Factors Shaping Delivery Location Preferences for Somali Women at Childbearing Age

Background Maternal mortality remains a significant public health issue in sub-Saharan Africa, particularly in Somalia. Despite global efforts, high maternal mortality rates persist due to limited access to skilled birth attendants and healthcare facilities. This study examines maternal healthcare accessibility in Somalia, focusing on childbirth locations among women of childbearing age, using data from the Somali Health and Demographic Survey 2020. Methods This cross-sectional study analyzed data from the SHDS 2020, involving 16,162 women aged 15–49. Univariate, bivariate and multivariate logistic regressions were conducted using STATA software to identify sociodemographic factors associated with facility-based delivery. Results The prevalence of facility-based delivery was 19.95%. Key factors significantly associated with facility-based delivery included education level, household wealth, husband's employment, and household size. Women with primary education (aOR = 3.04, 95%CI = 2.74–3.37, p < 0.001), secondary education (aOR = 6.79, 95%CI = 5.62–8.20,p < 0.001), and higher education (aOR = 16.57, 95%CI = 11.68–23.54,p < 0.001) were more likely to deliver at health facilities. Larger households (11 + members) also increased the likelihood (aOR = 1.44, 95%CI = 1.33–1.56,p < 0.001). However, increasing age reduced the odds of facility-based delivery: ages 25–34 (aOR = 0.87, 95% CI = 0.79–0.95,p = 0.003), 35–44 (aOR = 0.81, 95%CI = 0.72–0.91, p < 0.001), and 45+ (aOR = 0.48, 95%CI = 0.33–0.70,p < 0.001). Additionally, women who did not watch television were less likely to deliver at a health facility (aOR = 0.21, 95%CI = 0.19–0.23,p < 0.001). Conclusion Education, household wealth, husband's employment, and household size significantly influence facility-based delivery among Somali women. These findings highlight the need for targeted interventions to improve access to maternal healthcare services, especially for economically disadvantaged. Enhanced government funding for free maternal and newborn healthcare and local community involvement are crucial to reducing maternal and neonatal mortality and achieving sustainable development goals in Somalia.