Abstract
BACKGROUND: 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. METHOD: 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. RESULT: 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.