Prevalence and Determinants of Facility Delivery Among Women in Somalia: Insights from the 2020 Somali Demographic and Health Survey (SDHS)

Background: High maternal mortality in sub-Saharan Africa has been linked to inadequate medical care for pregnant women due to limited health facility delivery utilization. In Somalia, many births still take place at home, most often without a skilled birth attendant. This study aimed to identify the prevalence and determinants of facility delivery among pregnant women in Somalia using data from the 2020 Somalia Demographic and Health Survey (SDHS). Methods: This cross-sectional study analyzed SDHS 2020 data for 18,561 women aged 15– 49 years. Descriptive statistics summarized participant characteristics and delivery location. Binary logistic regression was used to identify determinants of facility delivery. Variables with p < 0.05 were considered statistically significant, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: The prevalence of facility delivery was 20.8%, indicating high utilization of home delivery. Several factors were significantly associated with increased odds of facility delivery. Women in the highest wealth had over five times higher odds of delivering at a health facility (AOR = 5.63; 95% CI: 4.56– 6.97). Women who attended ANC had four times higher odds of facility delivery (AOR = 4.42; 95% CI: 3.99– 4.89). Women who perceived the distance between their home and the nearest health facility as a barrier had 75% lower odds of facility delivery (AOR = 0.25; 95% CI: 0.23– 0.27). Additionally, nomadic residence, high parity (≥ 5 children), and early marriage were significantly associated with lower likelihood of facility-based delivery. Conclusion: Facility delivery remains low in Somalia. Wealth status, ANC attendance, and perceived distance to health facilities were key determinants of facility delivery, alongside residence type, parity, and early marriage. Improving ANC coverage, enhancing birth preparedness education, and increasing access to skilled birth attendants are vital steps to reduce home delivery. Keywords: facility delivery, antenatal care, home delivery, maternal health, Somalia, SDHS 2020