Family Planning and Reproductive Determinants of Short Birth Intervals among Women in Somalia: A Survey-Weighted Analysis of the 2020 Somali Health and Demographic Survey

<title>Abstract</title> <p>Background Short birth intervals are associated with adverse maternal and child health outcomes, yet evidence on the prevalence and determinants of short birth intervals in Somalia remains limited. This study assessed the prevalence and factors associated with a most recent birth interval shorter than 33 months among women in Somalia. Methods This study used data from the 2020 Somali Health and Demographic Survey. The analysis included 7,944 women with a valid most recent birth interval. A short birth interval was defined as an interval of less than 33 months between the most recent birth and the preceding birth. Descriptive statistics were used to summarize sociodemographic and reproductive characteristics. Survey-weighted logistic regression was performed to identify factors associated with short birth intervals, with results reported as adjusted odds ratios (AORs) and 95% confidence intervals (CIs). Results Among the 7,944 women included in the analysis, 5,539 (69.73%) had a most recent birth interval shorter than 33 months. Most women were aged 25–34 years (47.13%), had no formal education (84.57%), and were married (88.91%). In the multivariable analysis, increasing maternal age was associated with lower odds of a short birth interval (AOR = 0.93; 95% CI: 0.92–0.94; p &lt; 0.001), while higher birth order was associated with increased odds (AOR = 1.13; 95% CI: 1.08–1.18; p &lt; 0.001). Wealth quintile, marital status, current contraceptive method, and fertility preference were not independently associated with short birth intervals after adjustment. In the survey-weighted bivariate analysis, the distribution of short birth intervals did not differ significantly across birth-order groups (p = 0.459). Conclusion Short birth intervals were highly prevalent among women in Somalia, with approximately seven in ten women having a most recent birth interval shorter than 33 months. Maternal age and birth order were independently associated with short birth intervals. Strengthening access to family planning services and birth-spacing counseling may help address the high prevalence of short birth intervals in Somalia.</p>