Emergency obstetric and newborn care in conflict-affected Somalia: rural access inequities, referral barriers, and health-system priorities - a policy and practice review.

Emergency obstetric and newborn care remains a critical maternal-health and health-system priority for reducing preventable maternal and neonatal deaths in Somalia. Prolonged conflict, displacement, recurrent climate shocks, poverty, and rural access inequities continue to expose pregnant women and newborns to delays in reaching timely emergency care. Although previous reviews have described broad maternal and newborn health challenges in Somalia, less attention has been given to how emergency obstetric and newborn care gaps interact with rural geography, insecurity, referral barriers, workforce shortages, weak facility readiness, and humanitarian service-delivery constraints. This policy and practice review synthesizes peer-reviewed literature, national survey evidence, policy documents, technical guidance, and authoritative reports to examine emergency obstetric and newborn care in conflict-affected Somalia. Sources published or made available between 2010 and 2026 were prioritized, while older seminal sources were retained only when they provided foundational frameworks or technical definitions. The review focuses on rural access inequities, referral barriers, facility readiness, workforce capacity, sociocultural determinants of care-seeking, and policy-practice priorities. The evidence indicates that low rates of skilled birth attendance, limited institutional delivery, inadequate basic and comprehensive emergency obstetric and newborn care coverage, weak referral systems, financial barriers, and shortages of skilled personnel continue to undermine timely care for obstetric and newborn emergencies. Strengthening emergency obstetric and newborn care in Somalia requires an integrated service-delivery and policy approach that expands rural coverage, improves referral coordination, invests in midwifery and emergency obstetric skills, stabilizes essential supplies and blood transfusion capacity, strengthens maternal and perinatal death surveillance, and aligns humanitarian and development programming. Addressing these priorities is essential for improving equitable maternal and newborn survival in conflict-affected and resource-limited settings.