Submission ID 131726
| Issue/Objective | Universal health coverage remains central to global health goals, and maternal and child health (MCH) represents one of its greatest inequities. The Sahelian region faces significant insecurity that undermines these health outcomes. Although progress has been made in MCH prevention and care across the region, gains remain fragile. In resource-constrained settings such as Burkina Faso, Mali, and Niger, insecurity further disrupts access to care and deepens inequities. Evidence on how insecurity impedes access to MCH care within the Sahel remains limited. This study, centered on the experiences of mothers and health workers, explored how insecurity influences access to MCH care across three Sahelian countries. |
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| Methodology/Approach | We present qualitative findings from semi-structured interviews with mothers (n=47) and health workers or stakeholders (n=41) in Burkina Faso, Mali and Niger, as part of a larger mixed-methods study. Interviews took place between August 2024 to December 2025 in communities with prior violent incidents against civilians. Using Levesque's five dimensions of access as an analytical lens, we conducted a thematic analysis using a deductive-inductive approach. |
| Results | Insecurity reshaped health needs (e.g. exposure to violence, injuries, rape), and shifted care-seeking toward crisis response, reducing vaccinations, prenatal care and preventive services. It curtailed women's autonomy in care-seeking by intensifying gender norms and requiring accompaniment for safety. It narrowed the window to reach care through roadblocks, travel bans and health center closures. It pushed health care further out of financial reach by destroying livelihoods, displacing families, and increasing indirect costs (e.g. transport), pushing many to delay or rely on traditional medicines, undermining adequacy of care. On the supply side, attacks on health centres, staff exodus, medicine shortages, reduced outreach and funding constraints undermined approachability, acceptability, availability, affordability and adequacy of care, leaving untrained workers to fill gaps and overburdening remaining centres. Together, these processes contributed to participants' report of increased pregnancy complications, and maternal and child deaths. |
| Discussion/Conclusion | Insecurity profoundly impacted mothers and health workers, jeopardizing progress towards universal health coverage and preventive care. Findings can inform community-driven solutions to increase resources for MCH health services, especially in villages, and advance equity in maternal and child health. |
| Presenters and Affiliations | Théa Demmers Centre de Recherche en Santé Publique (CReSP), Université de Montréal Mohamed Ali Ag Ahmed Université de Moncton, l'Université des sciences, des techniques et des technologies à Bamako, Mali Kadidiatou Kadio Centre National de la Recherche Scientifique et Technologique (CNRST/IRSS) Matthew Mitchell University of Saskatchewan Federica Fregonese Centre de Recherche en Santé Publique (CReSP) Alice Bila Société d'Études et de Recherche en Santé Publique (SERSAP) Frank Bicaba Société d'Études et de Recherche en Santé Publique (SERSAP), Sciences de la Vie et de la Santé, Université Aix-Marseille Abel Bicaba Société d'Études et de Recherche en Santé Publique (SERSAP) Abdoul Moumouni Nouhou Groupe de Recherche et d'Action pour le Développement (GRADE Africa) Thomas Druetz Centre de Recherche en Santé Publique (CReSP), Université de Montréal, Tulane University School of Public Health and Tropical Medicine |
