Afridi Jawad Rahim, Jan Sajjad Ahmad, Asif Muhamad Farhan
Department of Economics, University of Peshawar, Peshawar, Pakistan.
UKM-Graduate School of Business, Universiti Kebangsaan, Bangi, Selangor, Malaysia.
BMC Health Serv Res. 2025 Sep 1;25(1):1167. doi: 10.1186/s12913-025-13312-5.
Maternal healthcare services are an important goal in SDGs around the world. Persistent inequalities and gaps in maternal healthcare access are strongly linked to poor maternal health outcomes. This study aims to evaluate inequality of opportunity in access to maternal healthcare services by assessing the contributions of circumstances and efforts to these inequalities. Additionally, it analyzes the key determinants influencing the utilization of maternal healthcare services in Pakistan.
Using data from the Pakistan Demographic Health Surveys (2012-13 and 2017-18), the research examines determinants of MHCS access, focusing on circumstances and efforts and their contribution to IO. This study uses the human opportunity index, Shapley decomposition index, and logistic regression.
The Human Opportunity Index findings indicate notable improvements in antenatal care (from 25.70% in 2013 to 37.78% in 2018) and skilled birth attendance (from 38.97 to 55.73%), while postnatal care coverage declined significantly (from 35.56 to 22.56%) over the same period, underscoring the need for increased policy attention to postnatal services. Decomposition analysis reveals that the main circumstantial factors contributing to inequality are place of residence, region, and household wealth, while factors like the husband's education and proximity to healthcare facilities play a minor role. Efforts such as women's education, exposure to mass media, and women's autonomy in health decisions have a significant impact on the inequality in MHCS access. Binary logistic regression analysis indicates that the probability of accessing MHCS varies by region, with women in Sindh having higher odds compared to those in Khyber Pakhtunkhwa (KP) and Balochistan. Urban women are more likely to receive skilled birth attendance and postnatal care than rural women. Women with basic education and decision-making power regarding their health are more likely to use MHCS. The study emphasizes the need for targeted interventions to address these disparities and improve maternal healthcare outcomes in Pakistan.
孕产妇保健服务是全球可持续发展目标中的一项重要内容。孕产妇保健服务获取方面长期存在的不平等和差距与孕产妇健康不良后果密切相关。本研究旨在通过评估环境因素和个人努力对这些不平等现象的影响，来评价孕产妇保健服务获取机会的不平等情况。此外，还分析了影响巴基斯坦孕产妇保健服务利用的关键决定因素。
利用巴基斯坦人口与健康调查（2012 - 13年和2017 - 18年）的数据，本研究考察了孕产妇保健服务获取的决定因素，重点关注环境因素和个人努力及其对机会不平等的影响。本研究采用了人类机会指数、夏普里分解指数和逻辑回归分析。
人类机会指数结果显示，产前保健（从2013年的25.70%提高到2018年的37.78%）和熟练接生率（从38.97%提高到55.73%）有显著改善，而同期产后保健覆盖率显著下降（从35.56%降至22.56%），这突出表明需要在政策上更加关注产后服务。分解分析表明，造成不平等的主要环境因素是居住地点、地区和家庭财富，而丈夫的教育程度和与医疗设施的距离等因素影响较小。妇女教育、接触大众媒体以及妇女在健康决策方面的自主权等个人努力对孕产妇保健服务获取的不平等有显著影响。二元逻辑回归分析表明，获取孕产妇保健服务的概率因地区而异，信德省的妇女比开伯尔 - 普赫图赫瓦省（KP）和俾路支省的妇女更有可能获得服务。城市妇女比农村妇女更有可能接受熟练接生和产后保健。接受过基础教育且对自身健康有决策权的妇女更有可能利用孕产妇保健服务。该研究强调需要采取有针对性的干预措施来解决这些差距，并改善巴基斯坦的孕产妇保健结果。
