Armed conflict and maternal mortality: A micro-level analysis of sub-Saharan Africa, 1989-2013
Armed conflict and maternal mortality: A micro-level analysis of sub-Saharan Africa, 1989-2013
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DOI：
10.1016/j.socscimed.2019.112526
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发表时间：
2019-10-01
影响因子：
5.4
通讯作者：
Ostby, Gudrun
中科院分区：
文献类型：
--
作者：
Kotsadam, Andreas;Ostby, Gudrun
现有的国家一级证据表明，武装冲突越严重的国家，产妇死亡率往往越高。然而，在武装冲突期间，实际战斗通常局限于一个国家内的有限区域，影响到一部分人口。因此，研究国家一级的武装冲突和MMR之间的联系可能涉及生态谬误。我们在所谓的“姐妹情谊法”的基础上，对当地武装冲突是否影响产妇死亡率提供了一个更直接、更细微的检验。我们将Uppsala冲突数据计划中关于不同类型暴力事件的地理编码数据与人口与健康调查(DHS)中关于姐妹在怀孕、分娩或产褥期死亡的报告的地理参考调查数据结合起来。我们的样本涵盖了撒哈拉以南非洲30个国家的1335,161名12-45岁的成年姐妹和539,764名女性受访者。我们不是汇总姐妹的死亡来产生孕产妇死亡率，而是在个人层面上分析姐妹的死亡。我们使用姐妹固定效应分析来估计每个受访者家庭半径50公里内最近发生的有组织暴力事件对其妹妹在怀孕、分娩或产褥期死亡的可能性的影响。我们的结果表明，当地暴露在武装冲突事件中确实增加了产妇死亡的风险。在探索潜在的主持人时，我们发现农村地区的差异更大，但在富裕和受教育程度更高的地区也是如此。
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.