AJOG Global Reports · Published 2026-06-01 · DOI 10.1016/j.xagr.2026.100664
Isahaq Abdullahi, Lensa Toka, Katelyn M. Tessier, Cresta W. Jones, Bethany A. Sabol, Sarah A. Wernimont
BACKGROUND: Black birthing individuals experience worse perinatal outcomes compared to White counterparts, yet within-group differences among Black populations remain understudied. The U.S. Black population is heterogeneous, encompassing long-established U.S.-born communities and immigrants from across the African diaspora, whose health profiles may differ. Somali immigrants represent the largest African-born population in many U.S. communities and face documented challenges including cultural adaptation and language barriers. However, severe maternal morbidity (SMM) has not been specifically studied in this population. OBJECTIVE: To compare severe maternal morbidity and neonatal birth outcomes between Somali and non-Somali Black birthing individuals. STUDY DESIGN: This was a retrospective cohort study from 2016 to 2024, in which Somali and non-Somali Black individuals were identified within an academic-community health system. Somali individuals were identified using self-reported Black/African race combined with documented primary language (Somali) and/or country of origin (Somalia); individuals meeting either language or country criterion with Black/African race were classified as Somali regardless of birthplace. SMM was defined using CDC 21-indicator criteria (excluding blood transfusion) and assessed during birth hospitalization and through 6 weeks postpartum. Neonatal morbidity was defined as a composite of respiratory distress syndrome, transient tachypnea of the newborn, retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, 5-minute Apgar ≤7, hypoxic-ischemic encephalopathy, NICU admission, or neonatal death. Comparisons were performed using chi-square, Fisher’s exact, and t-tests as appropriate. Logistic regression estimated adjusted odds ratios (aOR) controlling for parity, mode of birth, insurance type, maternal age, and hypertensive disorders of pregnancy. RESULTS: Among 63,435 index births, 7403 (11.7%) were to Black birthing individuals, including 2427 (32.9%) Somali and 4976 (67.1%) non-Somali Black individuals. Somali individuals were older, more frequently multiparous, more likely to have public insurance, and had lower epidural and cesarean birth rates (all P≤.001). SMM during birth hospitalization was similar between groups. Six-week postpartum SMM was lower among Somali births (0.5% vs 1%, P=.021; aOR: 0.53, 95% CI: 0.26–0.99). Neonatal composite morbidity was modestly lower among Somali births compared to non-Somali Black births (15.0% vs 18.7%, P=.001; aOR: 0.85, 95% CI: 0.74–0.98). Subgroup analysis demonstrated no differences in SMM or neonatal composite outcomes between Somali individuals who used interpreter services and those who did not. CONCLUSION: In this single health system study, SMM during birth hospitalization was comparable between Somali and non-Somali Black birthing individuals, whereas postpartum severe maternal morbidity and neonatal composite morbidity were lower among Somali births. This within-diaspora comparison underscores the importance of examining heterogeneity within Black populations and suggests that maternal and neonatal outcomes may differ across Black subgroups despite shared structural disadvantage.
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Abdullahi, I., Toka, L., Tessier, K., et al. (2026). Comparing Severe Maternal Morbidity and Neonatal Outcomes between Somali and Non-Somali Black Birthing Cohorts. AJOG Global Reports. https://doi.org/10.1016/j.xagr.2026.100664