Abstract
SummaryBackgroundThe population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa.MethodsWe tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and children from Demographic and Health Surveys done in 35 African countries from 1990 to 2016. Mortality among women was obtained from sibling survival data. We used cluster-area fixed-effects regression models to compare survival of women during periods of nearby conflict (within 50 km) to survival of women in the same area during times without conflict. We used similar methods to examine the extent to which children living near armed conflicts are at increased risk of becoming orphans. We examined the effects of varying conflict intensity using number of direct battle deaths and duration of consecutive conflict exposure.FindingsWe analysed data on 1 629 352 women (19 286 387 person-years), of which 103 011 (6·3%) died (534·1 deaths per 100 000 women-years), and 2 354 041 children younger than 15 years, of which 204 276 (8·7%) had lost a parent. On average, conflict within 50 km increased women's mortality by 112 deaths per 100 000 person-years (95% CI 97–128; a 21% increase above baseline), and the probability that a child has lost at least one parent by 6·0% (95% CI 3–8). This effect was driven by high-intensity conflicts: exposure to the highest (tenth) decile conflict in terms of conflict-related deaths increased the probability of female mortality by 202% (187–218) and increased the likelihood of orphanhood by 42% compared with a conflict-free period. Among the conflict-attributed deaths, 10% were due to maternal mortality.InterpretationAfrican women of childbearing age are at a substantially increased risk of death from nearby high-intensity armed conflicts. Children exposed to conflict are analogously at increased risk of becoming orphans. This work fills gaps in literature on the harmful effects of armed conflict on non-combatants and highlights the need for humanitarian interventions to protect vulnerable populations.FundingBill & Melinda Gates Foundation to the BRANCH Consortium.
Highlights
Between 40 and 68 countries, home to 46–79% of the world’s population, were involved in armed conflict in every year since 1990.1–3 Contrary to claims that wars, including armed conflicts, have been steadily receding since the mid 1940s,4 there is little evidence of a decline in the number of conflicts, the number of countries involved in conflict, or the proportion of the world’s population living in conflict-affected regions since 1990.2,5 The direct consequences of armed conflict are readily visible and include destruction of physical environments, injuries, and deaths of combatants and uninvolved civilians
Attempts to quantify a more complete picture of mortality due to conflict, including those in Iraq and South Sudan, suggest that the total number of deaths attributable to armed conflicts typically far exceed the estimates of direct conflict deaths.[9,10,11]
We showed that children 0–15 years-old exposed to armed conflict were 6% more likely to be orphans when living near any conflict, and 42% more likely when living near conflicts of the highest intensity
Summary
Between 40 and 68 countries, home to 46–79% of the world’s population, were involved in armed conflict in every year since 1990.1–3 Contrary to claims that wars, including armed conflicts, have been steadily receding since the mid 1940s,4 there is little evidence of a decline in the number of conflicts, the number of countries involved in conflict, or the proportion of the world’s population living in conflict-affected regions since 1990.2,5 The direct consequences of armed conflict are readily visible and include destruction of physical environments, injuries, and deaths of combatants and uninvolved civilians. In DR Congo, where chronic conflict was impli cated as a reason for the 40% higher crude mortality relative to the regional average, women are raped and used as weapons of war.[13,14] The hazards of childbirth might be increased in areas of conflict, because basic services, such as facilities for safe labour and delivery that reduce the mortality from post-partum haemorrhage or stalled labour, might not be accessible.[15] Conflict-related destruction of basic family and social structures, including households and local communities, Lancet Glob Health 2019; 7: e1622–31
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