UN peacekeepers Liberia UNMIL

Beyond security: UN peacekeeping's role in health and family planning


Published 23.04.24
Photo credit:
United Nations Photo

Evidence from Liberia highlights the role of peacebuilding interventions, through providing a ‘security umbrella’ that promotes local economic development and enables health services provision and access, in reducing fertility rates and improving health outcomes

War has far-reaching effects on reproductive behaviour and family planning. Women may decide to have more children when exposed to armed conflict as access to contraception is reduced, education is disrupted, and economic dislocation causes child labour to become more important to local economic activity (Iqbal 2010, Islam et al. 2016). In turn, high fertility rates pose significant health risks to mothers and children, leading to a large number of maternal and child deaths, 99% of which occur in less developed regions (Africa Health Organisation 2019). High birth rates can also hamper processes of post-conflict recovery and development by negatively affecting educational attainment, economic growth, and the environment (Birdsall et al. 2001, Casterline 2010).

While previous research has explored how insecurity influences fertility rates (Kraehnert et al. 2019, Torrisi 2020), the effects of post-conflict security provision have been subject to little empirical scrutiny. Our recent research (Bove et al. 2024) examines the effects of the external provision of security on fertility rates by investigating the effect of the UN peacekeeping operation in Liberia (UNMIL). Liberia is a crucial case for investigation both because of its history of violent conflict and its fertility rate, which at 4 children per woman is among the world’s highest (UN D.E.S.A. 2019). Following two devastating civil wars claiming an estimated 250,000 casualties between 1989 and 2003 (Economist 2022), the UN Security Council (UNSC) established the United Nations Mission in Liberia (UNMIL) to support the implementation of the peace process, provide humanitarian aid and assist the transitional government in restructuring the police force. The deployment, which continued for 15 years, reached its peak of 16,000 personnel in 2005.

Measuring effects of security building

Our methodology captures the impact of peacekeeping operations by measuring how exposure to the local presence of peacekeepers influenced fertility, health, and development outcomes. Data on fertility comes from the geocoded Demographic and Health Surveys (DHS) conducted in 2007, 2013, and 2019 in Liberia, which report women’s birth history. Combined with data on the geographic location on UN bases, we calculate the road distance between DHS data clusters (within which respondents are interviewed) and UN bases. Based on this distance, we construct a granular measure of individual exposure to peacebuilding activities which captures regional variation (Figure 1) and allows for an assessment of its effects on fertility. To isolate the impact of peacekeeping from other possible concurrent factors, we control for a wide range of women’s predetermined characteristics as well as for DHS district’ characteristics and time-period effects.

Figure 1: Liberia road network (orange) and peacekeeping locations.

Liberia road network (orange) and peacekeeping locations

Impact of peacekeeping efforts

Our results reveal that UNMIL’s peacekeeping activities had a negative effect on fertility rates which was not only statistically significant, but also economically meaningful in magnitude. We find that women residing within 10 km from peacekeepers experienced a 4.5-percentage point lower probability of giving birth compared to women living in regions without peacekeepers. This effect corresponds to a roughly 5.5% decrease in the average fertility rate. Moreover, exposure to peacekeeping reduced the number of children born post-deployment by 24%. This is equivalent to a decrease in the average number of children of roughly 0.5.

Figure 2 provides a visual representation of our results by mapping the average difference in fertility rates between DHS clusters exposed to peacekeeping activities and those unexposed to peacekeeping activities before and after UNMIL’s deployment. This difference is minimal prior to deployment but increases significantly in magnitude during the years after deployment, revealing the effects of peacekeeping efforts on those areas where `Blue Helmets’ operated. In short, our results suggests that peacekeeping activities can meaningfully contribute towards mitigating the deleterious effects of conflict on family planning.

Figure 2: Panel event study on fertility rates.

Panel event study on fertility rates

Peacekeeping and the ‘Security Umbrella’

How do peacekeeping activities help moderate post-conflict fertility rates? Our study points to three mechanisms related to the way in which peacekeeping’s provision of a ‘security umbrella’ promotes local economic development and enables health services provision and access (Gizelis and Cao 2021, Campbell and Di Salvatore 2023).

First, peacekeepers create a supportive environment that facilitates development and humanitarian projects, including the provision of key services and the construction of vital infrastructures for the local community by other international actors. Our study finds evidence of this mechanism by analysing nighttime light data as a proxy for levels of infrastructural and local economic development. Using data from the period 1999-2012, we show that significant differences emerge in nighttime light intensity between areas exposed to peacekeeping activities and those unexposed, after the deployment period commenced, suggesting that peacekeeping activities facilitated infrastructural and economic development.

As a second test, we estimate the correlation between World Bank aid projects and peacekeeping presence. The results provide suggestive evidence that areas hosting UN peacekeepers are also more likely to host aid projects, pointing to the way in which peacekeeping activities help to usher in additional external sources of aid. In tandem, this evidence indicates that the peacekeeping mission had a positive long-term effect on the economic and social development of the areas which they reached and engendered a safe environment for international actors, as previous research has also found (Bove and Elia 2018, Bove et al. 2021).

