Health-seeking in fragile and conflict-affected settings: how armed violent conflict shapes maternal and child health-seeking behaviours

Abstract Background Maternal and child mortality rates remain unacceptably high in fragile and conflict-affected settings, where insecurity, displacement, and systemic disruption hinder access to healthcare. Nigeria is one of the countries most severely affected, and continues to experience widespread maternal and neonatal deaths despite global and national efforts to achieve SDG 3.1. This study explored stakeholders’ perspectives on how armed conflicts shapes maternal and child health-seeking behaviours and outcomes in northeastern Nigeria. Methods A qualitative approach was employed, involving Key Informant Interviews with healthcare workers, community leaders, local officials, and caregivers in three fragile and conflict-affected states: Adamawa, Borno and Yobe. These semi-structured interviews explored access to and quality of care, barriers to seeking healthcare, vaccination practices and community trust. The audio recordings were transcribed and translated, then analysed thematically in accordance with Braun and Clarke´s approach. Results The analysis identified five interrelated themes on how armed conflict shaped maternal and child healthcare seeking behavior. Prolonged insecurity generated psychological trauma, stress-related illnesses, malnutrition, and infectious disease outbreaks, particularly in Internally Displaced Camps. Health systems collapsed due to facility destruction, workforce flight, and drug shortages, limiting service availability. Access was further constrained by poverty, insecurity, transport barriers, gender norms, low literacy, and negative provider attitudes. These challenges contributed to unsafe deliveries, increased maternal and child mortality, declining immunisation coverage, and a heightened fear of vaccine side effects amid misinformation. While trust in frontline health workers often persisted, confidence in government institutions declined. Conclusion Armed violent conflict undermines maternal and child health through compounded psychosocial, structural, and behavioural pathways. To restore equitable service use in conflict-affected settings, it is essential to leverage residual trust in local healthcare workers, alongside community-based, conflict-sensitive strategies that address issues such as fear, costs, gender norms, transport and vaccine misinformation.