International Family Health: Somalia's SDG 3 and Maternal Health

This report provides an in-depth analysis of maternal health in Somalia, focusing on its relationship with Sustainable Development Goal 3 (SDG 3), which aims to ensure healthy lives and promote well-being. It begins by highlighting the importance of SDG 3 in Somalia, a nation facing significant healthcare challenges due to civil strife and economic instability. The report examines the maternal mortality rate as a key health indicator, discussing its causes, including lack of access to healthcare, malnutrition, and complications during childbirth. It explores global and regional maternal health trends, challenges, and barriers, such as inadequate healthcare financing and disparities between urban and rural areas. The report also delves into the causes of increasing maternal mortality rates in Somalia, like unsafe abortions and complications during pregnancy. It concludes by offering strategies and solutions to improve maternal health, along with recommendations for future actions, emphasizing the need for long-term strategies and solutions to reduce mortality rates and achieve SDG 3 goals. The report underscores the importance of addressing healthcare infrastructure, improving access to skilled birth attendants, and implementing effective policies to enhance maternal health outcomes in Somalia.

International
Family Health

Table of Contents
INTRODUCTION...........................................................................................................................1
PART 1............................................................................................................................................1
Identify the importance of SDG in Somalia related to health................................................1
Sustanable Development Goals..............................................................................................2
Indicator- Maternal Mortality rate..........................................................................................2
Reproductive and maternal health globally............................................................................5
Challenges and barriers..........................................................................................................5
Causes of increasing maternal mortality rate in Somalia.......................................................6
Strategies................................................................................................................................7
Solutions.................................................................................................................................7
RECOMMENDATION...................................................................................................................8
CONCLUSION................................................................................................................................8
REFERENCES..............................................................................................................................10

INTRODUCTION
The sustainable development goals (SDG) refers to the global goals which aims to
maintain health & well-being of people. It is the best plan to develop better world for planet and
people by year 2030 (SUSTAINABLE DEVELOPMENT GOALS, 2019). SDG ensures proper
providence of resources to population so that better outcomes can be gain. It is an approach
which is use by country that helps in balancing or saving resources so that it can available for
others. In this assignment, the selected sustainable development goal is Goal 3: Good Health and
Well-Being which aims to ensure healthy lives as well as promote well-being for all at all ages.
In this, Maternal Health is taken as an indicator to discuss the goal.
In order to discuss this, the selected host country is Somalia which is a sovereign nation that
is located in Horn of Africa. The current population of country is approximately 15,893,222
among which 50.14% are female population (Somalia Population, 2020). This report covers
information about sustainable development goal, i.e., Good Health and Well-Being by
considering the maternal health indicator. This is discussed in context of Somalia which is taken
as a host nation. Apart from this, critical analysis of the topic as well as its importance in family
health are discussed. It also includes barriers, challenges, solutions and strategies for the goal in
host nation along with short and long solution and strategies for accomplishment of sustainable
development goal in Somalia. At last, recommendation as well as actions for immediate future in
summary are included in the report.
PART 1
Identify the importance of sustainable development goals in Somalia related to health
Somalia is one among the very poor Nation its per capita income is lowest in all over the world.
The population have been confined in the middle of chaos and protracted civil strife which has
written inevitably to overwhelm the existing precarious health care situation. In Somalia, the
ongoing civil war over the past two decades has destroyed all the economic infrastructures and
healthcare in nation (Kaakinen, Coehlo, Steele and Robinson, 2018). The hospitals and
community clinics established through government were completely pillaged and shattered. It
resulted in widespread food crisis. Relative to other countries, the health care in Somalia under
performs. The maternity mortality rates are highest in the world. Its main causes include acute
respiratory diseases, lack of adequate immunization, malnutrition, malaria, poor sanitization etc.
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(Masters et. al., 2019). The Federal government rapidly fostered mother and child care centres so
that people can avail health care services free of charge regarding immunizations and nutritional
supplements (Bell, 2015). The civil strife in the nation caused shortage of health care
professionals. The rapidly changing political, economic and social environment in Somalia
developing opportunities and conditions to reconstruct and create health care system (Folland,
Goodman, and Stano, 2016).
sustainable development goals
The SDG refers to sustainable development goal which have main objective to provide
better health to all population of country (SUSTAINABLE DEVELOPMENT GOALS, 2019).
They address various challenges that faces by population with the help of various indicator as the
public health system of Somalia is poorly developed as it was destroyed by civil war (Ali, 2017).
