Where and why mothers discontinue healthcare services: a qualitative study exploring the maternity continuum of care gaps in Somalia

Abstract Background Despite significant progress in expanding and improving maternal, newborn, and child health (MNCH) globally, gaps remain in low- and middle-income countries (LMICs), particularly in sub-Saharan African countries, including Somalia. Somalia is among the 15 countries that the WHO marked as very high alert countries for maternal, newborn, and under deaths. The maternity continuum of care (CoC) throughout pregnancy, childbirth, and the postnatal period is essential for the health and survival of mothers and their babies. This study aimed to explore the maternity continuum of care gaps in Somalia. Methods This qualitative study included 5 FGDs (44 childbearing mothers) purposively sampled from urban, rural, IDPs, agro, and nomadic pastoralists and 19 in-depth interviews (IDIs) from healthcare providers, policymakers, recently delivered and childbearing mothers, community leaders, and traditional birth attendants in 6 regions of Somalia in January 2024. We used thematic analysis to analyze the data. Results Five key themes and twelve subthemes emerged from the analysis: service availability, access to care, decision-making, quality of care, and traditional beliefs. The maternity continuum of care gaps varies across different community categories, such as urban areas, rural areas, IDPs, agro-pastoralists (beeraley-baadiye), and nomadic pastoralists (reer-guuraa), due to diverse reasons, including service availability, access to care (financial, distance, and transportation), socioeconomic disparities, infrastructure, climate-related, and security issues. Conclusion The maternity continuum of care gaps varies across different community categories, such as urban, rural, IDPs, agro-pastoralists (beeraley-baadiye), and nomadic pastoralists (reer-guuraa), due to a combination of diverse reasons, such as service availability; access to care, including financial, distance, and transportation; socioeconomic disparities; infrastructure; climate-related issues; and security issues. Key terms: Maternal health, continuum of care, cultural beliefs, home delivery, Somalia