# Problems with accessing healthcare and associated factors among reproductive-age women in Somaliland: a multilevel analysis of data from the 2020 SLDHS

## TL;DR

This study identifies barriers to healthcare access for women of reproductive age in Somaliland and highlights factors that contribute to these challenges.

## Contribution

The study provides a multilevel analysis of healthcare access barriers specific to reproductive-age women in Somaliland using recent survey data.

## Key findings

- Nearly 75% of reproductive-age women in Somaliland reported at least one barrier to healthcare access.
- Individual factors like age, education, and employment status of husbands were significantly associated with healthcare access problems.
- Region-specific and wealth-related factors at the community level also influenced healthcare access.

## Abstract

Access to healthcare, particularly for women of reproductive age, is critical for achieving Universal Health Coverage (UHC) and reducing maternal mortality. Somaliland faces significant challenges in healthcare access, but specific barriers for women of reproductive age remain understudied. This study aimed to evaluate healthcare access problems faced by this population in Somaliland.

The study utilized secondary data sourced from the Somaliland Demographic and Health Survey. The outcome of the study was barriers to healthcare access. A two-level mixed-effects logistic regression approach, along with 95% confidence intervals (CIs), was employed to determine factors related to healthcare issues among women of reproductive age. Statistical significance was declared for p-values below 0.05.

Nearly 75% of women reported at least one barrier to healthcare access. The multilevel analysis revealed that being in the age group 25-29 (AOR = 1.58; 95% CI; 1.00–2.48), 35–39 (AOR = 1.86; 95% CI; 1.12–3.07), 40–44 (AOR = 1.84; 95% CI; 1.03–3.29), a secondary education level (AOR: 1.70; 95% CI; 1.13–2.560), higher education (AOR = 3.72; 95% CI; 1.96–7.05), women with employed husbands (AOR = 0.69; 95% CI: 0.57–0.84) non-users or those who intend to use later (AOR = 0.51: 95% CI; 0.30–0.85), and having five and more children (AOR = 0.78 95% CI; 0.63–0.96) were significantly associated with healthcare problems at an individual level. On the contrary, regions Woqooyi-galbeed (AOR = 0.50 95% CI; 0.35–0.72), Togdheer (AOR = 0.41; 95% CI; 0.28–0.60), Sool (AOR = 0.37; 95% CI; 0.25–0.54), and Sanaag (AOR = 0.54; 95% CI; 0.38–0.76), women in the middle wealth status (AOR = 2.26; 95% CI; 1.55–3.32), fourth wealth index (AOR = 3.14; 95% CI; 2.17–4.56), and the highest wealth status (AOR = 4.23; 95% CI; 2.88–6.22) were the community-level determinants in access to healthcare.

A substantial proportion of women of reproductive age in Somaliland experience significant barriers to healthcare access. Addressing these challenges requires targeted interventions focusing on improving the socioeconomic status, infrastructure, accessible and affordable healthcare services, and region-specific strategies.