II. Global Public Health Issue
Somalia is a country that has suffered from many issues since the collapse of any sort of centralized government. The Somali people have suffered from countless diseases, poverty, conflict, environmental disasters, and constant displacement. For almost an entire generation the country has been without an effective central government, which in turn had major effects on the country’s health system. The Somali health system consists primarily of fragmented and privatized services that are insufficient and unequally distributed. The country’s public health system has very little central governance or management. Due to these factors most of the population do not have access to the most basic health services and definitely do not have access to higher level of services if needs arises. The lack of an overall adequate health system that is controlled by a centralized government has crippled the progress of reproductive health. Giving birth in Somalia is extremely dangerous and very unpredictable. Somali woman are among the highest risk women in the world with a Maternal Mortality (MMR) of 1,044-1,400 per 100,000 live births compared to a 12 per 100,000 in the United States.1 Even after a mother survives all these risks and delivers her baby, both mother and child continue to face constant risks. The under-five infant mortality rate is 225 per 1,000 live births2 compared to 8 per 1,000 live births in the US3, putting infants in Somalia in the highest risk category worldwide.
A woman’s health and behavior during pregnancy affects the health of her unborn baby. A poor diet, certain environmental exposures, illnesses, medication, and other factors affect the baby’s development. Prenatal and antenatal care is extremely important in order to ensure the health of the baby and the mother. In Somalia only one out of every four pregnant woman gets antenatal care and for those lucky few that do, the service isn’t even good enough and they do not receive vital interventions. 4This missed opportunity to catch any complications that would arise contributes to the high MMR and IMR in Somalia. The lack of adequate antenatal care also increases the chances of pregnant women developing eclampsia during their pregnancy, a complication that is one of the major causes of maternal mortality in the country and could be easily prevented with a simple blood or urine test. Interestingly the amount of women that receive antenatal care differs across the region. Somaliland, a northwestern region of Somalia that has declared itself a sovereign state and enjoys a higher level of stability and governance, has the highest antenatal care coverage percentage according to the last survey done by MICS in 2006. Somaliland had 32% of its population receiving at least four antenatal visits, followed by Puntland that has 26% of antenatal care coverage. The lowest coverage in the country was recorded in the central south region, a pattern that is the same for most other health disparities in the country.5 Aside from the lack of proper antenatal care during pregnancy, traditional beliefs that are held by the Somali population affects the maternal mortality rate in the country. Most Somali mothers do not believe in prenatal health precautions, such as taking vitamins and attending checkups. They take on the motto of, “if one isn’t experiencing pain or bleeding there is no need to see a doctor until birth. The rest should be left to god”. This type of behavior greatly contributes to the high MMR. Infections due to unattended and unhygienic deliveries also contribute to the high maternal mortality rate in the country. For all the births that take place in Somalia only a mere 2% of births take place in a health care facility that is attended by skilled staff6. Most rural women do not have the resources or access to deliver in facilities with staff that are trained in child delivery. By the time they go into labor most are alone or...
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