Second, the ‘security umbrella’ not only makes critical infrastructures and services available, but improves citizens’ access to such services. To provide evidence of this mechanism, we evaluate the impact of peacekeeping on maternal and child health outcomes by analysing key indicators, including the number of prenatal visits, iron intake during pregnancy, birthweights of children, number of postnatal visits, number of child deaths under the age of five and rates of contraceptive use. Our results show that peacekeeping is linked to improved health outcomes for both mothers and children, suggesting that improved access to family planning services might have proven effective (Voena 2019). This points to the possibility of peacekeeping inducing a ‘quantity-quality trade-off’ through the provision of prenatal and healthcare services whereby fertility rates are reduced because of better planning and health outcomes (Becker 1960).

Third and finally, there may be an opportunity-cost dynamic at play wherein partners delay childbearing because of better economic and labour market conditions (Zipfel 2022). To investigate this dynamic, we estimate the effect of peacekeeping on both DHS respondents’ and partners’ occupations. The results demonstrate that peacekeeping activities causes jobs re-allocation away from agriculture and towards more clerical positions and occupations in the services and sales sector, which are better paid and carry better career prospects. This suggests that the decline in fertility may be partly attributable to the improvement of job-market prospects resultant from peacekeeping activities.

Implications for security policy

Our research suggests that the benefits of peacekeeping activities should be couched not only in their provision of security, but also the broader platform for development which the ‘security umbrella’ provides. Peacekeeping activities in Liberia aided in moderating the post-conflict fertility rate through the provision of infrastructure, economic development, healthcare, and improved job-market opportunities. In turn, peacekeeping activities aid in reversing the deleterious effects of conflict and violence on family planning and maternal and child health outcomes.


Africa Health Organisation (2019), “Maternal Mortality Fact Sheet”,
https://aho.org/fact-sheets/maternal-mortality-fact-sheet/ (Accessed 10 February 

Becker, G S (1960), “An economic analysis of fertility” In: Demographic and Economic Change in Developed Countries, New York, Columbia University Press: 209–240.

Birdsall, N, A C Kelley, S W Sinding, and S Sinding, Eds. (2001), Population Matters: Demographic Change, Economic Growth, and Poverty in the Developing World, Oxford University Press, Oxford. https://doi.org/10.1093/0199244073.001.0001 

Bove, V and L Elia (2018), “Economic development in peacekeeping host countries”, CESifo Economic Studies 64 (4): 712–728. https://doi.org/10.1093/cesifo/ifx009 

Bove, V, J Di Salvatore, and L Elia (2021), “UN peacekeeping and households’ well-being in civil wars”, American Journal of Political Science 66 (2): 402–417. https://doi.org/10.1111/ajps.12644 

Bove, V, J Di Salvatore, L Elia, and R Nisticò (2024), “Mothers at peace: International peacebuilding and post-conflict fertility”, Journal of Development Economics, 167. https://doi.org/10.1016/j.jdeveco.2023.103226 

Campbell, S P and J Di Salvatore (forthcoming) "Keeping or building peace? UN peace operations beyond the security dilemma", American Journal of Political Science. https://doi.org/10.1111/ ajps.12797 

Casterline, J B (2010), Determinants and Consequences of High Fertility: A Synopsis of the Evidence-Portfolio Review, World Bank Group, Washington, DC.

Economist (2022), “Victims of Liberia’s Civil War Are Still Waiting for Justice” [online], https://www.economist.com/middle-east-and-africa/2021/11/13/ victims-of-liberias-civil-war-are-still-waiting-for-justice (Accessed 8 February 2022).

Gizelis, T I, and X Cao (2021) “A security dividend: peacekeeping and maternal health outcomes and access”, Journal of Peace Research 58(2): 263–278. https://doi.org/10.1177/0022343320917198 

Kraehnert, K, T Brück, M Di Maio, and R Nisticò (2019), "The Effects of Conflict on Fertility: Evidence from the Genocide in Rwanda", Demography, 56(3): 935-68. https://doi.org/10.1007/s13524-019-00780-8 

Iqbal, Z (2010), War and the Health of Nations, Stanford University Press, Redwood City, CA.

Islam, A, C Ouch, R Smyth, and L C Wang (2016), “The long-term effects of civil conflicts on education, earnings, and fertility: evidence from Cambodia”, Journal of Comparative Economics 44(3): 800–820. https://doi.org/10.1016/j.jce.2015.05.001 

Torrisi, O (2020), "Armed Conflict and the Timing of Childbearing in Azerbaijan", Population and Development Review, 46(3): 501–56. https://doi.org/10.1111/padr.12359 

UN D.E.S.A., (2019), World Population Prospects 2019. United Nations, Department of 
Economic and Social Affairs, New York, NY, https://population.un.or 
g/wpp/Graphs/Probabilistic/FERT/TOT/947 (Accessed 18 October 2022).

Voena, A (2019). "Reducing fertility in sub-Saharan Africa." VoxDev. https://voxdev.org/topic/health-education/reducing-fertility-sub-saharan-africa (Accessed: 12 April 2024)

Zipfel, C (2022). Bursting the bubble of population growth: Evidence from sub-Saharan Africa. VoxDev. https://voxdev.org/topic/health-education/bursting-bubble-population-growth-evidence-sub-saharan-africa (Accessed: 12 April 2024)