Somali Women and Patient Autonomy During Childbirth

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I saw a TikTok video recently that stopped me in my tracks.

A woman was in labour. According to the story accompanying the video, she had already been in labour for three days. Doctors wanted to perform a Caesarean section, but her husband refused to give consent.My first thought was disbelief.There is no way this is happening in 2026.

Then came the question that bothered me more:

How can someone who is not the patient delay her medical treatment?I wanted to know whether this was simply one disturbing story on TikTok or whether there was a larger system behind it. So I started looking.What I found was far more uncomfortable than the video.

A 2026 study published in PLOS One examined Caesarean deliveries in Somaliland and found that family consent could be required before surgery. In the study setting, the woman’s husband, father or another close male relative could be expected to give consent. The researchers identified delayed family consent as an important contributor to delays in emergency obstetric care.The numbers make the problem harder to dismiss.

The study involved 516 women. Those experiencing hypertensive disorders of pregnancy had 8.49 times higher odds of delayed family consent, while women experiencing obstetric haemorrhage had 3.21 times higher odds.

These are not minor complications. Severe hypertension and heavy bleeding can become emergencies very quickly. In such situations, waiting for a husband or relative to arrive, agree, or change their mind can have consequences that cannot be reversed.

And Somalia already has one of the world’s most serious maternal health crises. The country’s maternal mortality ratio was estimated at about 621 deaths per 100,000 live births in 2020. Only around 32% of births are attended by skilled health personnel, according to WHO.

So there are already enormous barriers between a pregnant woman and lifesaving care: distance, poverty, insecurity, shortages of health workers and limited emergency facilities.Why should the final barrier be permission from someone who is not the patient?

This brought me to another question: Is this actually what Somali law requires?Interestingly, the answer does not appear to be a simple yes.

Somalia’s Provisional Constitution protects equality regardless of sex and protects physical integrity. Article 15 provides for consent to medical treatment, including provisions concerning people who lack legal capacity. Article 27 also recognises the right to healthcare and states that no one may be denied emergency healthcare for any reason.

The Constitution, therefore, does not simply say, a husband owns the final decision over his wife’s medical treatment.So where does this practice come from?Part of the answer appears to lie in the space between formal law and lived reality.

Research involving doctors working in Somali maternity hospitals found that male relatives could play a decisive role in women’s healthcare decisions. Doctors described situations in which they had to seek permission from husbands, fathers, brothers, uncles or other male relatives before proceeding. They also reported fearing the consequences of acting without that permission.

This is where the issue becomes bigger than Caesarean sections.It becomes a question of patient autonomy.

Consent is supposed to mean that a patient understands what is happening to their body and makes an informed decision about treatment. Of course, there are exceptions. Children and patients who lack decision-making capacity may require a legally authorised representative. Emergencies can also complicate ordinary consent procedures.

But marriage is not incapacity.Pregnancy is not incapacity.Being a wife does not mean becoming legally incapable of deciding what happens to your own body.

There is nothing wrong with a husband being involved in his wife’s healthcare. He can support her, accompany her to appointments, help her understand the risks and stand beside her when she is afraid.

But involvement is different from authority.A husband can be part of the decision without becoming the owner of it.

That distinction matters because some of the reasons families resist Caesarean sections are rooted in genuine fears. Research has documented concerns that surgery may affect future fertility, cause permanent physical problems or carry serious risks from anaesthesia. There are also cultural preferences for vaginal birth and beliefs about what makes a woman a strong mother.

Those beliefs deserve understanding. But understanding them should not mean allowing them to determine whether a woman receives lifesaving treatment.

And perhaps this is what disturbed me most about that TikTok video.We often talk about maternal mortality as though the only problem is getting women to hospitals.

But what happens when she finally gets there?What happens when the doctor says she needs an emergency Caesarean section?

Who answers?

The woman?

Her husband?

Her father?

A clan elder?

And if she says yes while someone else says no, whose voice does the hospital follow?Those questions cannot be answered by statistics alone.

Somalia’s maternal health crisis is undeniably connected to poverty, limited healthcare infrastructure and inadequate access to skilled birth attendance. But the evidence suggests that social and family structures can create another kind of delay: a delay in recognising a woman as the primary decision-maker over her own body.

That is why I keep thinking about the woman in that video.I do not know her name. I do not know the full circumstances of her case, and a TikTok video cannot establish all the facts.

But it made me ask something I had never seriously considered before:What does patient autonomy mean if the patient can say yes, but someone else can still say no?

In 2026, that should not be a strange question.It should be an uncomfortable one.Because when a woman is the patient, her voice should not have to compete with the authority of the man beside her.

It should be the voice that matters most.

Written by

Asha Mirriam

Asha Mirriam is a creative writer passionate about African story telling, social justice and emotionally rich narratives

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