A security dividend: Peacekeeping and maternal health outcomes and access
| Author | Xun Cao,Theodora-Ismene Gizelis |
| Published date | 01 March 2021 |
| Date | 01 March 2021 |
| DOI | 10.1177/0022343320917198 |
| Subject Matter | Regular Articles |
A security dividend: Peacekeeping and
maternal health outcomes and access
Theodora-Ismene Gizelis
Department of Government, University of Essex
Xun Cao
Department of Political Science, Penn State University
Abstract
United Nations Security Council Resolution 1325 highlights the distinct needs of women in security and well-being.
Few studies explore how peacekeeping affects women’s access to health and education. Yet, women’s access to public
services such as health is a form of gender inequality in post-conflict countries leading to unbalanced distribution of
resources. We argue that peacekeeping operations (PKOs) have both a direct and an important indirect impact on
maternal health and women’s well-being. First, peacekeeping can have a direct effect by providing medical and
training facilities. Second, peacekeeping has an indirect effect as improvement in the overall level of security facilitates
women’s access to medical services and education. We evaluate our argument by combining evidence from different
levels of analysis. First, we use a difference-in-difference analysis of 45 African countries with data between 1990 and
2013, comparing the changes in maternal mortality rates (MMR) for countries with and without PKOs. Second, we
look at within-country variations across areas with and without UN peacekeeping deployment in three countries with
integrative PKOs, combining geo-coded peacekeeping data with individual data on maternal health and education
from the Demographic and Health Surveys (DHS) in the Democratic Republic of Congo, Co
ˆte D’Ivoire, and
Liberia. We find strong empirical support for a positive relationship between peacekeeping presence and maternal
health outcomes and access to services.
Keywords
maternal health, peacekeeping, security dividend, women’s well-being
Introduction
UN peacekeeping missions (PKOs) often have mandates
that extend beyond short-term security objectives, aim-
ing at peacebuilding and social transformation. Complex
and ambitious UN peacekeeping missions often raise
questions about ‘whose peace’ is to be established, and
the distributional consequences fo r vulnerable groups
such as women.
Existing research offers two different understandings
of gender equality. Some normative approaches empha-
size how a more balanced distribution of resources
between men and women is fair and just. Others see
gender inequality as an indicator of social capacity, where
less female disadvantage relative to men reflects higher
human and social capital and a more equitable
distribution of resources (Forsberg & Olsson, 2016). For
instance, recent studies suggest that improving female
political representation increases the durability and qual-
ity of post-conflict peace (Demeritt, Nichols & Kelly,
2014; Shair-Rosenfield & Wood, 2017).
Women’s access to public services such as health and
education is a form of gender inequality in post-conflict
countries, since adverse conditions often affect women
more than men (Liebling-Kalifani & Baker, 2010).
1
We
Corresponding author:
xuc11@psu.edu
1
Childbirth with limited health care access is a driver of female
mortality in post-conflict environments (Urdal & Chi, 2013).
Journal of Peace Research
2021, Vol. 58(2) 263–278
ªThe Author(s) 2020
Article reuse guidelines:
sagepub.com/journals-permissions
DOI: 10.1177/0022343320917198
journals.sagepub.com/home/jpr
argue that UN PKOs have both a direct and an impor-
tant indirect impact on maternal health and women’s
well-being. The indirect impact implies that PKOs can
create a ‘peacekeeping dividend’ through improving
security. A signal that fighting has subsided allows for
improved infrastructure such as medical facilities and
schools, safer access to medical facilities and other ser-
vices such as schools.
We evaluate our argument using evidence from dif-
ferent levels of analysis. First, we use a difference-in-
difference analysis to compare changes in maternal
mortality rates (MMR) across 45 African countries with
and without PKOs. Second, we look at within-country
variations across areas with and without UN peacekeep-
ing deployment in three countries with integrative PKOs
– the Democratic Republic of Congo, Co
ˆte D’Ivoire,
and Liberia – combining geo-coded peacekeeping data
with individual data on maternal health and education
from the Demographic and Health Surveys (DHS). We
find that countries with UN PKOs see much higher
improvement in MMR, while women in locations where
peacekeepers have been deployed gained improved access
to public services.
