OBJECTIVES: Pakistan has very high maternal mortality ratio in South Asia. The high maternal mortality could be due to low prenatal care utilization and unsafe births. This analysis examines socioeconomic inequalities in prenatal care utilization and investigates the association between the household economic status, other socio-demographic variables and prenatal care in Pakistan.  METHODS:

The study draws data from Pakistan Living Standards Measurement Survey (PLSM) conducted in both rural and urban areas of Pakistan in 2010-11. This analysis is based on 4,177 married women of reproductive age i.e. 15-49 who gave birth during the past three years in Punjab and Sindh. Household economic status is measured using household annual consumption expenditures and households are categorized into quintiles.

RESULTS:

There are regional disparities in prenatal care utilization in Pakistan. The proportion of women receiving prenatal care in rural areas is much lower than their urban fellows (65.3% vs. 83.6%).  There is regional variation in seeking prenatal care as well, as 83.1% in north Punjab, 77.9% in central Punjab and 67.3% in south Punjab received prenatal care, whereas the proportion is 70.7% in southern Sindh and only 51.5% in north Sindh.

The multivariate logistic regression results reveal that women of bottom three quintiles are significantly less likely to receive prenatal care compared to members of the highest quintile. Those residing in rural areas and in the north and south Sindh have a significant and negative association with receiving prenatal care compared to women residing in urban and central Punjab. CONCLUSIONS:

Public health programs focussing on improving the prenatal care utilization, particularly of poor women and those residing in rural areas need to be initiated. Low prenatal utilization could be associated with high health care cost. Interventions aiming at reduced health care cost for poor and rural women need to be initiated.