Antenatal Care Utilization and Its Determinants Among Rural, Urban, and Rural-Migrant Women in Karachi, Pakistan: A Comparative Study.

Background: Rural-urban disparities in antenatal care (ANC) utilization are well-documented in Pakistan, but little is known about rural women who migrate to urban areas for childbirth. This study compared ANC utilization among three groups in Karachi: rural residents with rural birth (Group A), urban residents with urban birth (Group B), and rural residents with urban birth (Group C). Methods: A comparative cross-sectional study was conducted among 207 women who had given birth within the preceding 12 months (69 per group). Data were collected using a structured interview schedule. ANC adequacy was defined as four or more visits. Chi-square tests, one-way ANOVA with Welch's correction, and binary logistic regression were used. Results: Just over three-quarters of the women (77.3%) had adequate ANC. Adequacy was lowest in Group A (62.3%) and clearly higher in Groups B (85.5%) and C (84.1%); the difference between the three groups was significant (χ² = 13.27, p = .001). Mean ANC visits were 3.45 (Group A), 3.81 (Group B), and 3.68 (Group C) (F = 4.21, p = .016); Group A had significantly fewer visits than Group B (mean difference = −0.36, p = .009). After adjustment for education, spouse education, and household size, Group B had 3.32 times the odds (95% CI: 1.33–8.26) and Group C had 2.99 times the odds (95% CI: 1.32–6.79) of adequate ANC compared with Group A. Socioeconomic covariates were not significant. Distance to hospital (p = .017) and hospital type (p < .001) differed significantly across groups. Conclusions: ANC utilization was significantly lower among rural women compared to urban and rural-migrant women. Migration for delivery was associated with utilization comparable to urban women, unexplained by socioeconomic factors. Targeted interventions are needed for rural women in Pakistan.