Impact of War on Maternal Health Services in the War Affected Areas of the Amhara Region, Ethiopia: Disruption of Antenatal Care, Institutional Delivery and Postnatal Services

Abstract

Background: Health service delivery strategies such as the continuum of care (Antenatal care, delivery and Postnatal care services) are recommended as important components of strong health systems, needed to prevent and reduce maternal morbidity and mortality. The Amhara region has been struggling to improve the continuum of care to the utmost of its ability. Sadly, the ongoing efforts were disrupted as a result of the armed conflict that started in July 2021 in North Wollo and Wag Hemira zones. When the armed conflict was expanded up to north Shewa in December 2021, the damage on the health delivery system and other infrastructures was enormous and inconceivable. In relation to the disruption of health services in Amhara region, there was no study of this kind that attempted to explore the lived experiences of the mothers, health workers and the population at large.
Objectives: The aims of this study were to compare the Antenatal care, delivery and Postnatal care services provided before and during the war periods and to explore the impact of the war on the lives of women that desperately needed maternal health services during the war period.
Methods: The present study included two sources of data: primary and secondary. The primary data which consisted of 22 key informant interviews were collected through the application of purposive sampling. Twenty-four data collectors with at least a first degree in public health or related fields were involved in data collection. On the other hand, the secondary (quantitative) data were obtained from the regional health bureau and the zonal health departments of the war affected zones. Thematic analysis was used to analyze the qualitative data. Tabular and graphical representations were used to present the findings from the quantitative data. Moreover, in relation to the delivery services, a 95% confidence interval and a P-value were used to declare statistical significance.
Results: The overall continuum of care has shown a significant difference between the pre and during war periods. Before the onset of the war, all Antenatal care, delivery and Postnatal care services were given in all health facilities of the Amhara region. However, only 53 (46.9%) health facilities remained to provide these services in the war affected areas of the Amhara region. Before the armed conflict, the monthly average number of women who used Antenatal care services at least once in the last six months prior to the eruption of the war was 28,891. However, following the armed conflict, the monthly average of Antenatal Care users was reduced to 10,895 (i.e., a reduction by 62.3%). Similarly, the monthly average number of births attended by skilled health personnel before the armed conflict was 18,527. However, at the climax of the war, this figure was reduced to 5,062 resulting in a reduction of the delivery service by 72.7%. This reduction was statistically significant, (95% C.I. 9828, 17101; P = 0.002). By the same token, the monthly average number of women who received Postnatal care services within seven days of delivery in war affected zones of Amhara region had substantially reduced during the period of the war (a 71.8% reduction).
Conclusion: The damage that the armed conflict brought on the health delivery system of the war-affected zones of the Amhara region was very huge. The armed conflict had terribly affected the delivery of the continuum of care living aside thousands of innocent mothers without any medical assistance. The restoration of the health delivery system and the replacement of the looted and destroyed items should be a priority agenda for the concerned bodies. Furthermore, a mechanism should be developed to give psychosocial support to the needy population.