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. 2025 Jan 10;5(1):e0004102.
doi: 10.1371/journal.pgph.0004102. eCollection 2025.

Level of completion of maternity continuum of care among ever-married women: An analysis of Somalia's health and demographic survey 2020

Adam A Mohamed  1   2 , Ays'e Akın  1 , Sare Mihciokur  1 , Sarp Üner  3 , Abdi Gele  4
Affiliations

Level of completion of maternity continuum of care among ever-married women: An analysis of Somalia's health and demographic survey 2020

Adam A Mohamed et al. PLOS Glob Public Health. .

Abstract

Introduction: Somalia is continuing to recover from three decades of underdevelopment, political instability, civil unrest, and protracted humanitarian crises. However, Somalia has one of the lowest maternal health indicators in the world. For instance, the maternal mortality ratio is 621 per 100,000 live births. Extra efforts are needed to improve maternal health. In this study, we aim to investigate the level of completion and coverage along the maternity continuum of care in Somalia.

Method: The study used data from the Somalia Health and Demographic Survey 2020. We restricted our analysis to ever-married women who had a live birth in the five years preceding the survey (n = 2432). Completion of the continuum of maternity care was the outcome variable for this study. It was constructed into a binary variable with complete coded as one and incomplete coded as 0. We categorized it into three models: ANC4+ as the first model, ANC4+ & SBA as the second model, and ANC4+ & SBA & PNC as the third model.

Results: More than half of the women (53.1%) had their most recent births at ≤19 years old. Of all the mothers (n = 2432), only 235 (9.7%) had at least four or more of the recommended antenatal care (ANC4+), and 68 (2.8%) of them utilized skilled birth attendants. Only 14 (0.6%) women received all three maternal healthcare services (ANC4+, SBA, and PNC within 48 hours). About 78.1% of the mothers did not attend any of the three CoC services.

Conclusion: Maternal health care utilization decreases as they progress from ANC4+ to PNC utilization. The government and partners should design and implement strategies to improve maternal healthcare utilization specific to rural and nomads, less educated, not working, low income, and have less power in decision-making.

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Conflict of interest statement

The authors have declared that no competing interest exist.

Figures

Fig 1
Fig 1. Hypothesis structural relationships for CoC, Adapted from Kerber (Lancet) and Ajinkya (India) as in the references.
Fig 2
Fig 2. Selection process of eligible women aged 15–49 years old using Somalia Health and Demographic Survey 2020.
Fig 3
Fig 3. Maternity Continuum of Care.
Fig 4
Fig 4. Maternity Continuum of Care by residence.
See this image and copyright information in PMC

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