Sociodemographic determinants of reproductive healthcare service use among pregnant women in Pakistan

Background: Using the essential reproductive care services such as antenatal care (ANC) and skilled birth services are vital for ensuring safe motherhood and controlling maternal and child mortality. There is no recent evidence on the state of using reproductive care services in Pakistani women. We aimed to assess the prevalence of using essential reproductive care services including: 1) timing and 2) frequency of using antenatal care, 3) hospital/other institutional delivery, and 4) use of cesarean section (C- section) services. Secondly, we identified the sociodemographic factors that are associated with the use of these services. Methods: : We used the latest Pakistan Demographic and Health Survey (2017-18 PDHS) for this analysis. Data were collected by face-to-face interviews by trained interviewers. The analysis included 8,287 women aged 15-49 years. PDHS is a cross-sectional survey that collects data on women’s reproductive health issues along with various demographic and socioeconomic factors. The data on reproductive services were defined by standard guidelines by World Health Organization (WHO). Data analysis involved univariate tests and multivariate regression techniques. Results: : The percentage of women who attended ANC visit in the first trimester was 62.59%, and those who attended the minimum recommended number of 4 visits was 49.46%. The percentage of using hospital (or other institutional) and C-section services were respectively 76.20% and 19.63%. In the regression analysis, place of residence, education, household wealth status, access to using electronic media and learning about family planning from electronic media and before marriage were found to significantly predict the use of ANC (timely and adequate visits) and facility delivery services (hospital delivery and C-section). However, educational and household wealth status stood out as the strongest predictors of all. Conclusion: About half of the women Pakistan were not having adequate ANC visits and about one-third not making timely ANC contact. More than three-quarter reported choosing to deliver at hospital/other facility, and about one-fifth preferred C-section. Among the predictor of using these services, education and household wealth status were found to have the strongest association, highlighting the role of women’s socioeconomic well-being in availing the basic reproductive healthcare services.