Fear Over Facts: Barriers to Timely Antenatal Ultrasound in Somalia-A Case-Based Multidisciplinary Commentary

Delayed utilization of antenatal ultrasound in low-resource settings can reduce opportunities for timely recognition of fetal structural anomalies, counseling, referral, and delivery planning. This case-based multidisciplinary commentary uses an illustrative clinical encounter from Somalia to examine how safety misconceptions may interact with health literacy, socioeconomic constraints, geographic barriers, workforce shortages, imaging limitations, and weak referral pathways. A primigravida presented for her first antenatal visit at 38 weeks of gestation; ultrasound demonstrated open spina bifida and marked hydrocephalus. She reported avoiding earlier ultrasound because a family member had advised that hospital equipment could harm the fetus. The case is not presented as evidence of prevalence or causality, but as a clinical anchor for a narrative discussion of available Somalia-specific data and relevant East African evidence. The 2020 Somali Health and Demographic Survey documents low antenatal-care coverage, while reliable national estimates of obstetric-ultrasound coverage and the density of specialist sonographers or radiologists remain unavailable. Potential responses include culturally sensitive counseling, community communication, workforce development, expanded and affordable ultrasound access, stronger referral pathways, and targeted research and surveillance. Evidence from rural Uganda suggests that community messaging linked to ultrasound availability can increase antenatal-care attendance, while implementation work supports focused obstetric-ultrasound training for nurses and midwives in resource-limited settings. Because this commentary is based on one illustrative case and a narrative, non-systematic selection of literature, its observations cannot be generalized to the wider Somali population. Future research should quantify the relative contribution of sociocultural and health-system barriers and evaluate context-appropriate interventions in Somalia.