Stillbirths, miscarriages and early losses in armed conflict contexts. The modification effect of violence. The Colombian case.

Background: Colombia experienced a prolonged armed conflict that affected differently regions and periods. We explored how this regional violence influenced the well-being of newborns, using data from the National Centre of Historic Memory (NCHM) and the Vital Statistics Survey. The NCHM recorded the number of victims, while the Vital Statistics Survey reported data on births, stillbirths, and early losses.

Aim: We aimed to assess the impact of regional violence on newborns' well-being and to examine whether mothers' university education mitigated these effects. We focused on comparing two periods: 1998-2002 and 2003-2007, and two group of regions which differed in the intensity and distribution of violence.

Methods: We applied a difference-in-differences approach and logistic regression analysis to estimate the odds of stillbirths and miscarriages in regions exposed to violence during the treated regions. We also estimated the interaction effect between treated groups and mothers' university education.

Findings: We found a significant association between living in the most violent regions and having a higher risk of stillbirths, miscarriages, or early losses (OR: 1.721). Women living in less affected regions had a higher probability of giving birth to live babies and preserving the dyad. However, we observed a negative modifier effect of violence on the likelihood of live births for mothers with university education (OR:1.273).

Discussion: We observed that the effect modification points to a higher impact of stress on mothers with university education in violent regions and periods compared to those without higher education. These findings unveil the concealed impact of regional violence, which diminishes the protective influence of maternal education, regardless of the level attained.

Problem: The scarcity of empirical evidence regarding the causa through which violence modify the shield effect of university education in most affected areas.

What Is Already Known: When women are able to complete their university education before giving birth, they are better able to have healthier pregnancies and therefore achieve higher levels of well-being for their newborns.

What This Paper Adds: Pregnant women with university education are likely to be experiencing higher levels of stress compared to those mother with no university education within the most violent regions and periods embedded in armed conflict environments/contexts.