Barriers and facilitators to maternal, newborn, and child health service utilization among internally displaced populations in Somalia

Abstract

Background: Internally displaced populations (IDPs) in Somalia face a disproportionate burden of poor maternal, newborn, and child health (MNCH) outcomes due to conflict, recurrent displacement, poverty, and weak health systems. Evidence on the barriers and facilitators influencing MNCH service utilization in these settings remains fragmented. Objective: To synthesize the available evidence on barriers and facilitators affecting utilization of MNCH services among IDPs in Somalia, with a focus on antenatal care, skilled delivery, postnatal care, immunization, and care-seeking for childhood illnesses. Methods: This narrative review examined published literature, policy documents, and humanitarian reports on MNCH service utilization in Somalia and comparable fragile settings. The review focused primarily on sources published between 2015 and 2026, while older sources were retained only when they provided essential conceptual, contextual, or policy information. The review explored both demand-side factors, including socioeconomic hardship, gender norms, and decision-making autonomy, and supply-side factors, including distance, service quality, insecurity, and health system capacity. Results: The study found that MNCH service utilization among Somali IDPs is constrained by multiple, overlapping barriers. Major barriers include poverty and transport costs, geographic inaccessibility, insecurity, low female autonomy, cultural preferences, shortages of female and skilled health workers, weak referral systems, stock-outs, and limited service readiness. At the same time, important facilitators were identified, including community health workers, women's groups, mobile and outreach services, supportive NGO and government interventions, health system strengthening, and policy frameworks that increasingly recognize IDPs as a priority population. These factors influence service use across the continuum of care and are strongly interrelated. Conclusion: Improving MNCH service utilization among Somali IDPs requires integrated, equity-focused strategies that combine community engagement, gender-sensitive care, strengthened frontline services, functional referral systems, and better coordination between humanitarian and government actors.