The number of women and children living in close proximity to armed conflict and/or community-based violence has increased globally and in the United States in recent decades. Violence is known to disrupt health service delivery and individuals ability to utilize certain health services, including antenatal care and facility delivery. These disruptions likely contribute to poor maternal health outcomes, as well as disparities in maternal and newborn mortality and morbidity. However, the limitations of existing data make it difficult to identify the underlying mechanisms that shape these relationships, as well as how exposure to violence may differentially affect maternal health outcomes among different sub-populations. The objective of this project is to estimate how the precise location, timing, and intensity of community-based violence affect maternal health outcomes, including whether and how exposure to violence contributes to disparities in maternal health. This project draws on data from a three-year cluster-randomized controlled trial that began prior to the onset of escalated community-based armed conflict in the study area. Combining household panel survey data collected before and after the onset of violence, health facility records, and a dataset of violent conflict events provides a unique opportunity to study the effects of community-based violence on maternal health with two specific aims. In the first aim, we will analyze how differences in the precise location, timing, and intensity of community-based violence affect the timing and quality of antenatal care and whether women deliver at a health facility. In the second aim, we will test whether the relationship between exposure to violence and maternal healthcare utilization outcomes varies by the location of violent events. Under this aim, we will draw on health facility data to test whether exposure to violence near health facilities affects the uptake of maternal healthcare services differentially from other types of healthcare services. For the analyses in both aims, we will examine whether and how the relationship between exposure to violence and maternal healthcare utilization outcomes varies by womens socio-economic status and education. Addressing maternal health disparities is a key challenge in population health in the United States and globally, and a scientific priority. This research will enhance our understanding of the location-related mechanisms through which exposure to violence shapes maternal healthcare utilization, and disparities in maternal health outcomes; identify promising avenues for future research in this area; and generate rigorous evidence for effective interventions to improve maternal health outcomes and equity among populations affected by violence.
Funding:
Health and Human Services, Department of-National Institutes of Health
Funding Period:
09/26/2023 to 08/31/2025