Somalia Free Maternity Programme Shows Promise Despite Data Limitations

Somalia's maternal health crisis runs deep. Women die in childbirth at rates among the world's highest, blocked by poverty, distance, conflict, and the simple absence of skilled hands when complications arrive. Yardimeli Specialist Hospital in Mogadishu decided to try something direct: remove the money barrier entirely. Between January 2023 and January 2025, the hospital opened its maternity ward to economically disadvantaged women at no cost, and sent trained midwives into their homes before and after birth to watch for trouble.

Researchers looked back at what happened to 184 of these women—17 others had incomplete records and were set aside. The numbers tell a cautious story. Of 184 pregnancies, 170 ended in live birth. Seven ended in miscarriage, seven in stillbirth. One woman died. Among the 172 infants born alive, four did not survive the neonatal period. Most deliveries—165 out of 177—happened inside the hospital walls. Of those hospital births, seven in ten were vaginal deliveries, one in four were cesarean sections. When doctors recorded the five-minute APGAR score—the standard measure of a newborn's immediate health—95 percent of infants scored seven or higher, the threshold for normal.

These outcomes sit in an unusual position. They look better than what previous studies have reported from Somalia and other fragile health systems. The maternal death rate of 0.5 percent is substantially lower than the severe complication rates documented in earlier Somali research. The neonatal death rate of 2.3 percent trails the figures published from Mogadishu hospitals in prior years. Yet the researchers are careful—almost cautious to the point of hedging—about what this means. They have no comparison group. They cannot say whether the free care itself, the home visits, the continuity of attention, or simply the fact that these women were economically disadvantaged but not already in crisis made the difference. Seventeen women vanished from the records. Some variables, like HIV screening results and APGAR scores, were missing for portions of the cohort. The follow-up period after birth was not uniform across all infants.

What the programme actually did was straightforward. Women received free antenatal visits, ultrasounds, lab work, delivery care, and postnatal follow-up. Midwives visited homes during pregnancy and the early weeks after birth, checking on mother and baby, reinforcing health education, watching for warning signs, and calling the hospital when something looked wrong. The visits were not scripted by research protocol—they followed clinical judgment and individual need. Documentation of these home visits existed for 183 of the 201 women originally enrolled.

Somalia's health system operates under crushing constraints. Decades of conflict have fractured infrastructure. Skilled birth attendants are scarce. Referral systems are weak. Women delay seeking care because they cannot afford it, because the nearest facility is far away, because they do not know a complication is developing. The result is one of the world's highest maternal mortality ratios. Previous research showed that most Somali women do not complete the full sequence of antenatal care, delivery with a skilled attendant, and postnatal follow-up. Financial hardship, distance, and gaps in service continuity all play a role. Free maternity policies have worked in other countries—Kenya's removal of user fees increased facility deliveries—but whether they actually save lives remains uncertain, especially in settings where quality and continuity remain fragile.

This study cannot answer that question definitively. The researchers are explicit about this. They describe what they observed in one hospital's routine programme, not what the programme caused. To know whether integrated free care with home-based midwifery actually improves outcomes, Somalia would need a prospective study with a comparison group, standardized follow-up for all participants, complete data collection, and careful measurement of outcomes over time. The present work is a foundation—evidence that such a model can be implemented in a real-world setting and that the women who received care had outcomes worth documenting. What comes next is the harder work of proving whether this approach, or components of it, actually changes the trajectory of maternal and neonatal health in a fragile system.