Determinants of obstructed labor among pregnant women in Mogadishu, Somalia: A case–control study

OBJECTIVE: Obstructed labor is a preventable cause of maternal and perinatal mortality, with a disproportionately high burden in low-resource settings. In Somalia, decades of conflict have fragmented the health system, contributing to one of the world's highest maternal mortality ratios. The aim of the present study was to identify the determinants of obstructed labor among women delivering at Banadir Hospital, Mogadishu, Somalia. METHODS: A hospital-based unmatched case-control study was conducted from June to August 2025. A total of 450 participants were enrolled. Data were collected using a structured questionnaire through participant interviews. Multivariable logistic regression analysis was performed to identify independent risk factors associated with obstructed labor. Results are presented as adjusted odds ratios (aOR) with 95% confidence intervals (CIs). RESULTS: Cephalopelvic disproportion was the primary cause of obstructed labor (63.3%). Significant independent risk factors included diabetes in pregnancy (aOR = 9.09, 95% CI: 2.73-30.29), being referred from another health facility (aOR = 7.00, 95% CI: 2.98-16.46), labor duration ≥12 h (aOR = 5.11, 95% CI: 2.71-9.63), and attending fewer than four antenatal care (ANC) visits (aOR = 3.71, 95% CI: 1.21-11.40). Other determinants included residing outside Mogadishu (aOR = 2.84, 95% CI: 1.16-6.93), maternal overweight body mass index (BMI) (aOR = 2.56, 95% CI: 1.36-4.82), neonatal birth weight ≥3.5 kg (aOR = 2.41, 95% CI: 1.37-4.24), and a previous history of obstructed labor (aOR = 2.06, 95% CI: 1.20-3.53). Primiparity was also a major risk factor, as multiparity demonstrated a 90% reduction in risk (aOR = 0.10, 95% CI: 0.05-0.23). CONCLUSION: Obstructed labor in Mogadishu is driven by a convergence of physiological vulnerabilities and systemic health system failures, characterized by the three delays in accessing and receiving care. To reduce the burden of this condition, interventions must focus on strengthening the continuum of care. Key priorities include improving early risk identification and diabetes screening during ANC, streamlining referral pathways from peripheral clinics, and ensuring the consistent use of partographs for intrapartum monitoring to prevent dangerously prolonged labor.