Blockade as Reproductive Violence

May 1, 2025 by lkingston54    No Comments    Posted under: Volume XV, Issue 1

Sophia Medzoyan, Barnard College – Columbia University

Blockade as Reproductive Violence: Reproductive and Maternal Health Experiences of Artsakhtsi Women

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Azerbaijan blockaded the autonomous Republic of Artsakh (Nagorno-Karabakh) from December 2022 to September 2023, violating Artsakhtsis’ right to health by depriving them of medical care and life essentials. These conditions had a significant impact on Artsakhtsis’ reproductive rights. In collaboration with the Society for Orphaned Armenian Relief (SOAR), I developed a qualitative survey to interview a group of women recently displaced from Artsakh who were either pregnant during the blockade or had given birth to at least one child after September 2020, the start of the 44-Day War. Survey responses construct a narrative of the challenges these Artsakhtsi women faced in meeting their reproductive and maternal health needs, including food insecurity, undermined access to medical resources and services, and chronic stress. Findings also highlight the various responses and coping strategies that respondents used to navigate these barriers, falling into three categories: a community-based system of care, home alternatives to items in shortage, and the prioritization of their children’s health over their own.

In December 2022, the state of Azerbaijan initiated a blockade of the only road connecting the autonomous Republic of Artsakh (Nagorno-Karabakh) to Armenia. Lasting until the end of September 2023 – when Azerbaijan took control over Artsakh and displaced almost the entirety of Artsakh’s population of at least 100,000 people to Armenia – the blockade violated Artsakhtsis’ right to health[1] by depriving them of medical care and essentials such as food, fuel, medicine, and hygiene products (Human Rights Defender of the Republic of Artsakh, 2023). These conditions had an especially significant impact on pregnant people and mothers by restricting their access to comprehensive maternal and reproductive health services, which I argue is a form of reproductive violence. Through this study, I examine the agentive decision-making processes of Artsakhtsi women regarding their reproductive and maternal health in response to the specific challenges posed by the blockade. In collaboration with the Society for Orphaned Armenian Relief (SOAR), I developed a qualitative survey to interview a group of women recently displaced from Artsakh who were either pregnant during the blockade or had given birth to at least one child after September 2020, the start of the 44-Day War. By analyzing the responses, I construct a narrative of the challenges these Artsakhtsi women faced in meeting their reproductive and maternal health needs, including food insecurity, undermined access to medical resources and services, and chronic stress. I then synthesize the various responses and coping strategies that respondents used to navigate these barriers into three categories: a community-based system of care, home alternatives to items in shortage, and the prioritization of their children’s health over their own.

Background and Literature Review

Armed Conflict and Health

Armed conflict has a significant impact on public health, not only by directly causing fatalities and injuries through violence, but also through the breakdown of health and social services and the displacement of populations (Murray et al., 2002). Inadequate or entirely absent data systems, social breakdown, forced migration, and underreporting or overreporting biases render conflict’s effects on public health extremely difficult to document. In addition to employing public health methodologies to mitigate these challenges, the personal stories of individuals affected by conflict can serve as an effective way to inform the general public and policymakers about the public health implications of a conflict and encourage them to take action (Levy & Sidel, 2016). This process is facilitated by the rise of social media, allowing conflict-affected populations to directly share their experiences with the world at large.

In terms of reproductive and maternal health, women’s (and other gender minorities’) bodies increasingly fall at the center of armed conflict as a tool of population control, ethnic cleansing, and/or genocide. Conflict politicizes, securitizes, and weaponizes women’s bodily and reproductive autonomy, as their sexual and reproductive health (SRH) becomes “not incidental to war but integral to military tactics and strategies” (Hedström & Herder, 2023, p. 2). Women tend to be most vulnerable to restrictions of their bodily autonomy during times of insecurity and crisis, often facing the denial of comprehensive SRH services in these moments of exacerbated need. Building on the Depletion through Social Reproduction (DSR) model, Maria Tanyag (2018) argues that women must often make sacrifices that subordinate their personal needs to that of the family and community during crises such as armed conflict in a phenomenon she terms “the feminized burden of care.” This process manifests in a lack of self-care, such as eating and drinking less during times of scarcity, heightenedmaternal death and pregnancy-related complications, increased exposure to infectious disease, and psychological trauma (Tanyag, 2018).

The weaponization of reproductive capacity during times of crisis can better be understood in terms of an understudied form of harm perpetuated by armed conflict – reproductive violence. The Center for Reproductive Rights, an international human rights organization that advocates for the protection of reproductive rights in law, defines reproductive violence as “practices that directly or indirectly compromise and violate reproductive freedom, understood as the capacity of individuals to decide whether they want to have children or not and when, as well as their capacity to access sexual and reproductive health services and information such as contraception, safe abortion, and gynecological and obstetric health services” (Rosero Arteaga & Landazabal, 2020, p. 13). Under international humanitarian law, reproductive violence is often designated as a sub-category of sexual violence, which overlooks and minimizes the specific ways that reproductive violence perpetuates harm (Zammit Borda, 2024). Though they may sometimes overlap, reproductive violence does not always contain a sexual component. For example, forced sterilization is a non-sexual form of reproductive violence. Other acts of reproductive violence can include forced contraception or forced interruption of pregnancy, violence against pregnant people, coerced maternity or pregnancy resulting from rape, and obstacles to accessing reproductive health services (Rosero Arteaga & Landazabal, 2020, p. 15).

