title: Perceptions of the effects of armed conflict on maternal and reproductive health services and outcomes in Burundi and Northern Uganda: a qualitative study.
abstract: BACKGROUND
  Armed conflict potentially poses serious challenges to access and quality of maternal and reproductive health (MRH) services, resulting in increased maternal morbidity and mortality. The effects of armed conflict may vary from one setting to another, including the mechanisms/channels through which the conflict may lead to poor access to and quality of health services. This study aims to explore the effects of armed conflict on MRH in Burundi and Northern Uganda.
  
  
  METHODS
  This is a descriptive qualitative study that used in-depth interviews (IDIs) and focus group discussions (FGDs) with women, health providers and staff of NGOs for data collection. Issues discussed include the effects of armed conflict on access and quality of MRH services and outcomes, and the mechanisms through which armed conflict leads to poor access and quality of MRH services. A total of 63 IDIs and 8 FGDs were conducted involving 115 participants.
  
  
  RESULTS
  The main themes that emerged from the study were: armed conflict as a cause of limited access to and poor quality of MRH services; armed conflict as a cause of poor MRH outcomes; and armed conflict as a route to improved access to health care. The main mechanisms through which the conflict led to poor access and quality of MRH services varied across the sites: attacks on health facilities and looting of medical supplies in both sites; targeted killing of health personnel and favouritism in the provision of healthcare in Burundi; and abduction of health providers in Northern Uganda. The perceived effects of the conflict on MRH outcomes included: increased maternal and newborn morbidity and mortality; high prevalence of HIV/AIDS and SGBV; increased levels of prostitution, teenage pregnancy and clandestine abortion; and high fertility levels. Relocation to government recognised IDP camps was perceived to improve access to health services.
  
  
  CONCLUSIONS
  The effects of armed conflict on MRH services and outcomes are substantial. The mechanisms through which armed conflict leads to poor access and quality of MRH services vary from one setting to another. All these issues need to be considered in the design and implementation of interventions to improve MRH in these settings.
authors.affiliation: Peace Research Institute Oslo, PO Box 9229, Grønland, Oslo, Norway. prichi@prio.org.|Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, Oslo, Norway. prichi@prio.org.
authors.forename: Primus Che
authors.initials: PC
authors.lastname: Chi
authors.affiliation: International Organization for Migration, Plot 6A, Naguru Crescent, Kampala, Uganda. pbulage@iom.int.
authors.forename: Patience
authors.initials: P
authors.lastname: Bulage
authors.affiliation: Peace Research Institute Oslo, PO Box 9229, Grønland, Oslo, Norway. henriku@prio.org.
authors.forename: Henrik
authors.initials: H
authors.lastname: Urdal
authors.affiliation: Institute of Health and Society, University of Oslo, PO Box 1130, Blindern, Oslo, Norway. johanne.sundby@medisin.uio.no.
authors.forename: Johanne
authors.initials: J
authors.lastname: Sundby
mesh_terms: D000293:Adolescent; D000328:Adult; D002063:Burundi; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D011247:Pregnancy; D036301:Qualitative Research; D034121:Reproductive Health Services / Q000592:standards; D016896:Treatment Outcome; D014454:Uganda; D014857:Warfare; D055815:Young Adult