title: Individual and Area Level Factors Associated with Prenatal, Delivery, and Postnatal Care in Pakistan.
abstract: This research examines individual and area level factors associated with maternal health care utilization in Pakistan. The 2012-2013 Pakistan Demographic and Health Surveys data was used to model five outcomes: prenatal care within the first trimester, four plus prenatal visits, birth attendance by a skilled attendant, birth in a medical facility, and receipt of postnatal care. Less than half of births were to mothers receiving prenatal care in the first trimester, and approximately 57 % had trained personnel at delivery. Over half were born to mothers who received postnatal care. Evidence was found to support the positive effect of individual level variables, education and wealth, on the utilization of maternal health care across all five measures. Although, this study did not find unilateral differences between women residing in rural and urban settings, rural women were found to have lower odds of utilizing prenatal services as compared to mothers in urban environments. Additionally, women who cited distance as a barrier, had lower odds of receiving postnatal health care, but still engaged in prenatal services and often had a skilled attendant present at delivery. The odds of utilizing prenatal care increased when women resided in an area where prenatal utilization was high, and this variability was found across measures across provinces. The results found in this paper highlight the uneven progress made around improving prenatal, delivery, and postnatal care in Pakistan; disparities persist which may be attributed to factors both at the individual and community level, but may be addressed through a consorted effort to change national policy around women's health which should include the promotion of evidence based interventions such as incentivizing health care workers, promoting girls' education, and improving transportation options for pregnant women and recent mothers with the intent of ultimately lowering the Maternal Mortality Rate as recommended in the U.N.'s Millennium Development Goal 5.
authors: University of Alabama at Birmingham, 517D Ryals Public Health Building, 1665 University Boulevard, Birmingham, AL, 35294, USA. budhwani@uab.edu.
authors: Henna
authors: H
authors: Budhwani
authors: University of Alabama at Birmingham, 563 School of Health Professions Building, 1705 University Boulevard, Birmingham, AL, 35294, USA. khearld@uab.edu.
authors: Kristine Ria
authors: KR
authors: Hearld
authors: Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, THT 215 1900 University Boulevard, Birmingham, AL, 35294-0006, USA. hanne@uab.edu.
authors: Hanne
authors: H
authors: Harbison
mesh_terms: D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D010154:Pakistan / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data*; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D019035:Rural Health Services / Q000706:statistics & numerical data*
keywords: Maternal health; Pakistan; Postnatal visit; Prenatal care; Rural health