Healthcare Providers Experiences of Comprehensive Emergency Obstetric Care in Somaliland: An Explorative Study with Focus on Cesarean Deliveries

Abstract Background: Severe obstetric morbidity and mortality remain a serious challenge in developing countries such as Somaliland. Despite the wide implementation of comprehensive emergency obstetric care in Sub-Saharan Africa, including Somaliland, the reduction of severe maternal morbidity and mortality has been slow. Aim: This study aims to explore the experiences of healthcare providers (HCPs) regarding the provision of emergency obstetric care in a referral hospital and four maternal and child health centers in Somaliland. Method: An exploratory qualitative approach using focus group discussions was employed at the main referral and teaching hospital and four maternal and child health centers in Hargeisa, Somaliland. Twenty-eight healthcare providers were divided into groups of 6-8 for 1 to 2-hour discussions. HCPs included in the study had experiences in providing care to women with severe maternal complications. Data were analyzed using thematic analysis. Results: Collectivistic decision making through family ties was identified by HCPs to act as a barrier to provision of life saving obstetric interventions. This tradition of decision making at a group level rather than at the individual level was perceived as time-consuming and delayed HCPs from obtaining informed consent to provide lifesaving obstetric care. Low socioeconomic status, poor knowledge about maternal healthcare among users affected care seeking among women. Suboptimal care affecting provision of emergency obstetric care at the hospital was reported to be due to miscommunication, inadequate interprofessional collaboration and lack of infrastructure. Conclusion: HCPs experiences provided vital insights into the care provided to women with severe obstetric complications in Somaliland. To ensure smooth and timely decision-making processes, the antenatal period can be used to prepare families for potential obstetric emergencies and to obtain signed consents. Key Words: Maternal, Somaliland, Healthcare providers, Family ties, Emergency obstetric care, Cesarean section