In this, budget of the country was dedicated to military expenditure which leads to lacking of
availability of resources. There are a number of armed conflicts occur with in Somalia (Bogren
et. al., 2020). This develops lack of services that affect health of population. Due to conflicts in
Somalia, the government lack functioning and its economy collapse. There are lots of challenges
face by Somalia as the occurrence of famines and droughts lead people to difficulties in survival
(Hanson et. al., 2017).
Specific Goal 3/3.1/3.1.1
The goal of SDG is to ensure healthy lives and promote well-being for all at all ages by
2030 by reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
Indicator- Maternal Mortality rate
The health indicator that can help in analysing health of population is maternal
mortality rate. The maternal mortality ratio is referred as the yearly female deaths per 100,000
live births due to any cause associated with pregnancy or its management (Hickey and et. al.,
2017). This ratio involves deaths at the time of pregnancy, childbirth or in between 42 days of
termination of pregnancy, regardless of time period and place of pregnancy, for a stated year. In
year 2017, the Maternal mortality rate in Somalia is 829 deaths per 100,000 live births (Somalia
Maternal mortality rate, 2017).
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Figure 1: Maternal Mortality Rate Rank Chart
(Source: Maternal Mortality Rate Rank Chart, 2019)
In Somalia, little or no access to medical facilities creates problems for the women who is
pregnant and in most of the remote villages, all the deliveries are handled by traditional birth
attendants (Masters et. al., 2019). In the villages of Somalia, many women died due to pregnancy
related complications as traditional birth attendants are not able to handle such complications.
The maternal mortality ratio has been estimated with in country is 732 deaths per 100,000 live
births (Maternal Mortality in Somalia: What ARC is doing to combat this crisis, 2018). The aim
of sustainable development goal is to reduce mortality rate among female population. (Bogren et.
al., 2020). Due to malnutrition and large number of diseases, it causing high number of death in
the country. This health indicator, i.e., Maternal Mortality Ratio helps in recognizing death rate
in Somalia among mother. It assists in identifying that how much women are died in Somalia
annually due to pregnancy complications. It is necessary for the nation to identify long term
strategies and solution that helps in reducing the maternal mortality rate at place. With the help
of research, relevant SDG can be used with in the country. This help in providing solution to
challenges faced by country (Hanson et. al., 2017).
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Figure 2 Maternal mortality rate by year chart
(Source: Somalia Maternal mortality rate, 2017)
In Somalia, mothers suffer from diseases and high level of deaths. In the nation, a woman has 1
in 10 chances of dying because of pregnancy related issues during the tenure of her life (Folland,
Goodman, and Stano, 2016). Mothers die because of lack of access to medical facilities and
emergency obstetric care meant for timely treatment of some of the major complications related
to childbirth like eclampsia haemorrhage, infection and obstructed labour (Bogren et. al., 2020).
In Somalia, reproductive health service exposure is low. The number of emergency obstetric care
services per 500,000 populations is 0.8, in comparison to the international standard of 5 and
antenatal care coverage is around 26 percent (Reproductive Health in Somalia, 2020). In
improving the health of millions of individuals, fighting against major communicable diseases,
increasing life expectancy and reducing the maternal mortality rate in Somalia, major progress
has been achieved in good health and wellbeing goal (Ali, 2017). However, the progress has not
happening fast enough to address diseases like tuberculosis and malaria whereas, half of the
population does not have access to necessary health services or facilities and the people who
suffer from undue financial hardship, it potentially put them into poverty. for achieving
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sustainable financing and universal health coverage, concerted efforts are needed so that the
growing threat of non-communicable diseases can be addressed properly (Sundin et. al., 2015).
Reproductive and maternal health globally
Around 303,000 women died in the world due to complications in childbirth and
pregnancy in year 2015. Among all these deaths, almost are occurred in middle and low income
Nations and two third of those were in sub-Saharan Africa. With proper care and Management,
these deaths are preventable. In year 2018, around 81% of births took place all over the world
with the help of skilled birth attendants. In sub-Saharan Africa, there was only 59% coverage of
skilled birth attendants in year 2018 (De Souza and et. al., 2018).
In year 2017, per 1000 live births, the under 5 rate of mortality fell to 39 deaths, which
means 6.7% decline from deaths in year 2015 has been seen. In year 2017, the total number of
deaths reduced to 5.4 million from 9.8 million in year 2000 (PROGRESS OF GOAL 3, 2019).
Increasing access to modern contraceptive approaches and methods are essential to make
sure universal access to reproductive health Care facilities. The rate of adolescence fertility e
reduces from 56 birds per thousand adolescent women in year 2000 to 45 births in year 2015 as
well as 44 births in year 2019. In sub-Saharan Africa, the adolescent fertility level has remained
high, at 101 births per 1000 women. To achieve sustainable development goal, less than half of
6.4 % early rate is required. Improving maternal health is crucial for achieving sustainable
development goal of reducing maternity mortality rate (Bidgoli, Kebriaei and Moosavi, 2016).
