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Armed conflict and maternal mortality: A micro-level analysis of sub-Saharan Africa, 1989–2013

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  • Kotsadam, Andreas
  • Østby, Gudrun

Abstract

There is existing country-level evidence that countries with more severe armed conflict tend to have higher Maternal Mortality Rates (MMR). However, during armed conflict, the actual fighting is usually confined to a limited area within a country, affecting a subset of the population. Hence, studying the link between country-level armed conflict and MMR may involve ecological fallacies. We provide a more direct, nuanced test of whether local exposure to armed conflict impacts maternal mortality, building on the so-called “sisterhood method”. We combine geo-coded data on different types of violent events from the Uppsala Conflict Data Program with geo-referenced survey data from the Demographic and Health Surveys (DHS) on respondents' reports on sisters dying during pregnancy, childbirth, or the puerperium. Our sample covers 1,335,161 adult sisters aged 12–45 by 539,764 female respondents in 30 countries in sub-Saharan Africa. Rather than aggregating the deaths of sisters to generate a maternal mortality ratio, we analyze the sisters’ deaths at the individual level. We use a sister fixed-effects analysis to estimate the impact of recent organized violence events within a radius of 50 km of the home of each respondent on the likelihood that her sister dies during pregnancy, childbirth, or the puerperium. Our results show that local exposure to armed conflict events indeed increases the risk of maternal deaths. Exploring potential moderators, we find larger differences in rural areas but also in richer and more educated areas.

Suggested Citation

  • Kotsadam, Andreas & Østby, Gudrun, 2019. "Armed conflict and maternal mortality: A micro-level analysis of sub-Saharan Africa, 1989–2013," Social Science & Medicine, Elsevier, vol. 239(C).
    • Handle: RePEc:eee:socmed:v:239:y:2019:i:c:s0277953619305209
    DOI: 10.1016/j.socscimed.2019.112526
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    Citations

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    Cited by:

    1. Le, Kien & Nguyen, My, 2020. "The Impacts of Armed Conflict on Child Health: Evidence from 56 Developing Countries," MPRA Paper 109896, University Library of Munich, Germany.
    2. 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.
    3. Torrisi, Orsola, 2024. "Violent instability and modern contraception: Evidence from Mali," World Development, Elsevier, vol. 177(C).
    4. Bove, Vincenzo & Di Salvatore, Jessica & Elia, Leandro & Nisticò, Roberto, 2024. "Mothers at peace: International peacebuilding and post-conflict fertility," Journal of Development Economics, Elsevier, vol. 167(C).
    5. Signe Svallfors, 2024. "Giving Birth While Facing Death: Cesarean Sections and Community Violence in Latin America," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 43(2), pages 1-22, April.

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