Maternal mortality is a pressing public health issue in Pakistan, and reducing its rate would enhance human well-being and public health. This study aims to identify spatial dependence or heterogeneity in maternal mortality rate (MMR) in Pakistan, assess the spatial spillover effects of sociocultural factors on MMR, and measure the spatial variation in the impact of sociocultural variables on MMR across districts in Pakistan. This study utilized data from Multiple Indicators Cluster Survey (MICS), conducted by UNICEF in 2017-18 and 2018-19. Global and local Moran’s tests were employed to identify the spatial clusters and outliers in MMR. Spatial Durbin Model (SDM) was applied to measure the effects of sociocultural variables in own district (direct effects) and neighboring districts (indirect or spillover effects) on MMR, while Multiscale Geographically Weighted Regression (MGWR) assessed the extant of spatial sensitivity of sociocultural factors on MMR. The study found that districts were spatially dependent on their neighbouring districts up to 26%. LISA results showed a significant spatial cluster of high-high MMR in Baluchistan and KP, whereas low-low cluster of MMR was found in Punjab. Empirical findings confirmed that in terms of direct effects, MMR in own districts is influenced positively by multidimensional poverty index vulnerability (MPIV), traditional method of delivery (TDM), delivery by friends/relatives (DF/R), justification of wives in beating (JWB) while negatively affected by maternal education (ME) and first antenatal check-up in pregnancy (FACP). Concerning spatial spillover effect, the MMR in own districts is influenced positively by MPIV, TDM, DF/R, JWB of the neighboring districts and inversely influenced by ME and FACP of neighbouring districts. Furthermore, MPIV, TDM and DF/R were found to be highly sensitive, particularly in Baluchistan, while JWB was found to be more sensitive in KP and Baluchistan. The study concluded that districts in Pakistan exhibit significant spatial dependence regarding MMR, which are strongly influenced by socioeconomic and cultural variables. Prioritizing highly sensitive districts can significantly reduce maternal mortality by addressing advanced delivery methods, promoting maternal empowerment and autonomy, improving education, and enhancing the financial conditions of multidimensionally poor families, particularly in the districts of Baluchistan.
Sheikh et al. (Tue,) studied this question.