Complete continuum of maternal health care and Its determinants among women who gave birth in the past year in Mogadishu, Somalia

Abstract

Background Maternal mortality remains a critical global health challenge, particularly in fragile settings. The continuum of maternal healthcare—comprising antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC)—is essential for reducing preventable deaths. In Somalia, with a maternal mortality ratio of approximately 563 per 100,000 live births, evidence on completion of the continuum of care remains limited. Objective To assess the completion of the maternal healthcare continuum and its determinants among women who gave birth in the past year in Mogadishu, Somalia. Methods A community-based cross-sectional study was conducted among 422 women of reproductive age in Mogadishu including Internally displaced people (IDPs). Data were collected using structured interviewer-administered questionnaires. Completion of the continuum of care was defined as receipt of at least four antenatal care visits (ANC ≥ 4), facility delivery, and postnatal care within 48 h after delivery. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with completion. Results Overall, 18.2% of women completed the maternal health continuum. In the multivariable analysis, maternal education remained a strong predictor, with significantly lower odds among women with primary (AOR = 0.10; 95% CI: 0.02–0.43), secondary (AOR = 0.21; 95% CI: 0.05–0.86), and no formal education (AOR = 0.12; 95% CI: 0.02–0.56) compared to those with higher education. Husband's education was also significant, as women whose partners had no formal education (AOR = 0.14; 95% CI: 0.03–0.58) or primary education (AOR = 0.22; 95% CI: 0.05–0.95) had reduced odds of completion. Higher household income (≥300 USD) (AOR = 3.61; 95% CI: 1.28–10.14) and gravidity (4–7 pregnancies) (AOR = 5.08; 95% CI: 1.17–22.09) were positively associated with completion. Conclusion Although only 18.2% of women in Mogadishu completed the maternal healthcare continuum, substantial inequities persist. Socioeconomic status, maternal and partner education, and reproductive history significantly influence care completion. Strengthening maternal health programs through targeted education, economic support, and integrated service delivery is essential to improve equitable access and continuity of care in fragile settings.