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Background <p>High-risk fertility behaviour (HRFB), characterised by early or advanced maternal age at childbirth, short birth intervals, and high parity, remains a major public health concern because of its strong association with adverse maternal and neonatal outcomes. Somalia, a fragile and conflict-affected setting with persistently high fertility and maternal mortality rates, lacks comprehensive multilevel evidence on the determinants of HRFB. This study examined the socioeconomic and contextual factors associated with HRFB among women of reproductive age in Somalia.</p> Methods <p>A cross-sectional analysis was conducted using data from the 2020 Somalia Demographic and Health Survey (SDHS). The weighted sample included 12,796 women aged 15–49 years with a history of childbirth. HRFB was defined as the presence of at least one risk condition: maternal age &lt; 18 or &gt; 34 years at birth, birth interval &lt; 24 months, or birth order ≥ 3. Multilevel binary logistic regression models were fitted to identify individual-, household-, and community-level determinants, accounting for clustering at the community level. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.</p> Results <p><i>Overall</i>,<i> 70.5% of women experienced at least one high-risk fertility condition. Older maternal age was strongly protective against HRFB</i> ([AOR] = 0.33, 95 CI: 0.28–0.38, <i>p</i> &lt; 0.001). <i>while limited healthcare decision-making autonomy increased risk</i> (AOR = 1.18, 95% CI: 1.03–1.35, <i>p</i> &lt; 0.01). <i>Women in the middle wealth quintile and those with primary education had higher odds of HRFB compared with the poorest and uneducated groups</i> (AOR = 1.14, 95% CI: 1.01–1.30, <i>p</i> = 0.03) and (AOR = 1.16, 95% CI: 1.00–1.34, <i>p</i> &lt; 0.01) respectively. <i>Multiple births substantially increased the likelihood of HRFB</i>,<i> whereas health facility delivery reduced the odds.</i></p> Conclusion <p>HRFB is highly prevalent among women in Somalia and is shaped by intersecting individual, socioeconomic, and contextual factors. Interventions should prioritise delaying early childbearing, strengthening women’s autonomy in reproductive health decisions, expanding access to quality maternal and family planning services, and addressing marked regional inequalities. Targeted, context-specific strategies are essential to reduce fertility-related risks and improve maternal and child health outcomes in Somalia.</p>

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Socioeconomic and contextual determinants of high-risk fertility behavior among women in somalia: evidence from a multilevel analysis of nationwide survey

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月30日

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  • Abdirashid Muhumed Guled,
  • Abdulkadir Mohamed Nuh,
  • Mohamed Abdillahi Mohamed,
  • Abdisalam Hassan Muse,
  • Hamse Arab Ali,
  • Hamse Adam Abdi,
  • Mustafa Abdillahi Abdiqadir,
  • Osman Mohamed Osman,
  • Amani Yusuf yonis

摘要

Background

High-risk fertility behaviour (HRFB), characterised by early or advanced maternal age at childbirth, short birth intervals, and high parity, remains a major public health concern because of its strong association with adverse maternal and neonatal outcomes. Somalia, a fragile and conflict-affected setting with persistently high fertility and maternal mortality rates, lacks comprehensive multilevel evidence on the determinants of HRFB. This study examined the socioeconomic and contextual factors associated with HRFB among women of reproductive age in Somalia.

Methods

A cross-sectional analysis was conducted using data from the 2020 Somalia Demographic and Health Survey (SDHS). The weighted sample included 12,796 women aged 15–49 years with a history of childbirth. HRFB was defined as the presence of at least one risk condition: maternal age < 18 or > 34 years at birth, birth interval < 24 months, or birth order ≥ 3. Multilevel binary logistic regression models were fitted to identify individual-, household-, and community-level determinants, accounting for clustering at the community level. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported.

Results

Overall, 70.5% of women experienced at least one high-risk fertility condition. Older maternal age was strongly protective against HRFB ([AOR] = 0.33, 95 CI: 0.28–0.38, p < 0.001). while limited healthcare decision-making autonomy increased risk (AOR = 1.18, 95% CI: 1.03–1.35, p < 0.01). Women in the middle wealth quintile and those with primary education had higher odds of HRFB compared with the poorest and uneducated groups (AOR = 1.14, 95% CI: 1.01–1.30, p = 0.03) and (AOR = 1.16, 95% CI: 1.00–1.34, p < 0.01) respectively. Multiple births substantially increased the likelihood of HRFB, whereas health facility delivery reduced the odds.

Conclusion

HRFB is highly prevalent among women in Somalia and is shaped by intersecting individual, socioeconomic, and contextual factors. Interventions should prioritise delaying early childbearing, strengthening women’s autonomy in reproductive health decisions, expanding access to quality maternal and family planning services, and addressing marked regional inequalities. Targeted, context-specific strategies are essential to reduce fertility-related risks and improve maternal and child health outcomes in Somalia.