Improving the uptake of contraception, Somalia

The 2020 Somali Health and Demographic Survey showed that maternal mortality as well as that of children younger than five years, is very high in the country, with 692 deaths per 100000 population and 71 deaths per 1000 population, respectively.1 Furthermore, malnutrition affects one fourth of the Somali population.1 The total fertility rate in Somalia remains elevated at 6.9 children per woman, compared to 4.15 in Africa and 2.30 worldwide. The health survey estimates that unintended and short-interval pregnancies are also common. These unfavourable indicators place Somalia among the worst countries globally in terms of sexual and reproductive health indicators, as well as in maternal and child health.These figures also reveal that despite the successful implementation of the millennium development goals between 2000 and 20152 and the sustainable development goals being halfway to the 2030 target year, very little improvement is observed in Somalia. The country is significantly laggingbehind in achieving these goals. What needs to be done? Addressing these critical challenges requires prioritizing the availability, accessibility and use of modern contraception. However, Somalia falls considerably short of attaining these objectives. The recently published findings of the 2020 Somali Health and Demographic Survey1 reveal a concerning situation. Only an estimated 7% of women of reproductive age use any form of contraception, and less than 1% use modern contraceptive methods such as pills, condoms and intrauterine devices. Additionally, unmet need for contraception is reported at 37%.2 Therefore, Somalia has one of the lowest rates of contraception uptake in the world. Significant determinants of contraception use and unmet need for contraception include age; education level; number of children; exposure to family planning messages through mass media; and region and location of residence. Given the connection between contraception and other maternal and child health outcomes, including maternal and child mortality, these findings indicate that Somalia is unlikely to see improvements in maternal and child health, including maternal and child mortality, in the coming years unless initiatives to increase uptake of modern contraception are taken.