Home birth and its associated factors among mothers aged 15-49 years in Somalia: a nationwide population-based cross-sectional study.

Background: Understanding factors associated with home births is crucial for identifying appropriate interventions for mother and child survival and attaining the Sustainable Development Goals. No national studies have explicitly examined the distribution of home birth and its contributing factors. This study aims to assess the distribution of home birth and the contributing factors among mothers of reproductive age 15-49 years in Somalia.

Methods: We analyzed the data of 8,631 mothers who gave birth within five years preceding the survey and provided responses on variables studied. The data was obtained from the 2020 Somali Health and Demographic Survey. Respondents' characteristics were summarized using descriptive analysis. Chi-square tests were applied to test the association between the distribution of home birth and each predictor. Multivariate logistic regression was used to assess factors contributing to home birth. We employed the STROBE checklist for manuscript reporting.

Results: The prevalence of home birth among reproductive mothers in this study was, 75.5% (95% CI: 0.74-0.76). Living in the Northeast (AOR = 1.48, 95% CI: 1.17-1.86), no level of education (AOR = 2.38, 95% CI: 1.84-3.06), no media exposure (AOR = 3.67, 95% CI: 3.25-4.13), poor household wealth status (AOR = 3.80, 95% CI: 3.07-4.71), maternal autonomy (AOR = 1.36, 95% CI: 1.21-1.53), need companionship to treatment facility (AOR = 1.20, 95% CI: 1.07-1.36), and no antenatal visits (AOR = 3.91, 95% CI: 1.66-9.26) were associated with increased likelihood of home births among mothers. By contrast, urban and rural residences, low parity, and first-trimester antenatal visits were associated with a decreased likelihood of home births among mothers of reproductive age 15-49 years in this study.

Conclusion: The Somali government has made efforts to improve maternal health utilization and reduce the associated deaths. However, three-quarters of Somali mothers still undergo home births. To lower home births in Somalia, government and non-governmental organizations should consider scaling institutional births by improving maternal level of education, media accessibility, and household wealth status. Priority emphasis must be given to the maternal knowledge of the benefits of antenatal visits for both herself and her baby.