Challenges and barriers
There are several challenges that are taken into account while implementing the goal. These
challenges include rapid urbanization, widening social and economic inequalities, constant
burden of HIV as well as other infectious diseases, threats to environment and climate, and the
emerging challenges like non communicable diseases. In African countries, wide disparities in
reproductive and maternal health are found (Torremans and Fawcett, 2017). Several obstacles are
there that a pregnant women face due to which the mortality rate in Somalia increases. One of
the barrier includes lack of access to high quality skilled care before, at the time of pregnancy
and after childbirth (Masters et. al., 2019).
Health financing is one of the challenge that is faced by healthcare organisation and government
of Somalia in reducing maternity mortality rate. Apart from this, inequality in health outcomes is
the another challenge faced by government of Somalia. Due to poverty and lack of money,
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middle and low income level people are not able to access high quality care facilities. They not
able to seek medical help timely during their pregnancy time. Even though, the expenditure of
government on health is increased, it is not enough to deliver required healthcare services to the
poor people of Somalia (Bell, 2015). The depicts that the health is under financed and it is
required by government to allocate more resources to provide effective healthcare services to
people. Out of pocket expenditure of household on health is high which makes sustainability of
services delivery and health financing a serious concern in Somalia during the execution of
sustainable development goal, i.e., good health and wellbeing by improving maternity health
(Somalia Maternal mortality rate, 2017).
Between Urban and rural areas, high disparity is there in achievement levels among
regions among populations of distinct socio-economic status (Haque and Patel, 2016). The
achievements in millennium development goal is not equitable that the regions are there which
lag far behind others. Because of differential in capacity of health systems and socio economic
development differences between rural and urban areas and among regions in the nation, the
equity gap exists. These gaps are indeed the challenges that sustainable development goal
required to address by utilizing comprehensive strategies involving universal health coverage as
well as social health determinants approach (Lee, and Yoo, 2015).
Causes of increasing maternal mortality rate in Somalia
One of the major direct causes or reasons of maternal mortality and morbidity involves
unsafe abortion, infection, haemorrhage, high blood pressure and obstructed labour. All these
complications among pregnant women may arise unexpectedly (Bidgoli, Kebriaei and Moosavi,
2016). In Somalia, there is no vital registration system to review the maternal mortality rate. This
resulted in non-availability of adequate information on underlying factors of deaths that can be
utilised by government as well as other agencies for developing effective interventions and
policies (Smits and Steendijk, 2015). The another cause of increasing maternity mortality rate is
lack of education among women (Ali, 2017). In Somalia, majority of women had no education
and they made no antenatal care visits during their pregnancy. Haemorrhage is one of the most
common cause of mortality. As the people of Somalia are poor and has no access to quality
medical facilities, it is the leading cause of death of women were pregnant (Goodman, and et. al.,
2017). Lack of knowledge about warnings and danger signs at the time of pregnancy and failure
to seek immediate healthcare from health facilities are also the cause of increasing maternity
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mortality rate (De Souza and et. al., 2018). Delay in getting obstetric care facility is also the
reason. Due to lack of transportation facilities and seeking care from two or more medical
facilities are the contributing factors in non-access of quality emergency obstetric care. Difficulty
in gathering enough money to visit another health facility for accessing care highly contribute in
increasing maternity mortality rate (Folland, Goodman, and Stano, 2016).
Strategies
A Millennium Development Goal 5 (MDG 5) is set by WHO, i.e., improve maternal
health. It set the targets of declining maternal mortality by 75 percent and accomplish universal
access of women to reproductive health by year 2015 (Maternal and Perinatal Health, 2020).
However, so far progress in declining maternal mortality rate in developing nations and
rendering family planning services or facilities has been too sluggish to mitigate the targets. A
good progress is seen in the country against leading cause of diseases and deaths. By
implementing the sustainable development goal of good health and wellbeing in Somalia, life
expectancy has maximized dramatically. A decline has been seen in maternal mortality rates
(Bidgoli, Kebriaei and Moosavi, 2016). For the family as well as the woman who is pregnant,
good health is necessary to sustainable development and the agenda of year 2030 reflects the
interconnectedness and complexity of the two. One of the main strategy of government to
decline maternal mortality rate is by providing appropriate medical care in obstetric emergencies
timely (Lee, and Yoo, 2015).