The Convention on Elimination of all Forms of Discrimination Against Women (CEDAW) expresses the clearest attempt to protect against reproductive violence in international law, recommending that during conflict, states have an obligation to secure “access to reproductive health and rights information…planning services, including emergency contraception; maternal health services, including antenatal care, skilled delivery services, prevention of vertical transmission and emergency obstetric care; safe abortion services; post-abortion care…and care to treat…complications of delivery or other reproductive health complications” (United Nations, 1979). Acts of reproductive violence may constitute genocide, crimes against humanity, and/or war crimes. In the context of genocide, reproductive violence is usually interpreted according to Article II(d) of the Convention on the Prevention and Punishment of the Crime of Genocide (UN Genocide Convention): “imposing measures intended to prevent births within the group” (United Nations, 1948a). This clause has never been used as a foundation of prosecuting a state for genocide, perhaps because acts that do not directly result in death tend to be taken less seriously in genocide studies (Fein, 1999).

The Blockade of Artsakh: Reproductive Violence in Action

Located in the South Caucasus, the region known as Artsakh (also referred to by its Russo-Turkish toponym, Nagorno-Karabakh) has cultivated its own distinctive identity and maintained a relative degree of autonomy despite the expansionist aspirations of various empires across the centuries. Considered a province of Greater Armenia in ancient and medieval times, Artsakh has been inhabited by ethnic Armenians for most of known history, with the Armenian population constituting a majority in the early twentieth century (Chorbajian et al., 1995, p. xi, 53). Over the years, the Armenians of Artsakh both engaged with and resisted the non-Armenian elements around them, especially the Caucasian Albanians, a separate ethnic group that eventually disappeared via assimilation after the Middle Ages (Gippert & Dum-Tragut, 2023). Though Artsakhtsis consider themselves Armenians, they speak their own dialect of the Armenian language, practice their own unique cultural traditions, and celebrate their own distinctive architecture and cultural heritage sites, all of which set them apart from their counterparts in the Republic of Armenia, which lies to the west of Artsakh (CivilNet, 2024).

Following the dissolution of the Soviet Union in 1991, the Republic of Artsakh operated as a de facto independent state despite its internationally unrecognized status (Chaliand, 1995). Since then, Artsakh became embroiled in multiple conflicts with neighboring Azerbaijan, which opposed Artsakh’s declaration of independence. Spanning decades, this conflict culminated in Azerbaijan’s total blockade of the only road connecting Artsakh to Armenia from December 2022 to September 2023, when the Azerbaijani military invaded and occupied Artsakh, displacing nearly the entire population of 100,000 people (United Nations, 2023). Over the period of this nine-month blockade, the state of Azerbaijan violated Artsakhtsi Armenians’ right to access SRH services by preventing the flow of medicine, food, fuel, hygiene supplies, and other necessities in or out of Artsakh (Human Rights Defender of the Republic of Artsakh, 2023). This crisis came on the heels of the devastating 44-Day War between Azerbaijan and Artsakh in 2020, which was a conflict that displaced more than 90,000 Artsakhtsi Armenians and placed the healthcare system under enormous strain, exacerbated by the COVID-19 pandemic (Rostomian et al., 2023).

Experts contend that the blockade constitutes genocidal violence, as defined by international law. Luis Moreno Ocampo, former prosecutor of the International Criminal Court, released a report condemning Azerbaijan for committing genocide by starvation against Artsakhtsi Armenians via the blockade. He cited the UN Genocide Conventions’s Article II(c): “Deliberately inflicting on the group conditions of life calculated to bring about its physical destruction in whole or in part” (Ocampo, 2023; see also United Nations, 1948a). Similarly, the Lemkin Institute for Genocide Prevention (2023) also released a report about how the blockade imposed conditions of starvation and deprivation of necessities, in conjunction with Azerbaijan’s genocidal rhetoric, thereby showing genocidal intent.

Though data collection on the public health implications of the blockade was minimal, what limited information does exist suggests that the blockade had a particularly detrimental effect on Artsakhtsis’ maternal and reproductive health. A report released by the Human Rights Defender of the Republic of Arstakh (2023) during the blockade cites an acute shortage of medicine and infant formula and increased reproductive risks stemming from blockade-induced stress and fears. Artsakh’s Ministry of Health recorded anemia in over 90% of pregnant people and an increase in medically induced abortion (MOH of Artsakh Rep, 2023), as well as a tripling of early miscarriage rates (CivilNet, 2023).

This study provides qualitative data to describe and document the agentive decision-making processes and coping behaviors of Artsakhtsi Armenians seeking to meet their maternal and reproductive-health related needs throughout the crisis. It aims to fill gaps left by the inadequate data collection administered during the blockade, and to document displacement by amplifying the personal narratives of Artsakhtsi Armenians who experienced the effects of the blockade firsthand. The Armenian population is an underrepresented population in public health literature, despite experiencing extensive conflict in recent history; the only existing study on the effects of conflict in Artsakh on maternal health was conducted by Lara Rostomian et al. (2023) following the 2020 War and was used as a reference point for the design of this study.

