Background: Maternal mortality remains a critical public health challenge in low- and middle-income countries, with rural areas disproportionately affected due to limited resources and systemic healthcare disparities. In Pakistan, rural maternal mortality rates exceed urban rates by a significant margin. Objectives: To assess the availability and accessibility of maternal health services in rural areas and examine their role in reducing maternal mortality. Methods: A cross-sectional survey was conducted among 180 women in selected rural areas. Data were collected using structured interviews to assess demographic characteristics, service availability (antenatal care, skilled birth attendants, emergency obstetric care), and accessibility factors (distance, transportation, affordability). Health records from local facilities were reviewed to identify maternal mortality cases. Descriptive statistics summarized key variables, while chi-square tests examined associations between service-related factors and maternal mortality, with significance set at p < 0.05. Results: Over half of respondents (54.4%) had no formal education, and 57.8% had a monthly income below PKR 20,000. Antenatal care facilities were available to 84.4% of respondents, skilled birth attendants to 76.7%, and emergency obstetric care to 52.2%, while only 48.9% had access to 24/7 delivery services. Significant associations with reduced maternal mortality were found for the presence of skilled birth attendants (p = 0.006), distance to health facilities ≤10 km (p = 0.009), and availability of emergency obstetric care (p = 0.026). Conclusion: Improving service availability, accessibility, and affordability, alongside strengthening emergency obstetric care and skilled attendance, is essential to reduce rural maternal mortality in Pakistan. Keywords: Maternal Mortality, Rural Health, Skilled Birth Attendants, Emergency Obstetric Care, Accessibility
Bughio et al. (Sat,) studied this question.