Somalia is ranked 161 out of 163 states in UNDP’s 2001 global human development index, with maternal, newborn and child mortality and morbidity rates among the highest in the world. The northwestern part of the country, known as the Republic of Somaliland, declared independence from the rest of Somalia in 1991; however, it has not yet received recognition from the international community. Although more stable than some areas of Somalia, Somaliland remains a fragile state with low capacity to offer health services. The services which are available are fragmented, poorly financed and have inadequate infrastructure and staffing, making it difficult to provide more than the most basic health services to the majority of the population.
Somali women are particularly vulnerable; Somaliland’s maternal mortality rate is estimated at 1,013 per 100,000 live births1 – one of the highest in the world. Post-partum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for 34 percent of maternal deaths in Africa. In Somaliland, modern CPR is low at 4.6 percent of women aged 15-49 with a high total fertility rate of 5.9 births per woman. The high fertility rate means that women are repeatedly exposed to the risks associated with childbirth over their lifetime.
With support from the Dutch Government under the Strategic Alliance with International Non-Governmental Organisations (SALIN), PSI/Somaliland is working to reduce the high maternal mortality rate through the distribution of the uterotonic drug misoprostol for the prevention and treatment of post-partum haemorrhage,