Caught in the Crossfire: A Mixed Methods Analysis of the Impact of Violent Conflict on Maternal Health Care Utilization in Pakistan, Amina Ahmad, UG '22 (3957523)

For my senior thesis, I examined the impact of violent conflict on maternal healthcare utilization in Pakistan using a mixed-methods approach. For the quantitative analysis, I spatially merged nationally-representative surveys of maternal health care use with district-level data on violent events and fatalities. My results suggested that violence significantly reduced rates of antenatal care and institutional delivery and moderately reduced rates of skilled birth attendance. For my qualitative analysis, I conducted more than fifty semi-structured interviews to show how violent actors in Pakistan have weakened the foundations of the healthcare system by not only physically destroying the physical healthcare infrastructure but also killing, torturing and driving away healthcare workers who are necessary to keep those facilities functioning. Cumbersome travel restrictions such as roadblocks, security check posts and curfews have reduced or eliminated women’s access to maternal healthcare services by restricting the mobility of doctors and patients and limiting the hours of operations of health facilities. I also documented the psychological and psychosomatic impacts of experiencing violence and the phenomenon of pervasive gender based violence in conflict settings. Furthermore, I highlighted the determinative nature of identity as a hurdle to accessing care, particularly in regions with high anti-immigration sentiment and sectarian tensions. My research also emphasized the ways in which violent conflict interacts with other social determinants of health – such as rural/urban residence, socioeconomic status, and gender norms – to deepen pre-existing schisms and inequities.