Women’s perspectives on the impact of war on maternal and reproductive health: a cross-sectional study from Gaza

Palestinians in Gaza have been subject to a genocide that resulted in unprecedented loss of human lives, with over 38,000 women and girls killed were reported between October 7th, 2023 to April 2026, and produced inhumane living conditions. While the entire population of Gaza was affected by these living conditions, women and girls suffered the most. This has created higher risks for worse maternal and reproductive health outcomes, including adverse pregnancy and delivery experiences and outcomes. This study explores women’s experiences of war hardships and living conditions and their impact on maternal and reproductive health. This was a cross-sectional study conducted in March 2025. A questionnaire was used to collect information on socio-demographics, war-related hardships and living conditions, obstetrics history, Gynecological history, and menstrual hygiene assessment. A convenience sampling method was adopted due to the critical situation. Descriptive data were calculated as frequencies, percentages and means with standard deviations. Bivariate associations between war conditions and reproductive outcomes were assessed using Spearman correlations, and multiple logistic regression models were constructed to examine associations between the composite war hardship score and reproductive outcomes. 206 women participated in this study with a mean age of 30.3 years. The mean composite war hardship score was 5.7 (SD = 2.0), with 56.8% scoring high level of hardship (6 or more conditions). Difficulty securing clean water or food was reported by 73.3%, access to private toilet facilities was lacking for 36.4%, and limited access to menstrual hygiene products was reported by 67.5%. In turn, 61.2% reported unintended weight loss > 5%, yet only 7.8% received treatment for malnutrition, menstrual irregularities affected 58.7% and urogenital infections affected 73.3%. Among the 49 women with history of childbirth during war, the majority (53.1%, n = 26) rated their delivery experience as poor, scoring 4 or less on a 10-point scale. Adverse pregnancy outcomes (stillbirths, intrauterine fetal deaths, neonatal deaths, or preterm births), occurred in 13 cases. Postpartum care was severely compromised, with (81.6%, n = 40) receiving no postpartum care. Among the 46 women with babies who provided data on formula access, 21 (42.9%) were unable to secure formula milk. 27 women experienced miscarriages, and 24 of them did not receive post-miscarriage care. Women and girls in Gaza have suffered immensely both in direct deaths from military attacks and from inhumane living conditions affecting their reproductive and maternal health. The findings underscore that association between poor living conditions during the war and adverse maternal and reproductive health outcomes.