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Socioeconomic determinants of antenatal healthcare inequalities in urban Pakistan

Zahrah Rafique (University of Karachi Applied Economics Research Centre, Karachi, Pakistan)

International Journal of Social Economics

ISSN: 0306-8293

Article publication date: 12 December 2022




One of the targets of sustainable development goal (SDG) 2030 is to reduce maternal mortality ratio to 70 per 100,000 live births and ensure pregnant women attend at least four antenatal visits. In urban Pakistan, it is expected that more women utilize antenatal care (ANC) because urban areas have more resources, higher education and wealthier people. Despite these facilities, the lack of utilization of antenatal care among pregnant women is abysmal—the latest estimate by Pakistan Demographic and Health Survey (PDHS) places the figure at 63%. Therefore, the paper attempts to identify the factors that affect the utilization of ANC in urban areas by using the PDHS 2017–2018.


The study used cross-tabs to determine the socioeconomic characteristics of women, and used the marginal effects from the probit model to evaluate the significance and relationship between socioeconomic determinants and antenatal visits. Finally, the study used Adam Wagstaff's decomposition analysis to identify the magnitude and main determinants of inequality.


The marginal effects show that socioeconomic variables such as education, province of residence, birth of a first child, age, education and consulting a doctor predicted the probability of 4+ antenatal visits. The decomposition analysis shows that women who consulted a doctor, belonged to non-poor class, were more educated and older contributed significantly to the inequality of antenatal care utilization in urban areas.

Practical implications

The study calls for increasing the number of doctors, promoting education, increasing awareness related to pregnancy complications and reducing wealth inequality. Moreover, the study also calls for increasing global intervention by implementing programs similar to ending preventable maternal mortality (EPPM) to increase antenatal coverage.


The distinctiveness of the study can be found in the fact that no study has been conducted that analyses the inequality related to the usage of ANC in urban areas of Pakistan.

Peer review

The peer review history for this article is available at:



Rafique, Z. (2022), "Socioeconomic determinants of antenatal healthcare inequalities in urban Pakistan", International Journal of Social Economics, Vol. ahead-of-print No. ahead-of-print.



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