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

• Published in: PloS one 2018-01, Vol.13 (1), p.e0188654-e0188654
• Main Authors: Rivillas, Juan Carlos, Devia Rodriguez, Raul, Song, Gloria, Martel, Andréanne
• Format: Article
• Language: English
• Subjects: Aggression; Children & youth; Childrens health; Concentration gradient; Conflict; Demographic aspects; Demographics; Domestic violence; Empowerment; Evaluation; Family planning; Females; Gender; Gender inequality; Gender-based violence; Girls; Global health; Guerrilla forces; Health care; Health care disparities; Health risks; Health services; Indexes; Inequalities; Information systems; Maternal & child health; Medicine and Health Sciences; Mothers; National health insurance; People and places; Prenatal care; Relocation; Reproductive health; Research and Analysis Methods; Social inequality; Social protection; Statistical analysis; Sustainable development; Teenagers; Time; Victims; Violence; Welfare state; Well being; Women; Women's health; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0188654

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. 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. 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. Overall, the effects of conflict continue to threaten reproductive and maternal health in Colombia, impeding progress towards the realization of universal health care (UHC) and reinforcing already-existing inequities. Key messages and steps forward include the need to understand the two distinct patterns of inequalities identified in this study in order to prompt improved general policy responses. Addressing un