Socio-digital stratification and the threshold effects of digital inclusion on maternal health access in Somalia
Year: 2026
Type: article
Abstract: Background Maternal health utilization in fragile states is hindered by complex social and structural barriers.Objective This study examined socio-digital stratification and explored the threshold effects of digital inclusion on antenatal care (ANC) utilization in Somalia.Methods Using data from the 2020 Somalia Demographic and Health Survey (N = 8,940), we constructed a Digital Inclusion Index (0–3) and employed survey-adjusted logistic regression models to estimate the odds of achieving four or more ANC visits (ANC 4+).Results Only 8.4% of the women achieved the ANC 4+ threshold, with pronounced disparities between urban (14.0%) and rural/nomadic (5.5%) residents. Evidence consistent with a threshold effect was observed, whereby the initial transition from digital exclusion to basic connectivity (score = 1) was associated with the largest marginal gain in health seeking probability (OR = 1.55, p = 0.013). While mobile money penetration is high (85.2%), internet access remains deeply stratified by wealth (22.0% among the rich versus 1.0% among the poor). Interaction analysis suggests that digital inclusion complements but does not substitute for physical health infrastructure, partially mitigating distance-related barriers without eliminating the need for physical proximity to healthcare facilities.Conclusions Digital inclusion is a critical entry point for improving maternal health access in Somalia. Policies should prioritize universal basic connectivity and SMS-based interventions, while simultaneously addressing persistent physical and socioeconomic inequities.
Source: Global Health Action
Institution: Amoud University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,509
OpenAlex ID: W7165864514