounu & Rodriguez-Lesmes, Paul & Vargas, Juan F., 2020. "The Peace Baby Boom: Evidence from Colombia’s peace agreement with FARC," SocArXiv c2ypd, Center for Open Science.
    6. Eseosa Ekhator-Mobayode, Uche & Hanmer, Lucia C. & Rubiano-Matulevich, Eliana & Jimena Arango, Diana, 2022. "The effect of armed conflict on intimate partner violence: Evidence from the Boko Haram insurgency in Nigeria," World Development, Elsevier, vol. 153(C).
    7. Takahiro Tsujimoto & Yoko Kijima, 2020. "Effects of conflict on child health: Evidence from the 1990–1994 Northern Mali Conflict," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1456-1474, November.
    8. Douglas Kazibwe, 2023. "Violent Conflicts and Educational Outcomes: The LRA Insurgency in Northern Uganda Revisited," HiCN Working Papers 401, Households in Conflict Network.
    9. Uche Eseosa Ekhator-Mobayode & Lucia C. Hanmer & Eliana Carolina Rubiano Matulevich & Diana Jimena Arango, 2020. "The effect of armed conflict on Intimate Partner Violence (IPV): Evidence from the Boko Haram (BH) Insurgency in Nigeria," HiCN Working Papers 321, Households in Conflict Network.
    10. Elice, Paola & Martínez Flores, Fernanda & Reichert, Arndt R., 2023. "Religious terrorism, forced migration, and women's empowerment: Evidence from the Boko Haram insurgency," Ruhr Economic Papers 1044, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    11. Uche Eseosa Ekhator-Mobayode & Seyedsoroosh Azizi, 2019. "Does the Presence of Neighborhood Gang Affect Youth Criminal Behavior?," Economics Bulletin, AccessEcon, vol. 39(3), pages 2102-2109.

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