Inequalities in maternal health service utilisation in Somalia: analysis of the 2020 Somali health and demographic survey.
Maternal health service utilization in Somalia is low, with significant socioeconomic and geographic disparities. Targeted interventions are needed to improve equity in service access.
Where it sits
this study against the rest of the pnc-27 corpusSummary and findings
This study analyzed maternal health service utilization in Somalia using data from the 2020 Somali Health and Demographic Survey. It focused on wealth-related inequalities and determinants of service use among 8,598 ever-married women aged 15-49 years with a recent live birth. The study found low coverage of services and significant socioeconomic and geographic disparities.
Abstract
<h4>Background</h4>Somalia has one of the highest maternal mortality ratios and low coverage of maternal health services. Evidence on socioeconomic and geographic inequalities across maternal care continuum remains limited.<h4>Objective</h4>This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia.<h4>Methods</h4>We analysed data from the 2020 Somali Health and Demographic Survey (SHDS), including 8,598 ever-married women aged 15-49 years with a recent live birth. Outcomes were at least one antenatal care visit (ANC), health facility childbirth, and postnatal care (PNC) within 2 days of birth. Multilevel mixed-effects logistic regression examined associations with socioeconomic, geographic, and empowerment-related factors, while Erreygers Concentration Indices (ECIs) assessed wealth-related inequalities. Results are presented as adjusted odds ratios (aORs), ECIs, and 95% confidence intervals (CIs).<h4>Results</h4>Coverage was low: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received PNC. Nomadic women were less likely to deliver in a health facility (aOR = 0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR = 0.49; 95% CI: 0.32, 0.75). Rural residence, the Northeastern and Southcentral zones, and higher parity were associated with lower service utilisation, whereas higher education, mobile phone ownership, household wealth, and media exposure increased utilisation. Pro-rich inequalities were observed for ANC (ECI: 0.40), health facility childbirth (ECI: 0.38), and early PNC (ECI: 0.19).<h4>Conclusions</h4>Maternal health service utilisation remains critically low with socioeconomic and geographic inequalities. Equity-focused strategies targeting rural, remote, and nomadic populations are needed to accelerate universal health coverage.
Background
Somalia faces high maternal mortality and low maternal health service coverage, with limited evidence on the inequalities in service utilization. Understanding the socioeconomic and geographic disparities in maternal health services is crucial for improving health outcomes. This study aims to fill the gap by examining wealth-related inequalities and determinants of maternal health service use in Somalia.
Methods
The study used data from the 2020 Somali Health and Demographic Survey, involving 8,598 ever-married women aged 15-49 years with a recent live birth. It employed multilevel mixed-effects logistic regression to analyze associations with socioeconomic, geographic, and empowerment-related factors. Outcomes included at least one antenatal care visit, health facility childbirth, and postnatal care within 2 days of birth. Wealth-related inequalities were assessed using Erreygers Concentration Indices.
Results
The study found low coverage of maternal health services: 32.4% attended at least one ANC visit, 24.2% delivered in a health facility, and 10.9% received early PNC. Nomadic women were significantly less likely to deliver in a health facility (aOR = 0.45; 95% CI: 0.35, 0.58) and receive early PNC (aOR = 0.49; 95% CI: 0.32, 0.75). Pro-rich inequalities were evident, with ECIs of 0.40 for ANC, 0.38 for health facility childbirth, and 0.19 for early PNC.
Interpretation
The findings highlight significant socioeconomic and geographic disparities in maternal health service utilization in Somalia. While the study provides valuable insights into the determinants of service use, the observational nature limits causal inferences. The effect sizes indicate substantial inequalities, suggesting that targeted interventions are needed to address these disparities. The results align with existing literature on health inequalities in low-resource settings.
Key findings
- 32.4% attended at least one ANC visit.
- 24.2% delivered in a health facility.
- 10.9% received PNC within 2 days of birth.
- Nomadic women had aOR=0.45 for facility childbirth.
- Pro-rich inequalities observed for ANC (ECI: 0.40).
Limitations
- Observational study design.
- Self-reported data may introduce bias.
- Causality not established.
- Limited to ever-married women aged 15-49.
- Focus on recent live births only.