Saving mothers and newborns in Somalia:
Five years of evidence from conflict, crisis, and community
EQUAL Research Consortium · Mogadishu, May 2026
International Rescue Committee (IRC) · Somali Research and Development Institute (SORDI) · Johns Hopkins Center for Humanitarian Health
Funded by UK International Development from the UK Government
| BRIEFING · THE HUMAN COST
The women training as midwives — and what is stopping them They are motivated, qualified and determined. They navigate bombs on the way to class, clan bias in hiring, pressure to give up and get married, and communities that do not trust them. Most still cannot find a job. |
EQUAL’s research spent two years following 403 Somali midwifery graduates. What emerges is not a story of failure — it is a story of extraordinary determination against structural barriers that are entirely fixable. These women are not the problem. The system is.
Why they choose midwifery
The vast majority enter the profession not for the money — midwifery is poorly paid and socially undervalued — but because they witnessed the harm done by unskilled traditional birth attendants and wanted to offer something better. Many describe midwifery as a path to personal independence and a way to challenge gender norms.
| “What excites me is to see a mother who gave birth with my hands walking with her child after years. I feel joyful and proud. I didn’t just learn this to receive income, I learnt this to enrich my mind and to be able to help the community.”
— Recent graduate, Galgaduud |
Getting to class
| “Looking at our country, trying to study is difficult. There’s a chance that when you step out the door, you will hear a bomb go off close to you, or the roads will end up being closed and you will have to walk the rest of the day. But you have to look towards your goals, there’s no winning anything without struggle. You need to be strong-willed and believe you can overcome this.”
— Midwifery student, Mogadishu |
| “There were nights when the internet and communication were cut off. People were fleeing from the village, and I felt very scared because we had to cross the river to reach the safe part of the village, and I did not know how to swim.”
— Midwife, Galgaduud |
Gender pressure
| “Most of the time, we are told to get married. Huge pressure is put on us when we are not ready for it, and they believe that an educated girl will end up in the kitchen.”
— Midwifery student, Mogadishu |
| “Some communities do not support young, educated midwives, and they believe that only experienced TBAs can perform this job, and sometimes they do not trust us.”
— Midwifery graduate, Mogadishu |
The mental health toll
EQUAL’s research documents a workforce experiencing significant psychological distress: trauma from exposure to maternal deaths and birth injuries, moral injury from knowing the right action but lacking the resources to take it, and prolonged unemployment leading to depression and hopelessness. None of this is formally supported by the health system.
| “I used to be someone who stayed connected with relatives, but now I do not keep in touch with anyone because I feel I do not even have time for myself. Sometimes, I feel psychological pressure and wonder whether I am becoming a bad or irritable person.”
— Employed midwife, Mogadishu |
The data behind the experience
- 82% of Somali midwifery students intend to practise midwifery after graduation — motivation is not the problem
- 45% of students were yelled at by patients; 39% received negative remarks about their profession from community members
- Clinical preceptors — who should be mentors — appear in every category of mistreatment reported
- 5% programme withdrawal rate, with family responsibilities (39%) and financial concerns (17%) as leading reasons
- Average stress score of 15 out of 40 for Mogadishu students (9 in Galgaduud) — with disability and bullying as significant multipliers
What researchers say needs to change
- Transparent, merit-based hiring — the Galmudug Ministry of Health model shows this is possible and replicable
- Anti-bullying policies in clinical settings, with training for faculty, preceptors and health workers
- Regional admissions policies that recruit from rural areas — graduates largely return to where they came from
- Peer support networks and structured mental health support, currently absent
- Safety training integrated into midwifery curricula from the start
- Community engagement with traditional birth attendants, families and religious leaders to build trust in qualified midwives
Contacts
General EQUAL enquiries: EQUAL@rescue.org
Dr. Abdi Dalmar (SORDI): drdalmar@sordi.so
Dr. Hawa Abdullahi (SORDI, midwifery study): hawa.abdi@sordi.so
Asia Mohamed (SORDI, Midwifery specialist): asia@sordi.so
Shatha Elnakib (Johns Hopkins, midwifery study): selnaki1@jhu.edu
Website: www.EQUALresearch.org
About EQUAL
The EQUAL Research Consortium is funded by UK International Development from the UK Government and operates in Somalia, DRC, Nigeria and South Sudan. In Somalia, EQUAL is led by IRC, SORDI and Johns Hopkins Center for Humanitarian Health, in collaboration with Somalia’s Federal Ministry of Health. The programme runs July 2021 – April 2026.