Methods

I conducted qualitative data collection in collaboration with the Society for Orphaned Armenian Relief (SOAR) by administering surveys of 13 open-ended questions to a group of 21 women displaced from Artsakh to Armenia. SOAR is a U.S.-based non-profit organization whose primary focus is providing humanitarian aid to orphaned Armenian children internationally. Following the mass displacement from Artsakh, SOAR allocated resources to support displaced Artsakhtsi families through the Families of Fallen Soldiers Relief Fund and the Artsakh Families Fund (Society for Orphaned Armenian Relief, n.d.). SOAR also recently initiated the Maternal and Newborn Health Fund, which works to ensure that vulnerable mothers in Armenia receive quality care during pregnancy and childbirth. The Maternal Fund expanded to support expecting mothers from Artsakh once they arrived in Armenia post-displacement (Society for Orphaned Armenian Relief, 2024).

The subject population, identified through SOAR’s databases from these three humanitarian funds, consisted of Artsakhtsi women displaced from Artsakh to Armenia who were either pregnant during the blockade or who had given birth since September 2020, the beginning of the 44-Day War. This set of criteria assured that all respondents would likely have had some contact with Artsakh’s maternal and reproductive health care system during the period of the blockade from December 2022 through September 2023. At the time the surveys were administered, the respondents ranged in age from 21 to 42, with a mean age of 28. Eight were pregnant at some point during the blockade, two of whom miscarried, and an additional three became pregnant only after their displacement to Armenia. The respondents had resettled in various locations across Armenia, primarily Gyumri and Vanadzor but also Yerevan, Artashat, and Gharibjanyan. The women ranged from expecting their first child to having a total of six children.

The survey instrument focuses on their lived experiences, decision-making, and prioritization processes regarding their reproductive and maternal health during the blockade. I intentionally developed the questions to engage with the respondents as active agents rather than passive victims of the crisis. Most of the survey questions were structured as either open-ended questions or yes-or-no questions with probes encouraging an extended response.^[2] The survey instrument and consent form assuring voluntary participation and confidentiality were both developed in English. SOAR provided translation support to translate both into Eastern Armenian, the language spoken in the Republic of Armenia and the one most similar to the unique dialect spoken by Artsakhtsi Armenians. The surveys were then administered over the phone by a social worker affiliated with SOAR who lives in Armenia and is a native speaker of Eastern Armenian. She chose to conduct the surveys by phone to minimize disruption to the respondents, as nearly all the respondents had young children and could not easily attend an in-person session. The surveys took between 15 and 45 minutes to administer, including reading the consent form. The interviewer delivered the questions sensitively with the understanding that nearly all the respondents had undergone recent traumatic experiences. Altogether, she administered a total of 25 surveys, but four of the respondents did not fit the criteria of having given birth since September 2020, so their responses were discounted, leaving 21 respondents. Of the 25 women contacted to be surveyed, none declined participation. After conducting each survey, the interviewer then translated the responses from Eastern Armenian into English.

I analyzed the responses using NVivo qualitative software to code each response according to conceptual categories and topics formulated through the literature review, creating more codes when necessary.^[3] In order to further contextualize the responses with other firsthand accounts, I triangulated the data with additional information collected from social media posts made by Artsakhtsis on Twitter/X throughout the blockade and displacement. These posts help to fill in the gaps left by the lack of formal data collection during the crisis and offer a humanizing account of day-to-day life under the blockade. In determining patterns among categories, I identified the barriers that respondents faced most frequently in meeting their reproductive and maternal health needs, and how they responded to these barriers in terms of coping strategies, alternative means of seeking aid, and decision-making.

Findings: Barriers to Meeting SRH Needs

Food Insecurity

Nearly every respondent described experiencing food insecurity as a significant challenge to their maternal and reproductive health during the blockade. Several recalled waiting in queues outside bakeries and stores for hours, only to return home empty-handed. Antenatal vitamins and baby food were nearly impossible to find. One respondent’s doctor encouraged her to breastfeed her newborn despite her own inadequate diet. She relied on her home’s vegetable garden for fresh produce:

We gathered potato and zucchini from our small garden. That was good for my newborn child, as he started to taste different food besides milk. In recent months I needed sweet tea, but there was no sugar. I needed it to have milk for the baby. I had terrible dizziness that last period of the blockade, especially when I had to stand in long queues.

Several respondents experienced pregnancy complications or reproductive health issues as a direct result of the food shortages. One respondent who miscarried during the blockade specifically attributed her miscarriage to lack of food and vitamins. Another described having to cease a fertility treatment she was undergoing because of how difficult it was to find food during the blockade. Mothers with young children neglected their own health to be able to feed their children, with one lamenting: “There was nothing to eat. Even if we had something, we left it for the child to eat and waited aside. We were terribly exhausted.”

