Assessing the barriers to maternal, newborn and child health service utilization in internally displaced people (IDPs): a community-based cross-sectional study in Banadir, Somalia

BACKGROUND: Maternal, newborn, and child health (MNCH) services are critical for reducing maternal and child mortality, particularly in conflict-affected regions. In Somalia's Banadir region, ongoing displacement and fragile health infrastructure limit access to these essential services. This study examines the barriers to MNCH service utilization among internally displaced persons (IDPs) in Banadir. METHODS: A community-based cross-sectional study was conducted among 548 women of reproductive age (15-49 years) residing in IDP settlements. A multistage random sampling technique was used to select participants. Data were collected through structured interviewer-administered questionnaires, assessing perceived financial barriers and distance to health facilities. Data were analyzed using SPSS version 26. Logistic regression was performed to determine factors influencing MNCH service utilization, with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported. RESULTS: Significant predictors of MNCH service utilization included maternal education, immunization status, and age. Women with formal education were more likely to access antenatal care (ANC) (AOR = 2.61, 95% CI: 1.02-6.65, p = 0.044), skilled birth attendance (SBA) (AOR = 3.46, 95% CI: 1.76-6.80, p < 0.001), and postnatal care (PNC) (AOR = 2.65, 95% CI: 1.34-5.23, p = 0.005). Immunized women (those reporting having received immunizations) had significantly higher odds of using ANC (AOR = 13.40, 95% CI: 8.09-22.3, p < 0.001), SBA (AOR = 3.98, 95% CI: 2.07-7.63, p < 0.001), and PNC (AOR = 3.22, 95% CI: 1.97-5.24, p < 0.001). Limited healthcare access, financial constraints, and distance to facilities remained major barriers. CONCLUSION: Barriers to MNCH service utilization in IDP settings are multi-faceted, with education, immunization, and socio-economic constraints playing key roles. Strengthening community-based interventions, integrating MNCH services with immunization programs, and addressing structural barriers could enhance maternal and child health outcomes in Banadir.