Multilevel Determinants of Mother-Infant Skin-to-Skin Contact at Birth in Somalia: Findings from Somali Demographic and Health Survey.

Background: Skin-to-skin contact (SSC) is recognized as an affordable and effective strategy to reduce neonatal mortality; however, its implementation in fragile health systems remains limited. Objective: This study aimed to determine the prevalence of mother-newborn SSC and to identify its individual- and community-level predictors in Somalia. Design: A nationally representative cross-sectional study. Methods: A secondary analysis was conducted using data from the 2020 Somali Demographic and Health Survey involving 6,817 mothers aged 15-49 who had given birth to a live child in the five years preceding the survey. Multilevel binary logistic regression was used to identify predictors. Results: Findings revealed that only 18.2% of women reported engaging in SSC after birth. Delivery in a health facility is significantly associated with the likelihood of SSC (aOR = 6.01; 95% CI: 5.12-7.05). Individual-level factors such as higher education, household wealth, maternal employment, and media exposure were positively associated with SSC practice, while divorced mothers had reduced odds. Community-level socioeconomic status also influenced SSC uptake, with mothers from wealthier communities being more likely to practice it. Conclusion: SSC is practiced at a very low level with substantial disparities tied to social and regional factors. Improving neonatal survival requires prioritizing interventions that increase access to institutional deliveries, train healthcare providers in essential newborn care, and launch targeted public awareness campaigns to reach vulnerable populations.