Undermined Access to Medical Resources and Services

Lack of access to medicine, hospitals, and doctor’s offices throughout the blockade served as another significant challenge to the respondents’ maternal and reproductive health. A common experience among the respondents was being unable to locate medicine their doctors prescribed them in pharmacies. One respondent recalled: “When I was pregnant, I had a bad backache and the doctor told me to take ‘Duphaston’ medicine. I could not find it anywhere.” Duphaston, a hormonal medication, is typically prescribed to pregnant people suffering from a progesterone deficiency to prevent miscarriage or premature birth (FamiCord Suisse, 2023). Another described how her inability to access necessary medicine prevented her from conceiving a child in the first place:

Medicine could not be found at all. If we managed to find some in tricky ways, that was too expensive, and sometimes we could not get cars to take us there. I wanted to get pregnant for the second time, but I needed different analyses, and it was not possible. Then, some medicine would be needed that could not be found.

In addition to the scarcity of medicine, respondents shared their struggles locating personal hygiene products such as soap, baby diapers, and menstrual products in stores. A video posted on X after just one month of the blockade shows clothes hung out to dry at night in Stepanakert, Artsakh’s capital city, accompanied by the caption: “I didn’t expect a woman could cry for lack of washing powder. ‘No more baby diapers…I didn’t have any powder for laundry’” (Vanyan, 2023). Respondents also had difficulty obtaining hot water due to frequent electricity cuts and the fuel shortage.

Nearly every respondent spoke about having to walk far distances to reach hospitals and doctor’s offices, as the fuel shortage meant that driving was a luxury few could afford. This was extremely difficult for pregnant people to navigate. As one recalled, “I could attend antenatal check-ups. I went there on foot. But it was too far away, and I got tired. I had pain in my feet and back.” The situation caused excessive worry among mothers, as they feared experiencing an emergency and being unable to reach a hospital in time, especially if their children were to fall ill.​​ The lack of accessibility was exacerbated for those living in the villages.

Additionally, respondents shared that the lack of medical specialists in Artsakh meant that many procedures and operations had to be postponed, with the hope that they could be carried out in the better-equipped medical facilities in Armenia. This process was easier toward the beginning of the blockade, when the International Committee of the Red Cross (ICRC) was still able to transport patients to Armenia. However, this was no longer possible after the government Azerbaijan began blocking ICRC vehicles traveling along the Lachin Corridor in mid-July 2023 (Hakobyan, 2023). One respondent worried: “My main concern was to get from there [Artsakh] alive; my Cesarean section was to be done. I was afraid I would not manage to have a child.”

Chronic Stress

Nearly every respondent mentioned experiencing stress and anxiety while living through the blockade and displacement. Several spoke about loved ones lost to recent conflict, including the 44-Day War in 2020, or how much they missed their homes in Artsakh. When discussing pregnancy complications – either their own or that of community members – respondents cited chronic stress as a suspected cause of miscarriage, premature delivery, and gestational diabetes. One respondent noted: “At the early stages of the blockade, nearly beginning from the fifteenth day of it, many pregnant women appeared to be in hospitals because of the stress and lack of food. I was one of them. I was kept under care in order not to give birth before the supposed date.” Mothers also blamed themselves for not being able to meet their children’s needs during the blockade. One respondent shared: “The child got ill, and we blamed ourselves because the child was suffering and asking for help, and we could do nothing.” For many, this sense of helplessness continued even after the displacement to Armenia, as resettled Artsakhtsis struggled to make ends meet while navigating the challenges of rehousing and integration. Those who underwent especially traumatic experiences continue to grapple with feelings of profound grief and loss, including one respondent who lost both her husband and son in the Berkadzor fuel depot explosion – a devastating blast that claimed the lives of over two hundred Artsakhtsis in the frantic exodus out of Artsakh.

Stress, trauma, and anxiety also had a significant impact on fertility desires and decisions about reproduction. While some respondents expressed their continued desire to create a family and repopulate after so much loss, roughly half of the women surveyed expressed the opposite sentiment. One respondent explained the reluctance to bear children following the trauma of the past few years, saying: “Many are affected by the war and the blockade, as they are afraid to have boys because they will become soldiers.” The same individual shared that she chose to terminate a pregnancy during the blockade because of her fears of being pregnant during that time. Another respondent described her persistent anxiety surrounding pregnancy throughout the blockade:

I thought about what would happen if I got pregnant in that situation. I know some different cases about pregnancies: a child was born ill, the other with less weight, another one was born dead. Some children were miscarried. I was afraid of those cases. The poor children had no chance to grow in their mothers’ wombs.[4]

In summary, the blockade imposed numerous challenges including shortages of food, medicine, and hygiene products; hospitals made unreachable due to lack of transportation; medical operations postponed indefinitely; and a pervasive sense of stress and anxiety. These barriers all restricted Artsakhtsis’ abilities to effectively access basic SRH services, treat reproductive and maternal health complications, and make agentive decisions about reproduction.

Findings: Responses and Coping Strategies

Community-Based Care

In describing how they navigated these challenges, respondents illustrate a common theme of turning to their own local communities as a resource to better care for their maternal and reproductive health. I choose to broadly define this pattern as “community-based care” to reflect the sense of communal support and continuous communication as a primary means of coping with and mitigating the various difficulties caused by the blockade.