The universal health coverage will compile to achieve sustainable development goal 3, i.e., good
health and wellbeing, reducing inequalities and ending poverty. The nation is off track to
accomplished health related sustainable development goal. Both within and between countries,
the progress has been uneven. With the longest and shortest life expectancies, there is a gap of
years among the Nations (Bell, 2015). For developing good health for all and addressing
inequalities, gender sensitive and rights-based approaches are necessary. In Somalia, National
plan reduces maternal mortality rate. Spacing births can intensely decline maternal mortality as
well as improve their chances to survive. There are three priorities on which The Somali
Reproductive Health National Strategy and Action Plan emphasize (Smits and Steendijk, 2015).
These includes addressing harmful practices such as female genital mutilation, safe delivery and
birth spacing. Along with the consortium of international NGOs, UNICEF and UNFPA, the
World Health Organization has been working to support authorities in maximizing number of
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trained nursing professionals and midwives and enhancing access to birth-spacing facilities (Ali,
2017).
Solutions
Investing in health systems by providing training to midwives is one of the way that helps
in improving quality of maternal care services in Somalia. Investment in making an emergency
obstetric care available to people round-the-clock is also the way key to reduce maternal
mortality (Bogren et. al., 2020).
By addressing the barriers through use of care and developing an environment within
families and community which helps a woman in seeking the required care will also help in
reducing mortality rate of pregnant women in Somalia (Goodman, and et. al., 2017).
Providing good care to women at the time of pregnancy is necessary for saving their lives. Apart
from this, providing education to girls is also one of the way to reduce maternal mortality rate as
the maternal death risk is 2.7 times high in the women who are not educated and two times high
Indian women with 1 to 6 use of education in comparison to the women with 12 years of
education (Folland, Goodman, and Stano, 2016).
Sustained and increased finance from stakeholders and government helps in improving the
healthcare facilities associated with maternal care. Developing comprehensive action plan with
appropriate strategy and tactics will help in declining mortality rate and improving maternity
health (De Souza and et. al., 2018). Sustainable development goal of good health and wellbeing
help in providing ambitious plan for people, prosperity and planet and for removing injustice that
underpin ineffective health and development outcomes (Bidgoli, Kebriaei and Moosavi, 2016).
RECOMMENDATION
As per the above analysis it is recommended that government should invest more on
improving health facilities in Somalia so that all the women's who are pregnant can get access to
medical and healthcare facilities. This will help in reducing maternity mortality rate in Somalia
as availability of high quality healthcare services will enable people to avail better care required
during that time (Smits and Steendijk, 2015). Apart from this, government and health care
organisations should provide training to midwife and nurses so that enable to handle complex
situations in more effective way and provide effective services to women who are pregnant. This
will also help in reducing mortality rate and improving maternity health. In addition to this,
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government should also ensure that the provided health care services will be availed by all
individuals so as to ensure their health and well-being.
CONCLUSION
As per the above mentioned report, it has been concluded that sustainable development
goals are the goals that are developed to accomplish more sustainable and better future for all.
These goals address global challenges that people face in different nations. This will help in
improving health and wellbeing of individuals and develop more sustainable planet. Maternal
mortality rate it is the number of deaths that occur due to complications from childbirth or
pregnancy. The maternity mortality rate in Somalia is 732 deaths per 100000 births. There are
various causes associated with maternal mortality rate including less or no access to high quality
healthcare services, social and economic inequalities etc. Formulation of appropriate plans and
policies is necessary in order to overcome all the challenges and barriers that takes place during
implementation of sustainable development goal.
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SUSTAINABLE DEVELOPMENT GOALS, 2019. [Online]. Available through:
<https://sustainabledevelopment.un.org/>
Somalia Population, 2020. [Online]. Available through:
<https://worldpopulationreview.com/countries/somalia-population/>
Maternal Mortality in Somalia: What ARC is doing to combat this crisis, 2018. [Online].
Available through: <https://reliefweb.int/report/somalia/maternal-mortality-somalia-
what-arc-doing-combat-crisis>
Reproductive Health in Somalia, 2020. [Online]. Available through:
<http://www.emro.who.int/som/programmes/reproductive-health.html>
Maternal and Perinatal Health, 2020. [Online]. Available through:
<https://www.who.int/maternal_child_adolescent/topics/maternal/maternal_perinatal/
en/#>
Somalia Maternal mortality rate, 2017. [Online]. Available through:
<https://www.indexmundi.com/somalia/maternal_mortality_rate.html>
PROGRESS OF GOAL 3, 2019. [Online]. Available through:
<https://sustainabledevelopment.un.org/sdg3>
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