Factors Associated With Modern Contraceptive Use and Unmet Need for Family Planning Among Mothers in Borama, Somaliland: Community-Based Cross-Sectional Study.

BACKGROUND

National estimates in Somaliland report a modern contraceptive prevalence rate (mCPR) of 1%-3%, yet localized urban data are scarce. This study assessed mCPR, unmet need for family planning (FP), and sociodemographic determinants among mothers in Borama, Somaliland.

METHODS

A community-based cross-sectional study was conducted among 426 mothers with children under five using multistage cluster sampling (October-November 2025). Data were collected via structured interviews. Multivariate logistic regression with robust standard errors was performed to identify factors associated with contraceptive use, reported as adjusted odds ratios (AORs) with 95% confidence intervals (CIs).

RESULTS

The mCPR was 18.5%, and unmet need was 17.4%, resulting in a total demand of 35.9%. Injectables (42%) and oral pills (30%) were the most common methods. The strongest predictor of use was postpartum counseling by health workers (AOR = 18.62, p < 0.001) and family members (AOR = 6.30, p < 0.001). University education (AOR = 2.80, p = 0.034) and business ownership (AOR = 2.68, p = 0.005) also independently predicted use. Model diagnostics, including Hosmer-Lemeshow and variance inflation factor (VIF), confirmed appropriate fit and absence of significant multicollinearity.

CONCLUSIONS

Contraceptive use in Borama exceeds national estimates but remains low by regional standards. Postpartum counseling serves as a critical gateway to uptake. Policy considerations may include strengthening immediate postpartum counseling and community-based FP advocacy targeting husbands and mothers-in-law to address sociocultural barriers.