Trends and Inequities Related to Antenatal Care Utilization Among Pakistani Women From 1990 to 2019: An Insight From Demographic and Health Surveys

BACKGROUND: Antenatal care (ANC) utilization is an essential component of the continuum of maternal healthcare services to promote positive health outcomes for both the mother and newborns. An adequate number of ANC visits (at least 4 visits or more) provides pregnant women with an optimistic pregnancy experience. Otherwise, the inadequacy of ANC may result in adverse health outcomes, such as the risk of preterm births, low birth weight, and perinatal mortality. This research is aimed at investigating trends and inequities related to ANC utilization among women of reproductive age (15-49 years) across Pakistan from 1990 to 2019, covering almost the last three decades. METHODS: This study used secondary data for analysis of all rounds of Pakistan Demographic and Health Surveys (PDHSs) from 1990 to 2019, including the latest Pakistan Maternal Mortality Survey 2019. The analysis included those married women of reproductive age (MWRA) who had live births in the last 5 years preceding all waves of PDHSs. Women's sample weights were applied, using the IBM SPSS Version 25. We carried out univariate descriptive analysis and bivariate cross-tabulation analysis to determine the relationship between outcome and explanatory variables, where a p value ≤ 0.05 was considered statistically significant. Further, bivariate and multivariate logistic regressions were applied to explore the association of adequate ANC visits with explanatory variables, where odds ratios (ORs) and adjusted odds ratios (AORs) at 95% confidence intervals (CIs) were calculated. RESULTS: The research witnessed an upward trend in the utilization of adequate ANC visits, with an increase from 14.2% to 54.5% from 1990 to 2019 in Pakistan. Results showed that adequate numbers of ANC utilization had a strong association with population characteristics of MWRAs aged 15-49 years. Particularly, it was found to be higher among 25-34-year-old women who attained higher education and were employed in professional/managerial occupations. However, a variation of inequities related to ANC utilization was also manifested from other key factors, such as poor wealth quintile, nonavailability of transportation, women's and husbands' lower education levels, lack of mass media exposure, women's low autonomy, and shortage of healthcare providers (LHWs). Further, results also revealed a strong association between adequate ANC utilization and women's need factors, such as parity, gravidity, and desire for more children. CONCLUSION: This research concludes the increased utilization of adequate ANC visits in Pakistan over the past three decades; nonetheless, persistent disparities necessitate immediate attention. Focused interventions, particularly in rural and remote areas, are imperative to increase the uptake of ANC and achieve universal healthcare for mothers and newborns. Addressing service delivery gaps and expanding the skilled healthcare workforce are pivotal for effective ANC services provision and promotion of its benefits. To further enhance ANC utilization, government efforts should prioritize investment in community awareness campaigns aimed at educating and empowering pregnant women and their families.