1. Effects of Socio-cultural factors on Family Planning use in Somaliland
Aden Qodax, Research and M&E Manager, PSI Somaliland
BACKGROUND
Somalia has one of the highest Maternal Mortality Rates (MRR) in the world at 732 per 100,000 births. Family planning, which plays a major role in reducing maternal and newborn mortality, remains unpopular. Religious beliefs, cultural barriers, and misconceptions associated with contraceptive use are known to prevent both women and men from accessing reproductive health services and information.
Somali mCPR remains at 5.1%. A thorough understanding of the attitudes and practices responsible for this trend is lacking, because of the scarcity of health data available in Somalia. This study provided us with information on the levels and trends in behaviors and related factors.
METHODS AND OBJECTIVES
Trends in Family Acceptance of Modern Birth Spacing Methods
Indicator
 2012
2015 
P value 
Has discussed birth spacing with husband
35.6
26.4
<.001
My husband supports me to use modern birth spacing
34.6
Has discussed birth spacing with family members
30.1
28.4
.005
Confidence to discuss birth spacing with husband
47.3
56.1
.007
PSI conducted a cross-sectional household survey in Somaliland among households with married women of reproductive age (15-49) who were also caregivers of at least one child under the age of five years.
A multi-stage cluster sampling approach was employed to select 2,201 households across urban areas in Somaliland. 88 clusters were then randomly selected, from which 25 households were identified in each for interviews. Descriptive statistics were computed for all variables to see distribution, then UNIANOVA was used to determine association between the outcome variables (MBS use) and exposure variables (sociocultural)
Objectives of this study:
Understand the levels and trends of identified modern birth spacing (MBS) behaviors 
Determine sociocultural factors associated with the voluntary use of
modern birth spacing methods (MBS)
RESULTS
Trends in Perceptions of Modern Birth Spacing Methods
Indicator
2012
2015
P value
Modern methods are acceptable within our religion
48.8
50.7 NS
Modern methods are acceptable in our culture
46.5
56.3
<.001
Modern birth spacing is safe
46.3
59.3
Pills are effective in preventing pregnancy
48.4
63.3
Injectable are effective in preventing pregnancy
44.4
59.0
Pills can cause infertility
29.7
33.7
Injectables can cause infertility
35.7
36.2
Traditional methods are an effective means of birth spacing
68.8
66.8
.031
Intends to use birth spacing in the future
14.4
26.4
CONCLUSION
The results of this study imply that the husbands and religious leaders are a major entry point for birth spacing interventions along with Mothers and doctors both play an important role in recommending a method to women, so programs should target both all those groups.
Cultural attitudes seem to be improving towards voluntary modern birth spacing, but continued education needs to be done to counteract beliefs that these methods are not acceptable in religion and may render women infertile.
Work needs to continue in encouraging women to discuss birth spacing with their husbands. This can be promoted via the recently launched interpersonal communication campaign with men.
@PSI_SOM