Utilization and Determinants of Antenatal Care Skilled Birth Attendance and Institutional Birth Delivery among Women in Rural Galmudug Somalia

Abstract Background In rural Somalia, many preventable maternal and newborn deaths occur because of issues such as limited healthcare facilities, cultural norms, and socioeconomic disparities. These challenges hinder the utilization of services such as antenatal care (ANC), skilled birth attendance (SBA), and institutional birth delivery (IBD). This study assesses the utilization of facility-based ANC, SBAs, and institutional birth delivery in seven rural villages in Galmudug State, Somalia, and identifies the factors associated with using these services. Methods As part of the EQUAL Research Programme Consortium, this cross-sectional study was conducted in 2023 in seven rural villages in Galmudug State, Somalia. The study surveyed 351 women aged 15–49 years who had self-reported having been born in the past twelve months. Data on socioeconomic and demographic characteristics, ANC, and location and birth attendants at birth were collected. In addition to descriptive analyses, multivariate logistic regression analyses were performed to identify factors associated with at least one or at least four facility-based ANC visits, SBAs, and IBDs. Results Approximately 60.9% had been married for less than 18 years. The mean number of total pregnancies was 5.9. Approximately 52.4% of women received at least one facility-based ANC visit, and 11.7% received more than four facility-based ANC visits. The SBA rate was 33.1%, and the IBD rate was 29.1%. Receiving at least one ANC visit, the number of total pregnancies, and awareness of family planning were significantly associated with both SBAs and IBD. Age at first marriage and travel time to health facilities were positively associated with institutional birth delivery. Decision-making on women’s health and awareness of family planning were also associated with receiving at least one ANC visit. Conclusion Rates of receiving facility-based services for pregnancy and childbirth remain critically low, as a large proportion of women continue to deliver at home. These findings underscore the urgent need for targeted interventions to increase access to and demand for quality facility-based MNH services and, in parallel, to invest in community-based services to fill the healthcare gap in the rural areas of Somalia.