Determinants of women’s exposure to mass media and its influence on healthcare utilization in Somaliland: a multilevel analysis of SLDHS 2020 data

Background Mass media is a critical tool for disseminating health information. This study identifies factors associated with women’s media exposure and its link to healthcare utilization in Somaliland. Methods Using SLDHS 2020 data ( $$\:N=449$$ ), we applied multilevel binary logistic regression to account for individual and community-level variations., with results reported as adjusted odds ratios (AOR) and 95% confidence intervals (CI) ( p < 0.05). Results Significant disparities in media access exist based on wealth quintile and residential status. Multilevel modeling revealed that community-level factors account for approximately 16% of the variance in media exposure. Women in the highest wealth quintile and those in urban areas had significantly higher odds of exposure compared to nomadic and rural counterparts. Conclusion Media exposure in Somaliland is shaped by structural, socioeconomic, and community-level barriers rather than individual choice alone. Policymakers should move beyond reliance on traditional broadcasting and prioritize community-based interpersonal communication, mobile/SMS health messaging, and outreach through trusted local health workers to reach uneducated, low-literate, rural, and nomadic women.