Background: Somalia has registered 732 maternal mortality every 100,000 live birth; the uptake of maternal health care service is lowest in the world. The purpose of study is to understand social and economic factors that hinder or facilitate the uptake of maternal health care service during the pregnancy in Somalia.
Methods: Cross-sectional data was collected from 642 mothers of reproductive age in Mogadishu town through a community survey in November 2020. Descriptive data analysis and propensity score matching models were employed to measure association between the determinants of the uptake of required ANC, Skilled birth attendance and confounding factors. In addition, the impact of minimum ANC attendance on the uptake of mother health care services was evaluated
Results: The study indicated that ANC is at its lowest level, only 10% women reported attending 4-ANC, 23% didn’t attend any ANC, and 61% attending 1 to 3 ANC; moreover, skilled birth attendance is low rate at 30%, against 67% average in Africa; 78% of women are unable to make decision to visit health clinic or hospital autonomously, rather the decision is made by other people, 44% decision is made by the husband and only 30% jointly by the woman and her husband. Contrary to the data on attendance, about 70% of the surveyed women were aware of health benefits of attending ANC. The cost associated with accessing health service at 31%, distance to health centers, 12%, and perception (ANC is not needed), 23% were the major reasons of not delivering at health institutions.
Conclusions: Thus, the number of ANC visits has an incremental positive effect on the probability utilization of skilled birth attendance and delivery at health facility. Access related factors are the most hindering barriers for the poor utilization of health care service as evidently indicated by the negative correlation of distance from health center. Improving access to health education, interventions targeting improved income and women empowerment lead to better maternal health outcome.