Strengthening Midwifery Services for Improved Maternal and Newborn Health Outcomes in Somalia: A Narrative Review of Epidemiological Patterns, Workforce Gaps, and Strategic Interventions.

Despite ongoing efforts to strengthen reproductive and maternal healthcare services, maternal and newborn mortality remains a major public health challenge in Somalia. Limited access to skilled birth attendants, shortages of qualified midwives, weak healthcare infrastructure, and persistent socioeconomic and security challenges continue to adversely affect maternal and newborn health outcomes in the country. This narrative review aimed to examine the epidemiological patterns of maternal and newborn health in Somalia, assess workforce gaps in midwifery services, and identify strategic priorities for strengthening these services. A literature search was conducted using PubMed, Scopus, Web of Science, Google Scholar, and reports from the World Health Organization, United Nations Population Fund, United Nations Children's Fund, and Federal Government of Somalia. A total of 55 records were identified, of which 18 were excluded as duplicates or irrelevant titles/abstracts, leaving 37 records screened and assessed for full-text eligibility; following full-text assessment, 22 publications were excluded (not focused on maternal/newborn health or midwifery in Somalia, insufficient data or unclear methodology, outside the review scope, or full text unavailable), and 15 studies and reports were included in the final review. The findings revealed that Somalia continues to experience among the highest maternal and neonatal mortality rates globally, with only 32% of births attended by skilled health personnel; this synthesis indicates that persistently low skilled birth attendance is closely linked to an inequitably distributed and under-resourced midwifery workforce, rather than any single isolated cause. Major workforce challenges include shortages and unequal distribution of midwives, inadequate training capacities, and poor working conditions. By explicitly linking epidemiological indicators to workforce production, distribution, and retention data, this review offers a more targeted evidence base than previous descriptive accounts, with direct implications for national midwifery workforce policy and investment planning. Strengthening midwifery education, workforce retention, professional regulation, and access to skilled maternal healthcare services is essential to improve maternal and newborn health outcomes in Somalia.