Abstract
OBJECTIVE: The objective of the study is to examine the impact of health insurance and social safety net programmes on maternal health service utilisation (MHSU) in Pakistan. DESIGN: Cross-sectional. SETTINGS: Data were obtained from Pakistan Demographic Health Survey 2017-2018. PARTICIPANTS: Out of 12 364 Pakistani ever-married women aged 15-49 years included in the survey sample, 7752 were included in the study. MAIN OUTCOME MEASURES: Three response variables (antenatal care (ANC) by skilled attendants (<4 visits=inadequate vs 4 or more visits=adequate), health facility-based delivery (home vs health) and postnatal care (yes vs no) were combined to assess MHSU. Health insurance was derived from the question 'are you covered with any health insurance?' and social safety net was derived from enrolment in social safety net programmes. Logistic regression analyses were conducted, and results were reported as ORs with 95% CIs. Results of adjusted logistic regression models were fit to control for individual and community-level factors. RESULT: Prevalence of social safety net was larger than health insurance (7.7% vs 2.0%) while attendance of ANC+4, facility-based delivery and postnatal care was 48.5% (n=3760), 65.9% (n=5097) and 22.6% (n=1745) respectively, among respondents. Women were twice more likely to access maternal health services when they were covered by health insurance (adjusted OR 2.61, 95% CI 1.19 to 5.74, p<0.017) after adjusting for age at marriage, education level, wealth index, rural/urban area, parity, employment, empowerment status, exposure to media, visits and distance to health facility while no significant association of social safety net programmes with MHSU was found. CONCLUSION: Expanding access to health insurance can provide comprehensive coverage for maternal healthcare services. Social safety net programmes can be made conditional, subject to regular health checkups for mothers and children to improve maternal and child health outcomes.