Effects of pregnancy intention at conception on the continuity of care in maternal healthcare services use in Somalia

Unintended pregnancies present a substantial challenge to the utilization and continuity of maternal healthcare services, particularly in low-resource settings. Continuity of care (CoC) refers to consistent access to healthcare services throughout the pregnancy period. This study examines the effects of pregnancy intention at conception on the utilization of CoC in Somalia. Cross-sectional survey design. Data of 7,079 women were extracted from the 2020 Somali Health and Demographic Survey and analysed in this study. Multilevel multinomial logistic regression model was used to assess the effects of pregnancy intention at conception on CoC completion. Approximately 38% of live births in Somalia were unintended at conception. Only 2.4% (95% CI: 1.9-3.1) of mothers achieved full CoC, with higher rates observed among those with intended pregnancies (3.0%, 95% CI: 2.3-3.9) compared to those with mistimed (1.6%) or unintended pregnancies (1.1%, 95% CI: 0.4-3.2). Mothers having mistimed (aRRR, 0.59, 95% CI, 0.37-0.95) and unintended (aRRR, 0.28, 95% CI, 0.10-0.79) pregnancies had significantly lower likelihoods of achieving moderate and higher levels of CoC compared to those having intended pregnancies after adjusting for socio-demographic factors. Unintended pregnancies are associated with lower level of CoC in Somalia. Strengthening family planning, promoting contraceptive use, enhancing sexual education, and raising awareness about maternal healthcare are key to reducing unintended pregnancies and improving maternal and child health outcomes.