Maternal and Newborn Health in Somalia: A Narrative Review of Health System Challenges and Public Health Priorities

Abstract: Maternal and newborn health in Somalia remains a critical public health challenge within a fragile and conflict-affected health system. This review aims to examine the magnitude, determinants, and health system challenges affecting maternal and neonatal outcomes in Somalia, and to identify priority public health actions and research gaps. A narrative review methodology was employed, drawing on peer-reviewed literature from PubMed and Google Scholar, alongside grey literature including national surveys (SHDS 2020), policy documents, and reports from international organizations. Findings show that maternal mortality remains high (approximately 563 per 100,000 live births), with neonatal mortality at 36 per 1000 live births, and critically low service coverage, including only 32% skilled birth attendance and limited antenatal and postnatal care utilization. Key determinants include limited women’s autonomy, financial constraints, low awareness of services, and strong sociocultural influences. Health system challenges include weak implementation of the Essential Package of Health Services (EPHS), shortages of skilled health workers, inadequate referral systems, and weak health information systems. Although progress has been observed through ongoing RMNCAH interventions and partner-supported programs, significant gaps remain in service quality, equity, and accessibility. Priority actions include strengthening antenatal care, scaling up emergency obstetric and newborn care, improving referral systems, enhancing community engagement, and strengthening health information systems. Future research should focus on evaluating intervention effectiveness, regional disparities, and quality of care, to support evidence-based policy and progress toward Sustainable Development Goals. Keywords: fragile states, health systems strengthening, maternal mortality, neonatal mortality, RMNCAH, Somalia