Background <p>Maternal mortality in Somalia remains alarmingly high, with an estimated ratio of 692 deaths per 100,000 live births. Health facility delivery, a key intervention for reducing maternal and neonatal mortality, is underutilized, with only 22.3% of women delivering to health facilities. This study examined the prevalence, regional disparities, and sociodemographic determinants of health facility delivery among Somali women.</p> Methods <p>Data from 8,951 women aged 15–49 years who reported their place of delivery in the Somali Demographic and Health Survey (SDHS) were analyzed. Descriptive statistics were used to assess the prevalence of health facility deliveries and regional disparities. Bivariate and multivariable logistic regression models were used to identify sociodemographic factors associated with health facility delivery, including education, wealth, residence, and geographic region.</p> Results <p>The overall prevalence of health facility deliveries was 22.3% with substantial regional variation. Woqooyi Galbeed had the highest prevalence (58%), while Bakool recorded the lowest (2%). Women with higher education (AOR: 4.24, 95% CI: 2.16–8.32) and those in the highest wealth quintile (AOR: 6.01, 95% CI: 4.04–8.94) were significantly more likely to deliver at health facilities. Rural and nomadic residences as well as distance to health facilities were associated with lower odds of health facility delivery.</p> Conclusion <p>Education, wealth, and geographic access significantly influence health facility delivery in Somalia. Addressing these disparities through targeted investments in education, healthcare infrastructure, and culturally tailored interventions is essential to improve maternal health outcomes.</p>