By Azeezat Modesola Abereijo
Conflict situations inflict unimaginable pain on individuals and societies, but the impact on pregnant women often goes unnoticed. Beyond the visible destruction, these women face life-threatening challenges that extend far beyond the physical injuries caused by war.
In war-torn regions, survival often takes precedence over critical maternal health needs. The lack of access to antenatal care, skilled birth attendants, and essential medicines leads to severe complications for pregnant women, who bear the brunt of the healthcare crisis in these areas.
Maternal Mortality in Conflict Situations
Maternal mortality remains a pressing global issue, but in conflict zones, the crisis reaches catastrophic levels. According to the World Health Organisation (WHO), over 60% of preventable maternal deaths occur in countries affected by conflict or disasters.
In these regions, maternal mortality ratios (MMR) are disproportionately high compared to more stable areas. For example, South Sudan has one of the highest MMRs globally, with 1,150 deaths per 100,000 live births. In Yemen, years of conflict have caused the MMR to rise to 183 per 100,000 live births, more than twice the global average.
Similarly, in northern Nigeria, where the Boko Haram insurgency has disrupted healthcare services, women are more than twice as likely to die during childbirth compared to their counterparts in the southern part of the country.
The State of Healthcare in Conflict-Affected Areas
The northeastern region of Nigeria, encompassing states like Borno, Yobe, and Adamawa, has been the epicenter of Boko Haram’s insurgency. This has left millions of displaced persons without access to basic healthcare. According to the WHO, less than 60% of health facilities in these areas are functional due to widespread destruction, leaving pregnant women without critical maternal healthcare services.
In Uganda, which hosts over 1.5 million refugees—primarily from South Sudan and the Democratic Republic of Congo—the strain on healthcare systems is evident. Refugee camps are overcrowded, with an alarmingly low ratio of healthcare workers to patients. A PubMed report reveals that only 59.9% of pregnant women in these camps receive the recommended four or more antenatal visits.
Pregnant women in such camps often face complications like preeclampsia and sepsis due to inadequate prenatal care. Many deliver without skilled birth attendants, increasing the risk of obstructed labor and postpartum hemorrhaging.
Malnutrition is another major factor. Conflict disrupts food supplies, leaving pregnant women in affected areas malnourished and unable to provide adequate nutrients for themselves and their unborn children.
Cultural barriers further hinder access to care. For instance, in northern Nigeria, consultations between women and male doctors are often discouraged, delaying essential medical interventions.
Sanitation and hygiene issues compound these challenges. Many camps lack access to clean water and proper sanitation facilities, heightening the risk of infections during and after childbirth. Emergency obstetric care is also limited, as camps are often located far from referral hospitals.
Maternal Health Outcomes in Conflict Zones
The situation in Nigeria and Uganda reflects the broader struggles faced in conflict zones across the globe. In Yemen, only 46% of health facilities are fully functional, leaving pregnant women with limited access to life-saving care. Afghanistan, even before its recent escalation of conflict, recorded an MMR of 638 per 100,000 live births due to systemic barriers, cultural stigma, and a shortage of female healthcare providers.
In Syria, the civil war has caused maternal mortality to rise, with the United Nations estimating an MMR of 31 deaths per 100,000 live births. The WHO reports that 57% of public hospitals in Syria have been severely damaged, and 37% are completely out of service.
However, targeted interventions have shown promise in some areas. In South Sudan, mobile clinics operated by the International Committee of the Red Cross (ICRC) have significantly reduced maternal deaths by providing emergency obstetric care and training community health workers.
The Invisible Wounds of War: Maternal Mental Health
Beyond physical complications, conflict profoundly affects maternal mental health. Pregnant women in conflict zones are particularly vulnerable to post-traumatic stress disorder (PTSD), anxiety, and depression.
According to the WHO, one in five people in conflict settings experiences mental health conditions, with pregnant women being disproportionately affected. The emotional toll of displacement, loss, and uncertainty further exacerbates these issues.
“Mental health issues among displaced mothers often lead to developmental delays and emotional disturbances in their children, perpetuating a cycle of trauma,” the WHO stated.
Addressing maternal mental health in conflict-affected areas is crucial not only for the mothers but also for their children, whose development can be significantly impacted by their mothers’ mental health conditions.
Successful Interventions: Signs of Hope
Several initiatives have demonstrated the potential to improve maternal health outcomes in conflict zones:
- Mobile Clinics and Field Hospitals: In South Sudan, ICRC-operated mobile clinics provide essential prenatal care and emergency services, significantly reducing maternal mortality rates in hard-to-reach areas.
- Mental Health Integration: The WHO’s Mental Health Gap Action Programme trains non-specialist health workers in countries like Uganda and Syria to address the psychological needs of displaced mothers, providing critical mental health support.
- Safe Spaces for Women: In Bangladeshi refugee camps hosting the stateless Rohingya population, UNFPA-supported safe spaces offer physical and mental counseling, prenatal care, and post-rape care, creating comprehensive maternal health facilities.
- Technology-Driven Solutions: In Yemen, telemedicine platforms connect community health workers in remote areas with medical specialists, improving the quality of maternal healthcare despite limited resources.
Solutions: What Can Be Done?
Improving maternal health in conflict zones requires a multifaceted approach. Key recommendations include:
- Rebuilding Healthcare Infrastructure: Investing in the reconstruction of health facilities and deploying mobile clinics to reach remote and conflict-affected areas.
- Training Healthcare Workers: Providing training for midwives and community health workers to deliver basic and emergency maternal care.
- Integrating Mental Health Services: Incorporating counseling and mental health support into maternal care programs.
- Addressing Gender-Based Violence: Establishing safe spaces and providing post-rape care kits for survivors of sexual violence.
- Global Advocacy: Increasing funding and policy focus on maternal health in conflict settings.
Azeezat Modesola Abereijo is a passionate and dedicated researcher with a strong academic background in Public Health (M.A., Nottingham Trent University) and Health Education (B.Sc., Lagos State University). Her primary area of interest is Maternal and Child Health, where she strives to improve health outcomes for vulnerable populations through evidence-based research and innovative interventions.
Her professional experience includes working with the Lagos State Ministry of Health on impactful programs, such as the “Saving One Million Lives” initiative, where she contributed to health campaigns, vaccination drives, and welfare distribution for underserved communities. She also has hands-on experience in providing emotional support and compassionate care in her roles as an Health Care Worker in the UK.
Azeezat is deeply committed to advancing public health initiatives that foster societal growth. Outside of her professional pursuits, she enjoys mentoring, traveling, and exploring innovative trends in global health.
