Bridging the Information Gap: A Spatial and Multilevel Analysis of Exposure to Family Planning Messages Among Women in Somaliland (SLHDS 2020).

BACKGROUND

Access to family planning (FP) information is vital for reproductive autonomy and the Sustainable Development Goals. In Somaliland, modern contraceptive uptake remains critically low. While sociodemographic barriers are known, geospatial dimensions of information accessibility remain unexplored. This study investigates individual, community, and spatial determinants of women's exposure to FP messages.

METHODS

We analyzed data from the 2020 Somaliland Health and Demographic Survey among women aged 15-49. We employed multilevel mixed-effects logistic regression to assess predictors of media exposure. Additionally, spatial analysis techniques including Global Moran's I and Getis-Ord Gi* statistics were utilized to identify geographic clusters ("hotspots" and "cold spots") of exposure.

RESULTS

Only 25.28% of women reported exposure to FP messages, primarily via TV and radio; mobile dissemination was underutilized (11%). Multilevel analysis indicated that higher education (adjusted odds ratios [AOR] = 6.48), wealth, and internet usage significantly increased exposure odds. Conversely, nomadic populations (AOR = 0.38) and rural residents faced severe exclusion. Spatial analysis revealed a sharp East-West divide: significant "hotspots" clustered in western regions (Awdal, Marodijeh), while significant "cold spots" were identified in the eastern region of Sool.

CONCLUSIONS

A profound "digital and developmental divide" characterizes reproductive health communication in Somaliland. Current strategies benefit urban, educated women in the west, leaving nomadic populations in an information vacuum. Policy must shift to spatially targeted interventions, utilizing community outreach in identified "cold spots" and voice-based mobile technology to reach uneducated and nomadic women.