Prevalence and determinants of cesarean section delivery among Somali women: a multivariable analysis of a nationally representative survey

Background Cesarean section is a life-saving obstetric intervention when medically indicated, yet access remains severely limited in Somalia, where maternal morbidity and mortality are high.Objective(s) To determine the magnitude of cesarean section delivery and identify factors associated with its utilization among Somali women using nationally representative survey data.Methods A secondary analysis of the 2020 Somali Health and Demographic Survey was conducted using data from 23,445 women aged 15–49 years. Odds ratios (ORs) with 95% confidence intervals (CIs) were reported, with statistical significance set at p < 0.05.Results The prevalence of cesarean section was 0.3% (61/23,445). Compared with women aged ≥ 35 years, those aged 25–34 years (OR = 6.483; 95% CI: 2.160–19.458; p = 0.001) and <25 years (OR = 6.293; 95% CI: 2.422–16.351; p < 0.001) had statistically significantly higher odds of cesarean delivery. Rural residence (OR = 0.177; 95% CI: 0.091–0.346; p < 0.001) and low household wealth (OR = 0.243; 95% CI: 0.097–0.611; p = 0.003) were statistically significantly associated with lower odds of cesarean delivery. Women with ≥6 children had statistically significantly higher odds of cesarean delivery (OR = 3.960; 95% CI: 2.072–7.569; p < 0.001). Breastfeeding was not significantly associated with cesarean delivery (p = 0.079).Conclusions Cesarean section utilization in Somalia remains extremely low, indicating substantial inequities in access to emergency obstetric care. Maternal age, parity, place of residence, and household wealth were associated with cesarean delivery.