From Fragmented Projects to an Integrated, Conflict-Sensitive Reproductive Health System for Women in Somalia

Women and girls in Somalia face reproductive health risks that are intensified by protracted conflict, displacement, climate shocks, poverty and, since 2025, sharp contractions in humanitarian funding. Reproductive healthcare in emergencies is still often reduced to maternal delivery services, although women's needs extend from adolescence through pregnancy, family planning, care after violence, female genital mutilation (FGM)-related care and later reproductive life. This commentary examines the main barriers to reproductive healthcare and proposes health system and policy actions to make care fairer and more continuous for women in Somalia. It is a narrative, policy-oriented synthesis of peer-reviewed studies, national survey analyses and United Nations and government documents, prioritizing evidence from 2020 to 2026. The evidence suggests that access gaps persist not only because services are scarce, but because they are short-term, donor-dependent, designed for settled populations, weakly connected across levels of care, and poorly measured for the women least likely to be reached: displaced, rural, nomadic and adolescent women among them. We argue that Somalia needs one nationally defined, conflict-sensitive reproductive health system, anchored in primary healthcare, protected from funding shocks and accountable to women. Seven priority actions are proposed, with lead actors and indicators. Respectful and confidential care, informed choice and the meaningful participation of women must guide implementation, because reproductive health is central to women's dignity, protection and participation in Somali society.