Experiences of women with disabilities accessing maternal and newborn health services in Mogadishu, Somalia.

Abstract

Background: Despite global commitments to inclusive and equitable maternal and newborn health (MNH) care, women with disabilities in fragile and conflict-affected settings remain overlooked. In Somalia, where maternal mortality is among the highest in the world, women with disabilities face systemic and structural barriers to accessing quality MNH services. This study examined experiences of and perspectives on equitable access to MNH care among women with disabilities in Mogadishu, Somalia.

Methods: A qualitative descriptive study was conducted in Mogadishu between July and September 2024. We conducted in-depth interviews with women living with physical or visual impairments (n = 8) and with caregivers of women with hearing impairments or intellectual disabilities (n = 4). We also conducted key informant interviews with representatives of national disability organizations (n = 5). Interviews explored pregnancy and birth experiences, access to and quality of MNH services and recommendations for improvement. Data were analyzed using a primarily deductive thematic approach with inductive refinement, informed by Andersen's Behavioral Model of Health Services Use and Morgan's Gender Analysis Matrix to examine individual, facility and systemic-level determinants.

Results: At the individual level, women with disabilities faced intersecting challenges related to gender, disability, poverty, unemployment, limited education, and social stigma. These factors pressured them into early marriage and childbirth to secure future caregiving support and social approval. Gendered power relations and unequal access to resources left many women relying on family members for transportation, financial support, and communication with healthcare providers, reducing their autonomy in MNH decision-making. Facility-level barriers included inaccessible infrastructure such as lack of ramps or adjustable beds, poor provider communication especially for patients with hearing impairments or intellectual disabilities, and provider stigma questioning women with disabilities' right to motherhood. These experiences led many women with disabilities to avoid health facilities, relying instead on traditional birth attendants. Systemically, limited disability-inclusive MNH policy implementation, lack of data disaggregated by disability, and inadequate nationwide public awareness further compounded exclusion. Despite these constraints, women with disabilities identified free public health facilities and strong family and community support networks as key enabling factors.

Conclusions: These findings demonstrate urgent MNH care gaps for women with disabilities in Mogadishu, Somalia and provide evidence for action. Priorities include disability-inclusive infrastructure, provider training, accessible communication approaches, stronger disability-disaggregated data systems, and women with disabilities participation in planning and service design.