Background: Unintended pregnancies pose a significant challenge to maternal healthcare service utilization and continuity of care (CoC) in low-resource settings. This study investigates the impact of pregnancy intention at conception on CoC in maternal healthcare service use in Somalia. Methods: Data comprising 7,079 mothers were extracted from the First National Health and Demographic Survey of Somalia conducted in 2020, with the condition that they had given birth within the three years preceding the survey. Level of Continuity of Care (CoC), categorized as lowest, middle, or highest, in receiving maternal healthcare services, was considered as the explanatory variable and assessed based on the receipt of antenatal healthcare (ANC, <4, <=4), skilled birth attendance (SBA), and postnatal healthcare (PNC, within 48 hours of birth). Mothers intention of most recent pregnancy at conception was the primary exposure variable. Unadjusted and adjusted multilevel multinomial logistic regression models were used to assess the effect of unintended pregnancy on the level of CoC completion. Results: Approximately 38% of live births in Somalia were unintended at conception. Only 2.4% of mothers achieved full CoC, with higher rates observed among those with intended pregnancies (3.0%) compared to those with mistimed (1.6%) or unwanted pregnancies (1.1%). Mothers having mistimed (aOR, 0.59, 95% CI, 0.37-0.95) and unwanted (aOR, 0.28, 95% CI, 0.10-0.79) pregnancies had significantly lower odds of achieving moderate and higher levels of CoC compared to those having intended pregnancies, even after adjusting for socio-demographic factors. Conclusion: Unintended pregnancies are associated with lower level of CoC in maternal healthcare service use in Somalia. Strengthening family planning services, promoting contraceptive use, enhancing sexual education, and raising awareness about the importance of maternal healthcare services are essential steps to reduce unintended pregnancies and improve maternal and child health outcomes in the country.

The authors have declared no competing interest.

The authors did not receive any specific fund to conduct this study.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The survey analyzed was approved by the institutional review board of SHDS, and informed consent was obtained from all participants. All necessary patient/participant consent has been obtained, and the appropriate institutional forms have been archived. Permission to access the survey and conduct this research was obtained, and all methods were performed in accordance with relevant guidelines and regulations. No separate ethical approval was required to conduct this study.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

We are not authorized to share the data file with any parties. However, those interested in accessing this data can do so by submitting a research proposal to the Somalia National Data Archive authority. They can be reached by visiting the following website: https://microdata.nbs.gov.so/index.php/catalog/50

https://microdata.nbs.gov.so/index.php/catalog/50