Influence of armed conflict-intensity on maternal health outcomes: the case of antenatal care visits in Colombia.

Abstract

This study assesses the effect of armed conflict intensity, measured by the frequency and severity of violent incidents at the departmental level, on women's uptake of antenatal care in Colombia. We conducted a cross-sectional analysis using the 2015 Colombian Demographic and Health Survey linked to data from the National Center for Historical Memory for 1985-2015. Multilevel logistic regression models were fitted to estimate the association between departmental conflict intensity and the probability of attending four or more antenatal visits, adjusting for individual-, household-, and area-level covariates. After adjustment, residing in departments with high conflict intensity was associated with lower odds of attending ≥4 antenatal visits compared with low-intensity departments (OR = 0.63, 95% CI 0.42-0.95, p < 0.005). Household wealth moderated this association. Independently, higher maternal wealth, autonomy, and education increased the likelihood of attending ≥4 visits, whereas shorter birth intervals, a greater number of children under five in the household, and urban residence reduced that likelihood. High intensity armed conflict is independently associated with reduced uptake of recommended antenatal care in Colombia. Maternal socioeconomic resources modify this relationship. Maternal health strategies tailored to the constraints of high conflict settings are needed to improve antenatal care coverage and equity.