Knowledge and Attitudes Toward Family Planning Among Married Women Living in a Fragile Conflict-Affected Setting: Insights From Mogadishu

Background: Family planning is a crucial aspect of reproductive health that allows individuals to determine the number and timing of their children. The main reasons include the very low use of contraceptives (approximately 7% among married women aged 15–49, with only 1–2% using modern methods) and limited access to family planning services. Unintended pregnancies are a major contributor to maternal mortality, resulting from delayed or inadequate antenatal care, unsafe abortions, high-parity births, and short birth intervals. In Somalia, the gap between high levels of awareness and low rates of utilization of family planning, as well as the uncertainties regarding attitudinal and sociocultural determinants, is particularly noteworthy. Somali society follows strict norms based on religious beliefs and cultural values, which influence family decision-making and often limit women’s ability to plan their fertility or use family planning methods. Additionally, due to health policies such as the illegality of elective pregnancy termination, the country’s high fertility rate poses a serious public health concern. Studies have shown that the use of family planning methods remains low across East African countries, including Somalia. Understanding women’s attitudes toward family planning is essential to addressing this issue. This study aimed to examine the attitudes of married women in Mogadishu toward family planning and to identify the sociodemographic and obstetric factors associated with contraceptive use. Methods: This descriptive cross-sectional study was conducted among 286 married women aged 18–49 years who attended gynecological outpatient clinics in Mogadishu, Somalia. Data were collected through structured face-to-face interviews using a validated Family Planning Attitude Scale (FPAS). Data were analyzed using means, standard deviations, medians, frequencies, and percentages using the Statistical Package for the Social Sciences (SPSS) version 21.0. Results: The mean age of participants was 28.7 ± 5.57 years. Although 30.8% of women were aware of family planning methods, 82.2% did not use any form of contraception. Oral contraceptive pills were the most widely recognized method (14.3%), while implants were the most commonly used (4.5%). Women with no formal education had significantly more traditional views toward childbirth (p < 0.05). Conclusions: The findings indicated low contraceptive utilization despite high awareness, with cultural and religious beliefs strongly influencing attitudes. Active participation in decision-making and increased knowledge of family planning were significantly associated with enhanced contraceptive use. These results highlight the need for targeted educational programs and policies that promote reproductive autonomy to improve family planning adoption in Mogadishu, Somalia. Achieving desirable women’s health outcomes requires improvements in national health service provision, strengthened efforts by non-governmental organizations (NGO), and the integration of these efforts into development goals.