Prevalence of any contraceptive use among women of reproductive age in Somaliland: Insights from SLDH2020: A regression analysis

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Original Article Background: Contraceptive use in Somaliland is exceptionally low. This study investigated the prevalence and determinants of any contraceptive use among women of reproductive age (15-49 years) to inform family planning strategies. Methods: We analyzed data from 8,681 women using the 2020 Somaliland Health and Demographic Survey (SLDH2020). A cross-sectional design and multivariate logistic regression were employed to identify factors associated with current use of any contraceptive method (modern or traditional). Results: The overall prevalence of any contraceptive use among women of reproductive age in Somaliland was extremely low at 3.0%. Multivariate logistic regression revealed complex associations. Women aged 46+ years had significantly lower odds of use than those aged 15-25 (AOR=0.03, 95% CI: 0.011-0.049, p=0.002). Divorced women were substantially less likely to use contraception than married women (AOR=0.034, 95% CI: 0.018-0.05, p<0.001). Counterintuitively, women with secondary education had significantly lower odds of use than those without education (AOR=0.319, 95% CI: 0.192-0.53, p<0.001). Similarly, women from middle-income (AOR=0.395, 95% CI: 0.214-0.732, p=0.003) and rich households (AOR=0.128, 95% CI: 0.082-0.201, p<0.001) had lower odds of use compared to those from low-income families. Urban residence (AOR=1.668, 95% CI: 1.266-2.198, p<0.001) and residing in regions such as Marodijeh, Togdheer, Sool, and Sanaag (compared to Awdal) were associated with significantly higher odds of contraceptive use (p<0.001). Conclusion: Contraceptive uptake in Somaliland is alarmingly low and influenced by complex socio-demographic and geographic factors. Unexpected findings regarding education and wealth highlight the need for context-specific interventions addressing regional disparities and the unique drivers of contraceptive behavior across different groups to improve reproductive health.