Community-based care strategies were used to survive having inadequate food and medical supplies, for instance. To cope with the food shortages, neighbors traded with each other – such as exchanging oil for salt – and, as one respondent described it, “shar[ing] with each other all we had.” A photo posted on X just prior to the displacement shows two women sharing their small harvests of berries and walnuts through the fence separating their home gardens (Sargsyan, 2023c). When alternative sources of aid became available, including aid packages provided by the government or a local hospital, social media ensured the quick distribution of information among parents. One respondent recalled learning about the availability of food packages through a maternity hospital’s Facebook page. Another described the chaos this resulted in: “If one heard that the Red Cross brought a kind of medicine to a pharmacy, the whole Artsakh seemed to be there in the queues.”

To navigate the lack of accessible medical services, people enacted strategies to connect virtually and identify alternative sources of medical care. One respondent recalled calling her doctor by phone instead of visiting in person, after the physician agreed to conduct check-ups remotely so the patient would not have to walk a long distance. Another respondent, unable to reach hospitals without a means of transportation, came to rely on a local nurse who lived nearby and was able to provide her with an alternative source of medical support as needed.

Activism was another key response to the blockade and its threats to human rights. Artsakhtsi communities organized themselves throughout the blockade to publicize the challenges they faced through activism. While describing her decision-making processes during the blockade, one mother spoke about a protest she participated in:

I remember a protest action organized by parents who became very hopeless. I also took part there. The government promised to think about our problems, but nothing was done. The protest action was organized by those parents who found it impossible to struggle with having nothing during those days: we had no food to feed the children and the elderly.

These protests, organized primarily by mothers, occurred more than once throughout the blockade and are extensively documented on social media. On Day 29 of the blockade, mothers organized outside the ICRC headquarters to demand international action to end the siege, bearing signs in English including, “Artsakh is under humanitarian crisis” (Sargsyan, 2023a). Later, on April 7 – Armenian “Motherhood and Beauty Day” – the Artsakh Mothers’ Club organized another protest calling for an end to the blockade and supporting Artsakh’s right to self-determination. In photos posted on X, women carried signs in Armenian that read, “We don’t want to become widows,” “Artsakh’s self-determination is the only alternative” (Beglaryan, 2023), and “We are not giving up” (Ghavalyan, 2023). Later, on 1 August 2023, more than 100 mothers and their children gathered in protest in Stepanakert’s Renaissance Square to share their concerns with the government of Artsakh (Sargsyan, 2023b).

In all these examples, women – and in particular, mothers – were at the forefront of the action, centering the specific challenges they faced in their role as caregivers and demanding that their government, and the world at large, uphold their human rights. Through activism, these Artsakhtsi women demonstrated not only their commitment to looking out for each other as a group, but also their implicit understanding of how the blockade systematically violated Artsakhtsis’ rights along gendered lines.

Coping with Shortages and Prioritizing Children’s Well-Being

Devising creative home remedies served as another prominent coping strategy in response to chronic shortage, often using whatever materials were on hand. One respondent described inventing alternatives for food items that were in short supply, which became increasingly difficult as the blockade progressed: “Instead of oil, we used animal fat…We squeezed salt from soil. But in the last months when we had no salt and oil, nothing could be cooked. We just boiled everything and ate. There was little flour. The bread that was given in queues was made with mixed flour with wheat bran.” Though many of the impossible-to-find medications had no substitute, people turned to home remedies as alternatives whenever possible. One mother described a time that her child fell ill, and lacking antibiotics, she used “homemade stuff – hot water, vinegar” to diminish the fever. When it came to personal hygiene products, women turned to even more creative methods: “We could somehow find alternative solutions for menstrual products and pampers [diapers].[5] We did not wash our clothes and hair for days. There were no soaps and shampoos. Our hair got too dry. We used to wash the dishes with soil.”

Finally, many mothers expressed that throughout the blockade, they consistently prioritized their children’s health (or, in some cases, their unborn child’s health) over their own as a coping strategy to allocate what resources they did have access to. Most shared that this reflected a change in priorities when compared to their lives pre-blockade. As one respondent described it: “Honestly, during the blockade, we thought about our children more than about ourselves.” Another echoed a similar sentiment: “After my daughter’s birth, the priorities were changed. My child’s health is important more than anything…As a mother I stopped paying attention to my eating. I happened to eat nothing, but I kept bread for my child.” This approach clearly took a toll on the mothers’ own health, with one mother stating outright that following the displacement to Armenia, “[t]here is a need to reinforce the importance of self-care and health [for Artsakhtsi women]. I need to be healthy to take care of my children. Because no one else can do it better for my own children.”

Altogether, these various coping strategies and responses to the blockade – including various manifestations of community-based care and advocacy, homemade alternatives, and the prioritization of children’s needs – reflect a marked change in Artsakhtsi women’s decision-making regarding their reproductive and maternal health.

Discussion and Conclusion

Findings suggest that shortage (of food, medicine, and hygiene products), the difficulty of physically accessing medical care, and persistent psychological stress all served as significant barriers to Artsakhtsi women meeting their maternal and reproductive health needs during the blockade. These conditions fall well within Center for Reproductive Rights’ definition of reproductive violence, which includes “obstacles to accessing reproductive health services” (Rosero Arteaga & Landazabal, 2020), as well as demonstrating a clear violation of Artsakhtsis’ right to access SRH services as outlined by CEDAW (United Nations, 1979). However, Artsakhtsi mothers are not passive victims of their circumstances: they organized protests to call attention to the humanitarian situation, devised homemade remedies and supplies from whatever they had on hand, shared useful information and resources with each other, and sought additional health support from their local communities.

