Quality and Access to Postnatal Care Among Women in Somalia: Evidence from the 2020 Somalia Demographic and Health Survey

Background: Neonatal mortality remains high in Somalia, and inadequate postnatal care (PNC) contributes substantially to preventable maternal and newborn deaths. Although PNC is critical during the first days after childbirth, both access to services and the content of care remain limited. This study examined access to postnatal care and the determinants of receiving appropriate-quality PNC among Somali women. Methods: This cross-sectional study analyzed data from the 2020 Somalia Demographic and Health Survey. The analysis included 2813 women aged 15– 49 years who had a live birth within the five years preceding the survey. Access to PNC was defined as receiving any postnatal check after delivery. Among women who received PNC, appropriate-quality care was defined as receiving all six essential postnatal care components within 48 hours of delivery. Weighted descriptive statistics and multivariable Poisson regression were used to identify factors associated with receiving appropriate-quality PNC. Results: Most women had no formal education and delivered at home. Access to postnatal care was limited, and among women who received PNC, only 3% obtained appropriate-quality care. Coverage of individual postnatal components was consistently low. Husband’s education and adequate antenatal care attendance were strongly associated with higher likelihood of receiving appropriate-quality PNC, while substantial regional disparities were observed. Conclusion: Both access to and quality of postnatal care in Somalia are extremely limited. Expanding skilled maternal services, strengthening antenatal care utilization, and improving community-based postnatal outreach are essential to improve maternal and newborn outcomes. Keywords: Somalia, maternal health, newborn health, appropriate-quality postnatal care, Demographic and Health Survey