Master of Science
As of 2019, over two billion people globally reside in conflict-affected areas, and as a result, face negative health implications. Burundi and the Democratic Republic of the Congo are among those countries classified as fragile and conflict-affected situations, resulting in disproportionally high maternal mortality rates. Grounded in Andersen’s Model of Healthcare Utilization, this thesis employed multivariate binary logistic regressions to examine factors which influence antenatal care and skilled birth attendant usage in these two countries. Findings indicate that women living in high conflict regions were significantly less likely than those in low conflict regions to have their first antenatal care visit within the first trimester, have four antenatal care visits, and meet the World Health Organization’s recommendations for care during pregnancy. This thesis elucidates the significant impact of conflict on antenatal care and skilled birth attendant usage and urges context-specific policy recommendations within fragile and conflict-affected situations to reduce maternal mortality.
Summary for Lay Audience
Fragile and conflict-affected situations are countries which have experienced prolonged conflict and whose governments are unable, or unwilling, to meet their citizens’ needs. Living in these situations has numerous effects on the health of citizens; women in particular face heightened susceptibility to the negative implications of conflict. As a result, these countries face exceptionally high rates of maternal mortality, deaths which often can be prevented with the usage of antenatal care and skilled birth attendants. Antenatal care is care provided to women during pregnancy, including identifying risks, providing counselling and education, treating conditions early in pregnancy, and providing emergency care. Skilled birth attendants include doctors, nurses, and midwives who assist women during childbirth. This thesis examined the impact of conflict on antenatal care in the fragile and conflict-affected situations of the Democratic Republic of the Congo and Burundi. Specifically, it investigated how living in regions of differing levels of conflict influenced whether women met three of the World Health Organization’s recommendations for a positive pregnancy experience. Survey data from 23 079 women surveyed in 2007, 2013-14, and 2016-17 by the Demographic and Health Surveys was used in this analysis. These surveys collected information regarding whether women living in the Democratic Republic of the Congo and Burundi had their first antenatal care visit within the first trimester, had four visits throughout pregnancy, used a skilled birth attendant, delivered in a hospital, and met the overall recommendations. The impact of conflict on these outcomes was investigated, as was the effect of other factors including gender-based violence, education, and employment. Findings show that women in both countries living in high conflict regions were less likely than those in low conflict regions to have their first visit in the first trimester, have four visits throughout pregnancy, and meet the World Health Organization recommendations in general. This thesis concludes that conflict experienced by women significantly influences their usage of antenatal care and as a result, their maternal health. From this conclusion, this thesis calls for policies that consider the influence of conflict and local context to improve pregnancy experiences and maternal health worldwide.
Ziegler, Bianca R., "Pregnancy in Peril: The impact of conflict on antenatal care and skilled birth attendant utilization in the Democratic Republic of the Congo and Burundi" (2020). Electronic Thesis and Dissertation Repository. 7057.