By prioritizing their children’s health needs and disregarding self-care, the Artsakhtsi women surveyed generally follow Tanyag’s (2018) model of the feminized burden of care – when responsibility to maintain households and communities primarily falls upon women during times of crisis, including through sacrifices such as not eating adequately in the face of food shortages. This process tends to result in short-term survival at the expense of long-term depletion. A needs assessment conducted by the Women’s Resource Center of Armenia on women displaced from Artsakh alludes to this burden: “Many women…lacked telephonic communication with the adult men from their families who were actively engaged in the self-defense battles against Azerbaijan. During this period, the entire responsibility for the family and the decision-making process fell upon the women” (WRC Armenia, 2024). This phenomenon indicates a greater need for psychological and social support for Artsakhtsi mothers as they resettle in Armenia, with an emphasis on sustainable self-care practices centered on replenishment rather than further self-sacrifice. Though the government of Armenia has extended the right to free antenatal and pediatric care to Artsakhtsi women in the aftermath of the blockade and displacement (Constantine, 2024), the findings documented here suggest the need for a specific focus on mental and physical health support for mothers after navigating such stressful conditions.

Moving forward, areas for continued research include focusing on the role of sociodemographic factors pre-displacement, particularly with respect to urban and rural residence, when it came to accessing SRH services and navigating the challenges posed by the Artsakh blockade. Future studies might investigate respondents’ locality within Artsakh, including factors such as families who experienced displacement within Artsakh multiple times since the 2020 War, when Azerbaijan invaded and occupied a large swathe of territory, as well as the vastly disparate experiences between Artsakhtsi Armenians who resided in Stepanakert and other urban centers compared to those who lived in more remote villages. Locality likely played a critical role in determining the accessibility of medical services, as villagers would have to travel longer distances to seek care in the cities.

In conclusion, this study is the first to investigate not only the impact of the Artsakh blockade and displacement on maternal and reproductive health, but also the agentive decision-making processes and coping strategies of Artsakh women while navigating these challenges. By examining how the blockade violated the right to safely access comprehensive maternal and reproductive services, it contributes to pre-existing literature exposing the myriad ways that armed conflict perpetuates reproductive violence, as well as adding to the limited literature available that applies this framework to the Armenian population of Artsakh. Moreover, as experts argue that the blockade itself was an act of genocide according to international law (Moreno Ocampo, 2023; Lemkin Institute for Genocide Prevention, 2023), studies like this one are critical to amplifying the lived experiences of Artsakhtsis themselves and demonstrating how the conditions induced by the blockade directly restricted the group’s ability to reproduce. In sharing their stories, this study memorializes both their pain and resilience in the face of such pervasive reproductive violence. Through it all, as one respondent described: “We passed through many fears, and from the psychological point of view, we got stronger.”

Appendix A

The following are the English-language translations of the questions and probes contained within the survey instrument:

1. How many children do you have? Please list their gender and date of birth.
2. Do you feel that your priorities as a mother, or expecting mother, changed after December 2022?
   1. No [SKIP TO Q3]
   2. Yes [PLEASE EXPLAIN BELOW]
3. Which resources or services with regard to your maternal and reproductive health did you prioritize throughout the blockade and your displacement to Armenia?
4. What was your decision-making process when it came to receiving or seeking healthcare services for mothers during the blockade? What were some of the factors that affected your decision-making?
5. Did you have difficulty meeting any of your reproductive or maternal health-related needs during the blockade?
   1.  No [SKIP TO Q7]
   2. Yes [PLEASE EXPLAIN BELOW]
6. How big of a barrier, ranked from 1 (not a barrier) to 5 (a significant barrier), were each of the following when it came to meeting the reproductive or maternal health-related needs that you described above?
   1. Inability to get to a doctor’s office or a hospital due to lack of transportation
   2. Healthcare providers’ inability to provide certain services, operations, supplies, or medicines due to shortages
   3. Lack of access to hygiene products, such as soap, baby diapers, menstrual products
   4. Lack of access to food or nutritional products, including baby formula, baby food, antenatal vitamins
   5. Lack of access to other basic household items such as hot water, electricity, fuel
   6. Other

Would you like to share your reasoning behind any of these rankings?

a.     No [SKIP TO Q7]

b.     Yes [PLEASE SHARE BELOW]

7. IF APPLICABLE: Were you able to attend regular antenatal, post-natal, and infant wellness check-ups throughout the blockade?
   1. No [PROBE: Please describe any disruptions to your care: what was the cause of the disruption, and for how long did it impact your care?]
   2. Yes [SKIP TO Q8]
8. Were there any alternative sources of care—institutions, programs, organizations, community spaces—that were able to support you as a mother during this time?
   1. No [SKIP TO Q9]
   2. Yes [PROBE: What resources did they provide? How did they address your needs? How did you learn about and gain access to these groups or resources?]
9. Do you feel that the instability in Artsakh led to any hesitancy within the community about having children during this time? For example, have community members expressed the desire to not have children, or wait to have children, because of the situation?
   1.  No [SKIP TO Q10]
   2. Yes [PROBE: Are you aware of any community members who chose to terminate a pregnancy during the blockade?]
10. At this point in time, do you anticipate or plan on having more children in the future? How have your experiences living through the blockade and displacement impacted your feelings about this?
11. Do you feel that your experiences during the 2020 Artsakh War influenced your decision-making and prioritization of services, resources, and care during the 2023 blockade and displacement?
    1. No [SKIP TO Q12]
    2. Yes [PLEASE EXPLAIN BELOW]
12. Going forward, what resources, services, or other forms of care do you consider most important to supporting and empowering Artsakh women resettling in Armenia in terms of reproductive and maternal health?
13. Is there anything else you wish to share at this time?

