The impact of armed conflicts on health-care utilization in Northern Nigeria: A difference-in-differences analysis

Women and children suffer worse health outcomes during armed conflicts. For more than a decade, Northern Nigeria has been facing one of the most violent armed conflicts in sub-Saharan Africa. Studies on the conflict's impact on healthcare utilization in the area are few. The aim of this study is to explore the effect of the protracted armed conflicts on healthcare utilization, measured by maternal care and child immunization, in Northern Nigeria. Data from the Armed Conflict Location and Events Data set are spatially merged to birth records from the Nigerian Demographic and Health Survey. An area is classified to be a conflict cluster if it is within a 5-10 km radius of conflict event(s) with at least one fatality. The difference-in-differences method is applied to estimate the effect of the armed conflicts on healthcare utilization in the area. We find that residing within a conflict cluster significantly reduces the probability of utilization of healthcare services. We conclude that robust policies and strategies to mitigate the adverse effects of the armed conflicts on healthcare delivery are necessary for the short run. In the long run, systematic efforts to identify and address the root causes of the conflict with a view to finding a lasting solution are necessary to improve health-care utilization in conflict-affected areas.