Toward maternal health equity in Iran: nationwide analysis of spatial and resource distribution in primary healthcare

BACKGROUND: Equity in maternal health is critical to achieving Sustainable Development Goals and Universal Health Coverage. Unequal distribution of maternal health resources threatens access and outcomes, particularly in Low- and Middle-Income Countries (LMICs) like Iran. This study assesses spatial and socioeconomic inequalities in the availability of human and physical maternal health resources across Iranian provinces in 2023. METHODS: This cross-sectional study analyzed data from 20 maternal health resource indicators collected in 2023 across all 31 provinces of Iran. Among these, 7 variables represented human resources and 13 represented physical resources. Data aggregation was performed at multiple levels, including provincial boundaries, geographic regions, deprivation categories, and classification of provinces as border or central, to comprehensively assess spatial and socioeconomic disparities. Composite indices for human and physical resources were constructed using min-max normalization followed by averaging relevant variables. Inequality was quantified using the Gini coefficient across provinces and data processing and statistical computations were performed using R software. RESULTS: Findings reveal generally moderate inequalities in maternal health resource distribution (Gini mostly below 0.5) with advantaged and border provinces showing higher resource availability. Specialized facilities and supervisory staff remain concentrated in select regions, while frontline workers show more equitable distribution. The concentration of border‑specific facilities in a limited number of provinces explains part of the observed regional disparities. CONCLUSIONS: While important progress has been made in expanding maternal health services, spatial and socioeconomic inequities in the distribution of resources persist across provinces in Iran. Policy efforts should prioritize equity-oriented resource allocation, strengthen services in deprived provinces, and implement continuous inequality monitoring to support more equitable maternal health outcomes.