Determinants of institutional delivery service utilization among internally displaced vulnerable populations in Benadir region, Somalia: A community based cross-sectional study

Background: Every day, nearly 830 women succumb to preventable pregnancy and childbirth-related complications, with 99 % of maternal deaths occurring in developing nations. Maternal mortality is disproportionately higher among women in rural areas and impoverished communities, especially in Sub-Saharan Africa, where approximately 85 % of cases are concentrated. In Somalia, a country grappling with prolonged conflicts and a healthcare system in disarray, maternal mortality remains alarmingly high at 692 per 100,000 live births. Delivery institutions in the IDP camps are mainly operated by humanitarian agencies and offer their services free of charge. We aim to investigate the prevalence of institutional delivery and factors associated with it among internally displaced mothers in Benadir region. Methods: Community-based survey was conducted in ten Internally Displaced Persons (IDP) camps in the Benadir region of Somalia from September to October 2023. Questionnaires were administered to 410 women who had given birth in the last 6 months. Subsequent to data collection, a logistic regression analysis was performed to reveal associations between covariates of interest and the outcome variable. Results: The study observed a 25 % prevalence of institutional delivery, with key associations identified. Women who were married during the data collection period had more than twice the odds of opting for healthcare facility deliveries (AOR 2.283, CI: 1.272-4.097), while employed women demonstrated nearly double the odds (AOR 1.916, CI: 1.109-3.312). Those who experienced their first pregnancy before the age of 20 had 1.7 times higher odds of delivering at a health facility (AOR 1.741, CI: 1.088-2.785). ANC attendees displayed over thirteen times the odds of choosing health facilities for delivery (AOR 13.299, CI: 6.752-26.196), and women knowledgeable about danger signs exhibited four times higher odds (AOR: 4.483, CI: 2.381-8.438). On the other hand, home deliveries are driven by various factors such as financial constraints, distant facility locations, urgent labor situations, lack of transportation, facility closures, a preference for the comfort of home, and fear of surgical procedures at health facilities. Conclusion & recommendation: The study highlights a troublingly low prevalence of institutional delivery compared with the national target, underscoring challenges in promoting healthcare facility utilization for childbirth. To improve rates, interventions should address socio-economic factors, emphasize healthcare benefits, and enhance community awareness of danger signs and antenatal care importance. Tackling access barriers, including financial constraints and facility distance, is pivotal in reducing the preference for home deliveries.