How Do We Reach the Girls and Women Who Are the Hardest to Reach? Inequitable Opportunities in Reproductive and Maternal Health Care Services in Armed Conflict and Forced Displacement Settings in Colombia

Citation:

Rivillas, Juan Carlos, Raul Devia Rodriguez, Gloria Song, and Andréanne Martel. 2018. "How Do We Reach the Girls and Women Who Are the Hardest to Reach? Inequitable Opportunities in Reproductive and Maternal Health Care Services in Armed Conflict and Forced Displacement Settings in Colombia." PLoS ONE 13 (1): 1-14. 

Authors: Juan Carlos Rivillas, Raul Devia Rodriguez, Gloria Song, Andréanne Martel

Abstract:

Objectives

This paper assesses inequalities in access to reproductive and maternal health services among females affected by forced displacement and sexual and gender-based violence in conflict settings in Colombia. This was accomplished through the following approaches: first, we assessed the gaps and gradients in three selected reproductive and maternal health care services. Second, we analyzed the patterns of inequalities in reproductive and maternal health care services and changes over time. And finally, we identified challenges and strategies for reaching girls and women who are the hardest to reach in conflict settings, in order to accelerate progress towards universal health coverage and to contribute to meeting the Sustainable Development Goals of good health and well-being and gender equality by 2030.

Methods

Three types of data were required: data about health outcomes (relating to rates of females affected by conflict), information about reproductive and maternal health care services to provide a social dimension to unmask inequalities (unmet needs in family planning, antenatal care and skilled births attendance); and data on the female population. Data sources used include the National Information System for Social Protection, the National Registry of Victims, the National Administrative Department of Statistics, and Demographic Health Survey at three specific time points: 2005, 2010 and 2015. We estimated the slope index of inequality to express absolute inequality (gaps) and the concentration index to expresses relative inequality (gradients), and to understand whether inequality was eliminated over time.

Results

Our findings show that even though absolute health care service-related inequalities dropped over time, relative inequalities worsened or remain unchanged. All summary measures still indicated the existence of inequalities as well as common patterns. Our findings suggest that there is a pattern of marginal exclusion and incremental patterns of inequality in the reproductive and maternal health care service provided to female affected by armed conflict.

Topics: Armed Conflict, Displacement & Migration, Forced Migration, Domestic Violence, Gender, Women, Girls, Gender-Based Violence, Gendered Power Relations, Gender Equality/Inequality, Health, Reproductive Health, Sexual Violence, SV against Women Regions: Americas, South America Countries: Colombia

Year: 2018