Perceived Quality of Infertility Care and Patient Satisfaction at a Specialized Fertility Center in Mogadishu, Somalia: A Cross- Sectional Study

Abstract Background Infertility has profound psychological, social, and economic consequences, particularly in resource-limited and fragile healthcare environments where specialized services are largely out-of-pocket and public support is scarce. Evaluating the quality and patient-centeredness of fertility care is vital for optimizing clinical outcomes and healthcare delivery. This study assessed the accessibility, perceived quality of clinical and diagnostic care, patient satisfaction, and service delivery priorities among patients receiving care at a specialized fertility center in Mogadishu, Somalia. Methods A facility-based cross-sectional study was conducted between February 1, 2026, and April 30, 2026. A total of 152 consecutive eligible fertility patients were invited, yielding 140 validated, fully completed structured questionnaires (valid response rate: 92.1%). Data were captured across six multi-item domains on a 5-point Likert scale: physical and administrative accessibility, clinical care quality, laboratory/diagnostic capabilities, communication and customer care, pharmacy support, and overall satisfaction. In direct response to expert peer review, the primary evaluation was restricted exclusively to fertility patients (n = 140) to eliminate provider self-assessment bias. Statistical analysis included descriptive proportions and bivariate inferential testing (Chi-square and Fisher's exact tests). Results Among the 140 patient respondents, 62.1% (87/140) were female, and 37.9% (53/140) were aged 25–34 years. Overall satisfaction was high at 80.0% (112/140). High positive ratings were documented for clinician professional competence (78.6%), visual and medical confidentiality (77.9%), diagnostic accuracy and reliability (76.4%), staff courtesy (75.0%), clear communication (74.3%), and on-site laboratory availability (73.6%). Conversely, accessibility domains showed notable vulnerabilities: waiting times were deemed acceptable by only 57.1% (80/140), and treatment affordability was rated positively by only 46.4% (65/140), with 35.0% reporting explicit disagreement. Age was significantly associated with overall satisfaction (χ² = 11.55, p = 0.021), with younger couples (25–34 years) demonstrating greater satisfaction than older attendees. Conclusion Patients reported favorable experiences regarding clinical competence, interpersonal dignity, and diagnostic reliability. However, substantial out-of-pocket costs and prolonged clinic waiting times represent major barriers. Interventions must prioritize tiered, transparent pricing schedules, structured patient counseling leaflets, and streamlined appointment scheduling.