Determinants of Maternity Care Across Continuum of Care Among Women Aged 15-49 Years in Pakistan: A Stratified Comparative Cross-sectional Study

Background: While numerous studies have explored sociodemo- graphic disparities in accessing maternity care in Pakistan, there remains a paucity of knowledge regarding the continuum of maternity care and the unequal access between urban and rural areas in the country. Thus, this study aimed to bridge this gap. Methods: We performed a secondary analysis using data from the Pakistan Demographic Health Survey (2017-18), stratifying by urban and rural residents. Poisson regression was employed to discern the sociodemographic factors associated with three crucial aspects of maternity care: adequate antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC), as well as the completion of the continuum of care (CoC). Additionally, path analysis estimated the relationship between adequate ANC, SBA, and PNC along the pathway of ongoing maternity care. Results: The results indicated higher education, wealth, living in ICT region, mobile phone ownership, internet use, TV viewership, and newspaper reading increased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Conversely, higher parity, living in Baluchistan/FATA regions decreased the likelihood of receiving ANC, SBA, PNC, and completing CoC. Adequate ANC increased the likelihood of SBA, PNC, and completing CoC. However, SBA did not impact PNC along the care pathway. Conclusion: Regardless of place of residence, higher levels of education and wealth, as well as access to mass media, were found to be the most significant determinants of receiving adequate ANC, SBA, PNC, and completing CoC and should be prioritized in future policy making in Pakistan to enhance the maternal and child health.