Maternal Mortality in Somalia: A Narrative Review of Burden, and Health System Challenges

Maternal mortality remains a major public health challenge in Somalia and is among the highest globally despite recent progress. This narrative review aimed to synthesize evidence on the burden of maternal mortality and the health system challenges contributing to its persistence. A literature search was conducted using PubMed, Google Scholar, and relevant grey literature, including national surveys, policy documents, and reports from international organizations. The review found that maternal mortality in Somalia remains alarmingly high, accompanied by low utilization of antenatal care, skilled birth attendance, facility-based delivery, and postnatal care services. Financial constraints, geographic inequalities, insecurity, and socioeconomic disparities continue to limit access to maternal healthcare, particularly among rural and nomadic populations. Key health system challenges include inadequate healthcare financing, weak infrastructure, shortages of skilled health workers, limited implementation of the Essential Package of Health Services, and dependence on donor-supported services. Direct obstetric complications, including postpartum hemorrhage, hypertensive disorders of pregnancy, sepsis, obstructed labor, and unsafe abortion, remain major contributors to maternal deaths. Maternal mortality in Somalia is driven by a combination of limited maternal healthcare utilization and persistent health system weaknesses. Strengthening primary healthcare, expanding access to skilled birth attendance and emergency obstetric care, improving referral systems, and addressing socioeconomic barriers are essential to reducing preventable maternal deaths and improving maternal health outcomes.