Perinatal mental health among women in Somalia a silent emergency demanding urgent health system action.

Perinatal mental health among women in Somalia represents a critical yet neglected public health emergency shaped by three decades of protracted conflict, gender-based violence, internal displacement, and one of the world's weakest health systems. With a maternal mortality ratio of 621 per 100,000 live births and fewer than 21% of births occurring in health facilities, depression and anxiety affect approximately one in four perinatal women-yet remain entirely absent from routine maternal care. This Perspective examines the structural, policy, and systemic barriers that perpetuate this neglect and proposes evidence-informed pathways for urgent action: integration of screening and brief interventions into primary healthcare, task-shifting to community health workers, culturally adapted psychosocial interventions, and strengthened governance frameworks. We emphasize that addressing perinatal mental health is foundational to Somalia's health system recovery, critical for reducing maternal and neonatal mortality, and essential for safeguarding the development and wellbeing of a generation of Somali children.