Comprehensive peace agreement implementation and reduction in neonatal, infant and under-5 mortality rates in post-armed conflict states, 1989-2012.

BACKGROUND: Previous studies suggest that countries with a higher child mortality rate are more susceptible to armed conflict onset as well as recurrence. Studies do not explain conditions under which child mortality declines among post-armed conflict states. This article argues that where armed conflict is terminated through negotiation and implementation of comprehensive peace agreements (CPAs), the child mortality rate declines. This is due to the implementation of provisions in CPAs, which addresses underlying grievances of the poor, underserved and marginalized segments of the population, as well as the successful reconstruction of the health sector. CPA implementation resolves hostilities between armed rivals and facilitates the return process for internally displaced persons and refugees. The CPA implementation may also encourage the return of aid workers and health professionals to conflict-affected zones.

METHOD: This study utilizes new data on CPA implementation and examines neonatal, infant and under-5 mortality rates among 73 post-armed conflict countries between 1989 and 2012. Multivariate cross-sectional time series correlation (fixed effect) methods are used to analyze the data.

RESULTS: Within post-armed conflict states, a decline in neonatal, infant and under-5 mortality rates is associated with higher CPA implementation rates. Additionally, this study shows that higher GDP per capita, higher levels of democracy, and more primary school enrollment are also associated with lower child mortality rates. On the other hand, child mortality rates increase following a rebel victory in armed conflict.

CONCLUSION: Ongoing armed conflicts are responsible for massive displacements and the destruction of economic, healthcare and human infrastructure, thus hindering improvements in child survival. For better health outcomes in post-armed conflict countries, ongoing armed conflict must cease through the signing and implementation of a CPA. Short-term and long-term public health issues are discussed in concluding comments.