Determinants of women’s Autonomy in Health Care Decision-Making in Somalia: Evidence from the 2020 nationwide survey

Background Women’s autonomy in health care decision making is a critical determinant of maternal and reproductive health outcomes in Somalia. This study examined the level of women’s autonomy in health care decision-making and its associated factors using nationally representative data. Methods A cross-sectional study was conducted using the 2020 Somalia Demographic and Health Survey. STATA17 was used for analysis. Descriptive statistics summarized sociodemographic characteristics and women’s autonomy. Bivariate associations were assessed using a chi-square test, and variables with p < 0.25 were entered into a multivariable multinomial logistic regression model. Results are presented as relative risk ratios (RRRs) with 95% confidence intervals; p < 0.05 indicates statistical significance. Results Older women were significantly more likely to make health-care decisions independently compared with adolescents, particularly those aged 45–49 years (RRR = 1.93; 95% CI: 1.42–2.62). Living in a city made it more likely that someone would make their own decisions. Women in the highest wealth quintile exhibited significantly greater autonomy than those in the lowest quintile (RRR = 2.68; 95% CI: 2.36–3.03). Maternal education exhibited a significant positive correlation, indicating that women with higher educational attainment are more inclined to make independent decisions. Conclusion Women’s autonomy in healthcare decision-making in Somalia remains limited and is influenced by age, education, wealth, residence, and access to health services. Enhancing women’s education, economic empowerment, and equitable access to healthcare, particularly for rural and nomadic populations, may improve autonomy and maternal health outcomes.