Women's Autonomy in Health Care Decision-Making in Somalia: Evidence from a Multinomial Logistic Regression Analysis of the 2020 National Survey

Background Women’s autonomy in healthcare decision-making is a key determinant of maternal and reproductive health outcomes in Somalia. This study examined the level of women’s autonomy and its associated factors using nationally representative data. Methods A cross-sectional study was conducted using data from the 2020 Somalia Demographic and Health Survey, including 32,272 women aged 15–49 years. Data were analyzed using STATA version 17, accounting for sampling weights. Multinomial logistic regression was used, and results were reported as Relative Risk Ratios (RRRs) with 95% Confidence Intervals (CIs). Results Overall, 15.3% of women made healthcare decisions independently, 32.9% made decisions jointly, and 51.8% had decisions made by others. Older women aged 45–49 years were more likely to make independent decisions compared to those aged 15–19 (RRR = 1.93; 95% CI: 1.42–2.62). Urban residence was associated with higher autonomy (RRR = 1.17; 95% CI: 1.07–1.28). Women in the highest wealth quintile had a higher likelihood of independent decision-making compared to the lowest quintile (RRR = 2.68; 95% CI: 2.36–3.03). Higher maternal education was also significantly associated with increased autonomy. Conclusion Women’s autonomy in healthcare decision-making in Somalia remains limited and is associated with socio-demographic and economic factors. Interventions focusing on improving women’s education, economic empowerment, and access to healthcare services may enhance autonomy and improve health outcomes.