Predictors of antenatal care service utilization among women of reproductive age in Somalia: a systematic review

Purpose: Antenatal care (ANC) is a cornerstone of maternal and neonatal health, yet its utilization remains suboptimal in Somalia, contributing to high maternal and perinatal morbidity and mortality. Understanding the predictors of ANC utilization is essential for designing effective interventions. This systematic review aimed to identify predictors of antenatal care service utilization among women of reproductive age in Somalia. Materials and methods: A systematic search of PubMed, Google Scholar, Medline, CINAHL, EMBASE, and African Journals Online was conducted for studies published between 2010 and 2025. Quantitative studies reporting predictors of ANC utilization using multivariable analysis were included. Study selection and reporting followed PRISMA guidelines. Methodological quality was assessed using standardized appraisal tools. The review protocol was registered in PROSPERO (registration number: CRD420251244002). Results: Nine studies met the inclusion criteria. ANC utilization in Somalia was influenced by a combination of sociodemographic, obstetric, knowledge-related, and health system factors. Consistently reported predictors included maternal education, place of residence, household wealth index, marital status, pregnancy intention, maternal age, and exposure to mass media. Early gestational age at first visit, gravida status, knowledge of ANC, distance to health facilities, accessibility of services, and perceived health worker attitudes were also significant predictors. Conclusion: Antenatal care utilization in Somalia is shaped by complex and interrelated individual, socioeconomic, and health system factors. Targeted interventions focusing on female education, community awareness, early ANC initiation, and improved access to quality maternal health services are critical to increasing ANC utilization and improving maternal and neonatal outcomes. Systematic Review Registration: https://www.york.ac.uk/inst/crd, PROSPERO registration number, CRD420251244002.