Global Health Action · Published 2026-08-05 · DOI 10.1080/16549716.2026.2712181
Jamila Aden, Delia Hendrie, Judith Daire, Daniel Gashaneh Belay, Jennifer Dunne
Background 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. Objective This study examined wealth-related inequalities and determinants of maternal health service utilisation in Somalia. Methods 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). Results 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). Conclusions 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.
Abstract from DOAJ. Public domain (CC0 1.0).
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Aden, J., Hendrie, D., Daire, J., et al. (2026). Inequalities in maternal health service utilisation in Somalia: analysis of the 2020 Somali health and demographic survey. Global Health Action. https://doi.org/10.1080/16549716.2026.2712181