Document
Metadata
Authors
Saad Ahmed Abdiwali, Teshome Gensa Geta, Olubukola A Adesina, Gedefaw Abeje Fekadu
Title
Effect of antenatal care attendance on maternal and birth outcomes in Somaliland: a cohort study
Journal
BMJ Open
Year of Publication
2026
Abstract
ObjectiveAntenatal care (ANC) plays a critical role in improving maternal and neonatal health outcomes. However, incomplete ANC attendance in Somaliland is associated with adverse maternal and birth outcomes. Barriers to ANC attendance may increase the risk of pregnancy-related complications, including maternal morbidity, mortality and poor neonatal health outcomes. Understanding the effect of ANC attendance on maternal and birth outcomes is crucial for informing policies and interventions aimed at reducing these risks. Hence, this study aimed to assess the effect of ANC attendance on maternal and birth outcomes in Somaliland.DesignA prospective cohort study was conducted among 1205 pregnant women enrolled by systematic sampling method.Setting and participantsThe study was conducted in the Republic of Somaliland, which is situated in the Horn of Africa. Baseline data were collected at recruitment, and participants were followed up to delivery for the collection of outcome variables. The number of ANCs was considered to be a dichotomous independent variable; incomplete attendance (≤ 3 visits) and complete attendance (≥4 visits). The risk of pregnancy outcome among those with incomplete ANC was assessed using multi-variable logistic regression.VariablesThe outcome variables of the study were the maternal and birth outcomes. The independent variables included socio-demographic characteristics, such as age, residence, educational status, occupation, family size, wealth index and marital status, and reproductive factors, such as parity, gestational age at first ANC visit, current pregnancy desirability and previous pregnancy history.ResultsOut of the total participants, 43.3% of women had complete attendance. The incidence of postpartum haemorrhage was 10.0% (95% CI 8.6 to 12.3); antepartum haemorrhage, 3.6% (95% CI 2.6 to 4.7); caesarean section, 14.8% (95% CI 12.9 to 16.8); preterm delivery, 13.7% (95% CI 11.7 to 15.4); low birth weight, 25.8% (95% CI 23.4 to 28.1); and stillbirth, 3.2% (95% CI 2.3 to 4.2). Complete attendance to ANC significantly reduced the risk of antepartum haemorrhage, caesarean section, preterm delivery and admission to the neonatal intensive care unit and stillbirth.ConclusionNearly more than half of women in Somaliland had less than four ANC visits. The incidence of maternal and birth complications is higher among pregnant women who attended <4 ANC visits than among those who attended ≥4 ANC visits. Promoting access and quality ANC services would help in reducing maternal and neonatal complications in the country. © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group.. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/.
DOI
10.1136/bmjopen-2025-104470
Category
Medicine and Health Sciences