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.