UN peacekeeping and the quality of peace
Peacekeeping has become the main method to contain
civil wars (Fortna, 2008; Howard, 2008). Although
some question the effectiveness of peacekeeping missions
(Autesserre, 2010; Barnett, Fang & Zu
¨rcher, 2014;
Beber et al., 2017; Pouligny, 2006), other studies suggest
that PKOs promote peace and peacebuilding, strength-
ening the capacity of governments (Doyle & Sambanis,
2000; Dorussen & Gizelis, 2013). Empirical studies on
peacekeeping have so far focused more on ‘negative’
peace, or the absence of armed conflict, than ‘positive’
peace including the well-being of civilians (Galtung,
1964). The definition of ‘positive’ peace as ‘the integra-
tion of human society’ goes beyond the protection of
civilians and highlights the ‘quality’ of peace in post
conflict societies. Crucially, the ‘quality’ of peace can
have different implications for the well-being of men and
women, linked to post-conflict distribution of resources
(Barnett, Fang & Zu
¨rcher, 2014; Joshi & Wallensteen,
2018; Olsson & Gizelis, 2015; Olsson, 2009).
The persistent high female mortality rate in sub-
Saharan Africa is partly attributable to the indirect effects
of conflict on the distribution of services such as health
and education (Guha-Sapir & D’Aoust, 2010). Conflict
undermines maternal health and well-being because of
deteriorating health care, higher rates of abortion and
pregnancy terminations, shortage of skilled health pro-
fessionals, greater risks of contracting infections, and
more malnutrition during pregnancies and after child-
birth. Increased fertility and weakened public health
institutions further exacerbate conditions for women
(McCarthy & Main, 1992; Ronsmans & Graham,
2006).
The decline in funding for health provision started
before the outbreak of wars, as resources were diverted
from public services to military expenditures (O’Hare &
Southall, 2007). Diseases spread easily through contami-
nated water and lack of access to clean water, while
medical personnel either are killed or flee (Li & Wen,
2005: 473). Health facilities, schools, and roads are often
destroyed during conflicts (Plu
¨mper & Neumayer,
2006: 729).
Resources redirected towards destructive use leave
legacies disrupting the provision of basic services in
post-conflict countries. In Liberia, for example, the civil
wars in 1989–96 and 1999–2003 killed approximately
250,000 (10% of the population), displaced around a
million people, and dismantled the national economy,
infrastructure, and a reasonably effective state. After 14
years of civil war, only 51 out of 293 pre-war medical
facilities remained functional in 2003 (Kruk, Freedman
& Anglin, 2010).
UN PKOS, security, and women’s well-being
External interventions from UN PKOs improve the pro-
vision of public services through a more secure environ-
ment, an essential component of post-conflict
reconstruction. Provision of public services such as
health and public education signal the accountability
of the government to its citizens and its capacity to
provide services and goods (Kruk, Freedman & Anglin,
2010; Southall, 2011; Lee, 2008). We argue that an
inadvertent consequence of PKO presence is ‘the peace-
keeping dividend’, associated with higher provision of
and access to public services. This is especially the case
for maternal health where better access to services can
expand to reach more people much faster than other
public services requiring more infrastructure and a longer
planning horizon. The presence of peacekeepers, espe-
cially in integrative missions, increases overall security,
here defined as absence of violent armed conflict.
2
2
Three indicators separate an integrative from a traditional mission:
(1) range of tasks: integrative missions included humanitarian
assistance, disarmament and re-integration of combatants, security
sector reform, promoting human rights and re-establishment of
264 journal of PEACE RESEARCH 58(2)
To continue reading
Request your trial