Appendix B

 I used the following codes on the qualitative software NVivo 14 to organize and categorize the data, including both the survey responses and review of social media posts. The number of references reflects how many data points were coded under that name.

References

Beglaryan, Artak [@Artak_Beglaryan]. (2023, April 7). Today, on Armenian Mother’s Day, the Women of Artsakh, with the Artsakh Mother’s Club, once again lead calls on the international community to take action…X. Retrieved from https://x.com/Artak_Beglaryan/status/1644378591025659905.

Chaliand, G. (1995). Preface. In L. Chorbajian, P. Donabedian, & C. Mutafian (Eds.), The Caucasian Knot: The History and Politics of Nagorno-Karabagh (pp. xi-xiv). London: Zed Books.

CivilNet. (2023, July 20). Miscarriages surge in Karabakh amid widespread food shortages. Retrieved from https://www.civilnet.am/en/news/745150/miscarriages-surge-in-karabakh-amid-widespread-food-shortages/.

CivilNet. (2024, August 14). Forcibly displaced from Artsakh, they work to preserve dialect despite discrimination. Retrieved from https://www.civilnet.am/en/news/793263/forcibly-displaced-from-artsakh-they-work-to-preserve-dialect-despite-discrimination/.

Constantine, L. L. (2024, June). Feeding Armenia. AGBU Insider. Retrieved from https://agbu.org/success-without-borders/feeding-armenia.

FamiCord Suisse. (2023, May 31). Duphaston in pregnancy—Indications and effects of the medicinal product. Retrieved from https://famicord.lu/en/pregnancy-zone-2/schwangerschaftsinformationen/duphaston-in-der-schwangerschaft-indikationen-und-wirkungen-des-arzneimittels.

Fein, H. (1999). Genocide and gender: The uses of women and group destiny. Journal of Genocide Research, 1(1): 43–63.

Ghavalyan, Anush [@aghavalyan]. (2023, April 7). We don’t give up!  Artsakh women’s message to the world on the Azerbaijan’s ongoing 4-month illegal and inhumane blockade of Nagorno-Karabakh aiming at ethnically…X. Retrieved from https://x.com/aghavalyan/status/1644295597304733697.

Gippert, J., & Dum-Tragut, J. (2023). Preface. In Caucasian Albania: An International Handbook, edited by J. Gippert and J. Dum-Tragut, pp. v–xii. Berlin: De Gruyter Mouton.

Hakobyan, S. (2024, June 12). The born and the unborn in the blockade. Media Max. Retrieved from https://mediamax.am/en/news/special-report/51902/.

Hedström, J., & Herder, T. (2023). Women’s sexual and reproductive health in war and conflict: Are we seeing the full picture? Global Health Action, 16(1). Retrieved from https://www.proquest.com/ibss/docview/2915453073/5A5D9D8E18D64A4BPQ/2?accountid=10226&sourcetype=Scholarly%20Journals.

Human Rights Defender of the Republic of Artsakh. (2023). 150 Days: Report on the Violations of Individual and Collective Rights as a Result of Azerbaijan’s Blockade of Artsakh (Nagorno-Karabakh). Retrieved from https://web.archive.org/web/20230513180351/https://artsakhombuds.am/en/document/1022.

Lemkin Institute for Genocide Prevention. (2023). Risk Factors and Indicators of the Crime of Genocide in the Republic of Artsakh: Applying the UN Framework of Analysis for Atrocity Crimes to the Nagorno-Karabakh Conflict. Retrieved from https://5d6eef0c-085c-40d1-8ffb-7cddabd099b3.usrfiles.com/ugd/9bc553_2e3babd9d7834d7fbcfa262f88c9fa74.pdf.

Levy, B. S., & Sidel, V. W. (2016). Documenting the Effects of Armed Conflict on Population Health. Annual Review of Public Health, 37: 205–218.

MOH of Artsakh Rep. (2023, August 8). Comprehensive Siege of Artsakh Leads to Significant Increase in Mortality and Morbidity Rates.Facebook. Retrieved from https://www.facebook.com/100064678300433/posts/pfbid0vyAPoGaY3GL96igLsYWRt9z3fuvaF3Q9ahhn9Z3Dr3vC8QDPzq6bqMtv3QrpGHHTl/.

Moreno Ocampo, L. (2023). Expert Opinion: Genocide Against Armenians in 2023. Retrieved from https://luismorenoocampo.com/wp-content/uploads/2023/08/Armenia-Report-Expert-Opinion.pdf?utm_source=Web&utm_medium=Landing&utm_campaign=Downloads.

Murray, C. J. L., King, G., Lopez, A. D., Tomijima, N., & Krug, E. G. (2002). Armed conflict as a public health problem. The BMJ, 324(7333): 346–349.

