Opinion: When Consent Becomes a Barrier to Life-Saving Obstetric Care in Somalia

“Consent should protect patients, not unintentionally place them at greater risk when every minute matters during a life-threatening obstetric emergency.” Dr. Rahma Yusuf Haji Mohamud

In an obstetric emergency, every minute can matter.

A woman with severe bleeding may need immediate intervention. A mother experiencing eclampsia may require urgent treatment. A woman with obstructed labour or uterine rupture may need emergency surgery without delay. In such situations, healthcare professionals are racing against time to prevent avoidable harm.

Yet another factor can add to this pressure: uncertainty over who has the authority to give consent. Somalia cannot improve maternal safety while leaving this question unresolved.

Consent Should Protect a Woman’s Voice#

Informed consent is an essential part of respectful healthcare. An adult woman with decision-making capacity should be supported to understand her condition and make decisions about her treatment. Her husband, father, brother or other relatives may provide emotional support and participate in discussions if she wishes, but their involvement should not automatically replace her own decision.

A 2025 qualitative study involving physicians working in maternity wards at five Somali hospitals found that consent for life-saving interventions was sometimes sought from paternal male relatives. The study also reported situations in which male signatures or witnesses were required on consent forms, and in which disagreement, refusal or the absence of male relatives could contribute to delays in care.

These findings do not mean that every Somali hospital follows the same practice, nor should they be used to portray Somali families negatively. Instead, they should prompt an important patient-safety question: What happens when a woman needs urgent treatment but healthcare workers are uncertain whether they can proceed without family authorisation?

Family Support and Decision-Making Are Not the Same#

Family involvement is deeply important in Somali society. Families provide emotional support, financial assistance, transportation, communication and practical help during pregnancy and childbirth. Respectful engagement with families should remain part of compassionate maternity care.

But support does not necessarily mean decision-making authority. A woman may want her husband or mother beside her when doctors explain a procedure, or she may ask relatives to help her consider difficult choices. The important point is that her wishes should remain central when she has the capacity to make and communicate a decision.

The problem arises when family participation becomes an additional condition for urgent treatment. Imagine a woman who understands that an emergency caesarean section has been recommended and agrees to it, but healthcare workers wait for a relative to arrive before proceeding. If that delay contributes to her deterioration, the issue is no longer simply paperwork; it becomes a patient-safety concern.

Maternal complications are complex and often have multiple causes. However, when an indicated emergency intervention is delayed because of disagreement, uncertainty or the absence of a perceived decision-maker, the incident should be documented and reviewed.

Somalia Already Has Warning Signs#

National data provide important context. An analysis of the 2020 Somali Health and Demographic Survey found that 15.3% of women reported making healthcare decisions independently, 32.9% participated jointly and 51.8% reported that decisions were made by others. Another nationwide analysis found that 46.03% of married women identified the need to obtain permission as a barrier to seeking healthcare.

These figures do not show how often emergency obstetric treatment is delayed because of consent and should not be interpreted as direct estimates of such delays. They do, however, raise a broader question about women’s participation in healthcare decisions. If Somalia is serious about reducing preventable maternal deaths, women’s meaningful participation in decisions about their own healthcare must be part of the conversation.

This Is Not a Choice Between Culture and Women’s Rights#

The discussion should not be framed as though Somalia must choose between respecting its culture and protecting women’s autonomy. It does not have to make that choice.

Families can remain closely involved. Husbands can support their wives, parents can support their daughters, and healthcare professionals can communicate with relatives respectfully and in culturally appropriate ways.

At the same time, an adult woman with decision-making capacity should not automatically lose her voice because she is married, pregnant or receiving emergency obstetric care. The objective should be culturally respectful care that does not unintentionally create barriers to necessary treatment.