Maternal health inequity in Somalia: A multivariate analysis of poverty and service utilization using nationwide cross-sectional survey data

IF 1.9 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Public Health in Practice Pub Date : 2025-08-06 DOI:10.1016/j.puhip.2025.100647

Asma Mahamoud Abdillahi , Omer Adam Farih , Mustafe Abdillahi Ali , Abdirizak Hassan Abokor , Hodo Abdikarim , Saeed Hassan Mohamed , Awale Ali Omer , Shabcan Mohamed Ali , Abdisalam Hassan Muse

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Abstract

Objectives

Maternal health is a fundamental human right, yet significant inequities persist in low-resource settings like Somalia. This study investigates the nexus between socioeconomic status and maternal healthcare utilization, specifically examining the determinants of antenatal care (ANC) visits and place of delivery, to inform strategies aimed at achieving health equity.

Study design

A quantitative, cross-sectional study.

Methods

We used data from the 2020 Somalia Health and Demographic Survey (SHDS), a nationwide survey. The final analytical sample included 8248 women with a recent birth. We analyzed two dependent variables: number of ANC visits and place of delivery (home vs. health facility). Independent variables included wealth index, maternal education, residence, region, and other social determinants. Zero-inflated Negative Binomial (ZINB) regression was used for ANC visits, and binary logistic regression was used for place of delivery, with all analyses adjusted for the complex survey design.

Results

Marked disparities were found based on wealth. A significantly larger proportion of poorer women delivered at home (87.6 %) compared to richer women (55 %). Richer women had higher rates of ANC visits (Adjusted Incidence Rate Ratio [aIRR] = 1.41, p < 0.001) and were more likely to have facility-based deliveries (Adjusted Odds Ratio [AOR] = 1.57, p < 0.001). Higher maternal education, mobile phone ownership, and not wanting to go alone to a facility were also associated with better utilization. Significant regional disparities were observed.

Conclusions

Socioeconomic status is a primary driver of maternal healthcare utilization in Somalia, leading to substantial health inequities. Addressing these disparities requires multisectoral, targeted interventions that tackle poverty, enhance education, improve access to technology, and address cultural barriers to care.

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索马里孕产妇保健不平等：利用全国横断面调查数据对贫困和服务利用情况进行多变量分析

产妇保健是一项基本人权，但在索马里等资源匮乏的环境中，严重的不平等现象依然存在。本研究调查了社会经济地位与孕产妇保健利用之间的关系，特别是检查了产前保健（ANC）访问和分娩地点的决定因素，为旨在实现健康公平的战略提供信息。研究设计定量、横断面研究。方法我们使用了2020年索马里健康和人口调查（SHDS）的数据，这是一项全国性调查。最终的分析样本包括8248名刚出生的女性。我们分析了两个因变量：ANC就诊次数和分娩地点（家庭vs.卫生机构）。自变量包括财富指数、母亲教育程度、居住地、地区和其他社会决定因素。ANC访问使用零膨胀负二项回归（ZINB），分娩地点使用二元逻辑回归，所有分析都针对复杂的调查设计进行了调整。结果根据财富发现了明显的差异。较贫穷妇女在家分娩的比例（87.6%）明显高于较富裕妇女（55%）。较富裕的妇女ANC就诊率较高（调整发病率比[aIRR] = 1.41, p < 0.001），更有可能在医院分娩（调整优势比[AOR] = 1.57, p < 0.001）。更高的母亲教育程度、拥有移动电话以及不愿独自前往医疗机构也与更好的利用有关。观察到显著的地区差异。社会经济地位是索马里孕产妇保健利用的主要驱动因素，导致严重的卫生不平等。要解决这些差异，就需要采取多部门、有针对性的干预措施，解决贫困问题，加强教育，改善获得技术的机会，并消除获得护理的文化障碍。

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