International journal of women's health · 2026
Antenatal Care Utilization, Maternal Satisfaction, and Access Barriers in Mogadishu, Somalia: A Cross-Sectional Study.
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Hassan Shafie Abdulkadir, Nor Muniro Hassan, Hirsi Fadumo Abdullahi, Sabrie Hamdi Hussein, Abdullahi Amina Mohamed, Hassan Najma Mohamud, Hassan Ahmed Nor Osman
Аннотация
BACKGROUND: Antenatal care (ANC) is critical for reducing maternal and neonatal mortality but remains severely compromised in fragile, conflict-affected settings. This study assessed ANC utilization, maternal satisfaction, and access barriers among pregnant women in Mogadishu, Somalia, a setting marked by protracted conflict and among the world's highest maternal mortality ratios.
METHODS: A facility-based cross-sectional study using consecutive convenience sampling was conducted between March and May and 2026 at four Maternal and Child Health (MCH) centers in the Hodan and Karaan districts of Mogadishu. Structured, face-to-face interviews were administered to 445 postpartum women, capturing sociodemographic characteristics, ANC attendance, satisfaction, and barriers. Data were analyzed using descriptive statistics, chi-square tests, Pearson's correlation, and multivariable logistic regression (p < 0.05).
RESULTS: Among 445 participants (median age 31 years; 80.0% urban), 60.0% initiated ANC by 9 weeks, yet only 6.5% completed the recommended four visits (39.0% attended two). Overall satisfaction was low (36.0%), with marked dissatisfaction regarding interpersonal communication (64.0%), provider competence (60.0%), and waiting times (57.0%). Multivariable analysis identified maternal education and parity as independent predictors of ANC completion, while education was the only independent predictor of satisfaction. Commonly reported barriers included favoritism (n=191), irregular facility hours (n=191), lack of privacy (n=189), restricted movement due to insecurity (n=145), and disrupted medical supplies (n=96).
CONCLUSION: Despite promising early ANC initiation, continuous engagement in Mogadishu is associated with profound maternal dissatisfaction, systemic inequities, and a challenging security environment; given the cross-sectional, convenience-sample design, these associations should be interpreted cautiously. Interventions extending beyond infrastructure, including strengthened respectful maternity care, stricter facility governance, and community-based midwifery, may help sustain ANC engagement in this fragile setting.
METHODS: A facility-based cross-sectional study using consecutive convenience sampling was conducted between March and May and 2026 at four Maternal and Child Health (MCH) centers in the Hodan and Karaan districts of Mogadishu. Structured, face-to-face interviews were administered to 445 postpartum women, capturing sociodemographic characteristics, ANC attendance, satisfaction, and barriers. Data were analyzed using descriptive statistics, chi-square tests, Pearson's correlation, and multivariable logistic regression (p < 0.05).
RESULTS: Among 445 participants (median age 31 years; 80.0% urban), 60.0% initiated ANC by 9 weeks, yet only 6.5% completed the recommended four visits (39.0% attended two). Overall satisfaction was low (36.0%), with marked dissatisfaction regarding interpersonal communication (64.0%), provider competence (60.0%), and waiting times (57.0%). Multivariable analysis identified maternal education and parity as independent predictors of ANC completion, while education was the only independent predictor of satisfaction. Commonly reported barriers included favoritism (n=191), irregular facility hours (n=191), lack of privacy (n=189), restricted movement due to insecurity (n=145), and disrupted medical supplies (n=96).
CONCLUSION: Despite promising early ANC initiation, continuous engagement in Mogadishu is associated with profound maternal dissatisfaction, systemic inequities, and a challenging security environment; given the cross-sectional, convenience-sample design, these associations should be interpreted cautiously. Interventions extending beyond infrastructure, including strengthened respectful maternity care, stricter facility governance, and community-based midwifery, may help sustain ANC engagement in this fragile setting.