Exploring the Determinants of High-risk Fertility Behavior among Child bearing Women in Somaliland: Insights from Somaliland Demographic and Health Survey, 2020

Purpose The purpose of this study was to investigate the determinants of high-risk fertility behaviors in Somaliland using data from the nationally representative Somaliland Demographic and Health Survey (SLHDS). This was done in accordance with Sustainable Development Goal (SDG) 3, specifically Indicator 3:1 which aims to reduce the maternal mortality ratio to less than 70 per 100,000 live births. Patients and Methods: The study utilized the SLHDS data, which provided information on a wide range of health and demographic indicators. The data were collected through self-reported surveys conducted in both urban and rural areas. Descriptive statistics, including mean, frequency, and percentage, were computed, and bivariate and multivariable binary logistic regression analyses were performed to assess the associated factors of high-risk fertility behaviors. Results The analysis revealed significant associations between high-risk fertility behaviors and various individual-level and community-level variables. Individual-level factors included maternal age group, maternal and husband education levels, contraceptive use, and child-related variables. Community-level factors encompassed residence, region, household size, mass media exposure, household wealth status, toilet facility, water source, and access to healthcare services. However, the study acknowledged the presence of social desirability and recall biases due to the self-reported nature of the survey. Some important variables had to be removed from the analysis due to data incompleteness and inappropriateness. Conclusion This study sheds light on the determinants of high-risk fertility behaviors in Somaliland, providing valuable insights for policymakers and healthcare professionals. The findings underscore the need for targeted interventions and reproductive health programs that address individual-level and community-level factors. Future research should employ rigorous data collection methods to minimize biases and explore additional factors that may influence high-risk fertility behaviors in the context of Somaliland.