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 WORKFORCE CRISIS
Trained midwives, no jobs Somalia needs 20,000 more midwives. It is training them. But most graduates spend years unable to find paid work — a policy failure with direct consequences for maternal survival. |
Somalia faces one of the worst maternal health crises in the world and desperately needs midwives. It is investing in training them. But it has no system to get them into jobs. The result: a generation of qualified women unable to find work, while women in rural areas give birth without skilled help.
The numbers
| 20,000
estimated midwife shortage in Somalia |
31%
of graduates employed as midwives within two years |
69%
lower likelihood of employment for private vs. community graduates |
- Only 22% of private university graduates were employed as midwives within 12 months of graduating; 27% within 24 months
- Community school graduates fared far better: 56% employed within 12 months, 68% within 24 months
- The default pathway into work is unpaid volunteering for 3–12 months — or longer
- Job searches are informal: personal networks and clan connections matter more than qualifications
- 82% of employed private graduates are concentrated in urban areas — leaving conflict-affected and rural areas without skilled midwives
- 58% of midwives who find work are on short-term contracts, with no job security
- Merit-based, transparent government hiring exists in Galmudug — but it is the rare exception
In their own words
| “There are other issues with job hunting, such as being excluded from the shortlist due to clan [tribal] favoritism or personal bias. At least 8 job opportunities I was professionally qualified for were denied to me.”
— Midwifery graduate, Mogadishu |
| “It took me 8 months to find a job. The Ministry of Health, Galmudug branch in Cadaado, announced job vacancies for midwives and auxiliary midwives. I applied for the qualified midwife position, an exam was given to me, and that was how I started this job.”
— Midwifery graduate, Galmudug — on one of the rare transparent hiring processes |
Working conditions for those who do find jobs
| 52 hrs
average working week |
18
patients per day shift |
58%
on short-term contracts |
| “There are times when the facility doesn’t have enough supply, and a mother who is in labour comes to you, and you see she is anaemic, but you don’t have any test to confirm that. So you tell them to go outside and take a blood test. She may refuse, or the family may refuse.”
— Midwife, Mogadishu |
| “A postoperative patient was brought in, but her family gave her water. The team went to them and explained the patient was not allowed to drink water. The male relatives became angry, brought a drip-stand, and hit the female staff with it.”
— Midwife, Mogadishu |
Supply gaps reported by midwives include: oxytocin, IV cannulas, sutures, haemoglobin testing, oxygen. Deliveries are sometimes conducted by torchlight. Some facilities have a single delivery set sent for sterilisation, leaving the ward unable to function until it returns.
| Somalia’s midwifery workforce challenge is not a shortage of trained people — it is a failure of deployment. There is no national mechanism to match qualified graduates with the communities that need them most. Without structured absorption pathways, investment in training is wasted.
EQUAL’s research shows that community school graduates — trained with direct government links and rural deployment expectations — enter the workforce faster and reach underserved areas. The model exists. It needs to be scaled. |
What researchers say needs to change
- A national graduate registry and transparent job-matching system, replacing informal clan-mediated searches
- Structured deployment mechanisms for private school graduates, who currently receive no government support into work
- Hardship postings in rural and conflict-affected areas with salary top-ups and security support
- Formal ‘transition to practice’ programmes: paid and structured, replacing the default of unpaid volunteering
- Mental health support for the workforce — research documents trauma, moral injury and social withdrawal as widespread but unaddressed
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.
