title: Conflict, displacement and sexual and reproductive health services in Mali: analysis of 2013 health resources availability mapping system (HeRAMS) survey.
abstract: OBJECTIVE
  Little is known specifically about the effects of conflict and displacement on provision of sexual and reproductive health (SRH) services. We aimed to understand the association between levels of conflict and displacement and the availability of SRH services in post-conflict Mali.
  
  
  METHODS
  A national assessment was conducted between April and May 2013 employing Health Systems Availability Mapping System (HeRAMS). Data from 1581 primary care facilities were analysed, focusing on SRH services. Descriptive analyses and multivariable logistic regression models were used to examine the availability of SRH services by different levels of conflict and displacement.
  
  
  RESULTS
  Of 1581 facilities, 1551 had data available to identify the details of service provision. The majority of the facilities were part of the public sector (79.1 %), identified as basic community primary care facilities (71.9 %). Overall 15.7 % of the facilities were in the zones under occupation, 40.3 % in the areas with high concentration of displaced population and 44 % in areas with low concentration of displaced populations. Between zones of low concentration of displaced populations and under occupation the likelihood of service availability varied between OR: 2.9 (95 % CI 2.0-4.4) for basic emergency obstetric care and OR: 41.7 (95 % CI 20.4-85.3) for family planning. All of the services within the three domains of SRH were more likely to be available in the low and high concentration displaced population areas compared to the facilities in the under occupation zones, after adjusting for other facility-related variables.
  
  
  CONCLUSIONS
  Areas with high concentration of displaced population had less service availability, and areas formerly under occupation had the least service availability. This suggests that those living in conflict areas, and many of those who are internally displaced, have poor access to essential SRH interventions. The systematic measurement of the availability of health services, including SRH, is feasible and can contribute to recovery planning in post-conflict and humanitarian settings.
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Özge
authors.initials: Ö
authors.lastname: Tunçalp
authors.affiliation: World Health Organization, Mali Country Office, Bamako, Mali.
authors.forename: Ibrahima Socé
authors.initials: IS
authors.lastname: Fall
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Phillips
authors.affiliation: Department of Emergency Risk Management and Humanitarian Response (ERM), World Health Organization, Geneva, Switzerland.
authors.forename: Inga
authors.initials: I
authors.lastname: Williams
authors.affiliation: World Health Organization, Mali Country Office, Bamako, Mali.
authors.forename: Massambou
authors.initials: M
authors.lastname: Sacko
authors.affiliation: World Health Organization, Mali Country Office, Bamako, Mali.
authors.forename: Ousmane Boubacar
authors.initials: OB
authors.lastname: Touré
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Thomas
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/The World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
authors.forename: Lale
authors.initials: L
authors.lastname: Say