Abstract
BACKGROUND: Infertility is a growing public health concern in developing nations, including Somalia, where medical, socioeconomic, and cultural factors profoundly affect reproductive health. This study aimed to determine the prevalence and identify the demographic, medical, and behavioral factors associated with infertility among women seeking reproductive care in Mogadishu. METHODS: A cross-sectional study was conducted among 390 women attending fertility centers in Mogadishu between December 2023 and February 2024. Participants aged 18 years and above were enrolled using a standardized, interviewer-administered questionnaire that collected data on sociodemographic characteristics, reproductive and medical history, and lifestyle factors. Infertility was defined as the inability to conceive after one year of unprotected intercourse. Logistic regression analysis was used to identify factors associated with infertility, and results were expressed as Adjusted Odds Ratios (AOR) with 95% Confidence Intervals (CI). A p-value < 0.05 was considered statistically significant. RESULTS: The prevalence of infertility was 58%, with secondary infertility more common (68%) than primary infertility (32%). Multivariate analysis identified several significant predictors. Fallopian tube blockage (AOR = 12.0, 95% CI: 4.0-36.0, p < 0.001), Polycystic Ovary Syndrome (AOR = 10.5, 95% CI: 3.4-32.5, p = 0.001), female genital mutilation (FGM) (AOR = 15.8, 95% CI: 6.2-40.3, p < 0.001), and multiple cervix burns (AOR = 20.4, 95% CI: 8.1-51.2, p < 0.001) were strongly associated with infertility. Conversely, having no formal education (AOR = 0.08, 95% CI: 0.01-0.60, p = 0.02) and a history of surgical interventions (AOR = 0.33, 95% CI: 0.10-0.90, p = 0.03) were associated with lower odds. Male-related factors, including husband age and fertility issues, were not significant after adjustment. CONCLUSION: Infertility in Mogadishu is multifactorial, with reproductive tract pathology, endocrine disorders, and culturally mediated practices such as FGM and cervix burns contributing most strongly. These findings highlight the need for culturally sensitive reproductive health interventions, targeted education, and early medical management to reduce infertility and its social impact.