Rosero Arteaga, C., & Riaño Landazabal, J. F. (2020). An Examination of Reproductive Violence Against Women and Girls During the Armed Conflict in Colombia. Center for Reproductive Rights. Retrieved from https://reproductiverights.org/wp-content/uploads/2021/09/ENG-FULL-Reproductive-Violence-Conflict-Colombia.pdf.

Rostomian, L., Chiloyan, A., Hentschel, E., & Messerlian, C. (2023). Effects of armed conflict on maternal and infant health: A mixed-methods study of Armenia and the 2020 Nagorno-Karabakh war. BMJ Open, 13(12). Retrieved from https://doi.org/10.1136/bmjopen-2023-076171.

Sargsyan, Siranush [@SiranushSargsy1]. (2023a, January 9). A group of women with their children are protesting in front of the ICRC #ArtsakhBlockade. X. Retrieved from https://x.com/SiranushSargsy1/status/1612363038727852032.

Sargsyan, Siranush [@SiranushSargsy1]. (2023b, August 1). Today, over 100 mothers, along with their kids, gathered in Renaissance Square and met with the President and State Minister, seeking answers to pressing concerns… X. Retrieved from https://x.com/SiranushSargsy1/status/1686443059079237653.

Sargsyan, Siranush [@SiranushSargsy1]. (2023c, September 24). Even through the toughest of times, through blockades and wars, Armenians continue to share their small amounts of garden harvest. Two women exchange berries… X. Retrieved from https://x.com/SiranushSargsy1/status/1705921319580148033.

Society for Orphaned Armenian Relief (SOAR). (n.d.). Major Projects. Retrieved from https://www.soar-us.org/major-projects/.

Society for Orphaned Armenian Relief (SOAR). (2024). The Maternal and Newborn Health Fund. Retrieved from https://www.soar-us.org/the-maternal-and-newborn-health-fund/.

Tanyag, M. (2018). Depleting fragile bodies: The political economy of sexual and reproductive health in crisis situations. Review of International Studies, 44(4): 654–671.

United Nations. (1948a). Convention on the Prevention and Punishment of the Crime of

Genocide. Retrieved from https://www.un.org/en/genocideprevention/documents/atrocity-crimes/Doc.1_Convention%20on%20the%20Prevention%20and%20Punishment%20of%20the%20Crime%20of%20Genocide.pdf.

United Nations. (1948b). Universal Declaration of Human Rights. Retrieved from https://www.un.org/en/about-us/universal-declaration-of-human-rights.

United Nations. (1979). Convention on the Elimination of All Forms of Discrimination Against Women. Retrieved from https://www.ohchr.org/en/instruments-mechanisms/instruments/convention-elimination-all-forms-discrimination-against-women.

United Nations. (2023, October 2). UN Karabakh mission told ‘sudden’ exodus means as few as 50 ethnic Armenians may remain. Retrieved from https://news.un.org/en/story/2023/10/1141782.

Vanyan, Marut [@marutvanian]. (2023, January 13). I didn’t expected a woman could cry for lack of washing powder. “No more baby diapers, at least I didn’t have any powder for laundry.” Good evening from Stepanakert… X. Retrieved from https://x.com/marutvanian/status/1613921467581751296.

WRC Armenia. (2024). Needs Assessment of Forced Displaced Women from Artsakh (Nagorno-Karabakh) Residing in Shelters. Retrieved from https://womenofarmenia.org/wp-content/uploads/2024/01/Needs-assesment-1.pdf.

Zammit Borda, A. (2024). Putting Reproductive Violence on the Agenda: A Case Study of the Yazidis. Journal of Genocide Research, 26(1): 94–114.

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Righting Wrongs: A Journal of Human Rights is an academic journal that provides space for undergraduate students to explore human rights issues, challenge current actions and frameworks, and engage in problem-solving aimed at tackling some of the world’s most pressing issues. This open-access journal is available online at www.webster.edu/rightingwrongs.

[1] The “right to health” is outlined under various international human rights frameworks and laws, including the 1948 Universal Declaration of Human Rights. Article 25.1 of the UDHR asserts that everyone has the right to “a standard of living adequate for the health and well-being of himself and his family,” including food and medical care. Notably, Article 25.2 contends that motherhood and childhood are entitled “special care and assistance” (United Nations, 1948b).

^[2] See Appendix A.

^[3] See Appendix B.

[4] Because of these worries, this respondent decided not to conceive a child at that time.

[5] The respondent did not specify what she meant by “alternative solutions,” but according to a report released by the Human Rights Defender of the Republic of Artsakh (2023), women resorted to using “rags, napkins, bandages, or even cotton wool for their female hygiene” throughout the blockade. Another respondent explained how she and her sister-in-law invented a new kind of washing powder to do their laundry by combining soap and soda water.

Author’s acknowledgement: I’d like to thank my faculty mentor, Dr. Alison Vacca, for all her support and guidance throughout this project. I am eternally grateful to the Society of Orphaned Armenian Relief (SOAR) for their invaluable help in connecting with respondents, administering the surveys, and translating between Armenian and English. Finally, a special thank you to the Laidlaw Foundation for their generous support of Barnard students.