Bonnet Emmanuel auteur aut IRD Lerosier T. auteur aut IRD Toure L. auteur aut IRD Diarra Y. auteur aut IRD Diabate S. auteur aut IRD Diarra D. auteur aut IRD Ridde Valéry auteur aut IRD text journalArticle eng text/pdf reformatted digital access Introduction In Mali, healthcare systems are severely affected by conflict. However, several studies suggest a lack of knowledge about its impact on maternal healthcare. Frequent and repeated attacks increase insecurity, limit access to maternal care, and thus represent a barrier to accessing care. The objective of this study is to understand how assisted deliveries are being reorganised at the health centre level, and how they are adapting to the security crisis. MethodT his is a mixed sequential and explanatory study. The quantitative approaches combine a spatial scan analysis of assisted deliveries by health centres, an analysis of health centre performance using an ascending hierarchical classification, and a spatial analysis of violent events in two health districts in central Mali: Mopti and Bandiagara. The qualitative phase analyses semidirective and targeted interviews with managers (n=22) of primary healthcare centres (CsCOM) and two agents of international institutions. Results The study reveals an important territorial heterogeneity of assisted deliveries. The primary health centres with high rates of assisted deliveries have mainly high-performance levels. This high level of use can be explained by the movement of the population to areas less exposed to attacks. The centres with low rates of assisted deliveries are those where qualified health workers refused to practice, where populations had few financial resources, and where they limited their travel to reduce their exposure to insecurity.ConclusionThis study confirms that combining methodological approaches is essential to explain significant use in the local context. The analysis of the number of assisted deliveries in conflict zones must consider the number of procedures, the nearby security context, the number of internally displaced persons and the presence of camps in which humanitarian organisations offer programmes. specialized Maternal health MALI 056 114 7 Suppl. 9 e010811 [10 ] 2023 2059-7908 https://www.documentation.ird.fr/hor/fdi:010087523 10.1136/bmjgh-2022-010811 2059-7908 [F B010087523] https://www.documentation.ird.fr/hor/fdi:010087523 https://horizon.documentation.ird.fr/exl-doc/pleins_textes/2023-05/010087523.pdf IRD - Base Horizon / Pleins textes 2023-05-12 2026-06-12 fdi:010087523 fre