Doctors' experiences on dealing with informed consent required for lifesaving interventions for pregnant women in Somalia.

Background: Informed consent is a crucial legal and ethical requirement in the physician-patient relationship for all aspects of care. Despite, patients have the right to make their own decision in health, women in the Middle East and Africa, including Somalia, often have limited autonomy in healthcare decisions due to patriarchal structures. In Somalia, male family members including husbands frequently hold the ultimate authority in women's healthcare choices, sometimes restricting access to lifesaving sexual and reproductive health services.

Purpose: To explore doctors' experiences of delay or refusal to provide consent for lifesaving interventions for pregnant women in Somalia.

Patients and methods: an exploratory, qualitative design. Purposive sampling was used to select doctors working in maternity wards in the five selected hospitals. A total of 22 medical doctors were interviewed using a semi structured interview guide, and the data were analyzed using thematic analysis.

Results: An overarching theme emerged: "The disconnect between healthcare system and patriarchy system" with five sub-themes namely: (1) Consent is given only by paternal male family members (2) Paternal and male witnesses signatures required for the consent form (3) Paternal male conflicts and other reasons for delaying or refusing consent (4) Potential consequences for the doctors without the consent of paternal male (5) Changing the consent guidelines from paternal male dependency. Consent of the pregnant women is given by paternal male family members since they are responsible for her life (blood/Diya) according to cultural practices. The husband's consent is sufficient only in the case of post-abortion care, as this also involves the fetus. Misconceptions that cesarean sections can damage the uterus, limit future pregnancies, or impair a woman's ability to perform daily activities also contribute to delayed or refusal of consent.

Conclusion: This study revealed that doctors require protection when performing their duties. All doctors who participated in the study were ready to save the lives of their patients, but were assured of their safety. Patients seem to cooperate with doctors, but the cultural practices of providing consent from male members remain a challenge to the intervention. A national health policy should be drafted and approved by the cabinet that grant women the sole right to consent to life-saving medical interventions. Additionally, community mobilization is needed to educate community leaders about the negative impact of delaying or denying women informed consent to essential healthcare due to the patriarchal norms.