Improving maternal health in Pakistan: toward a deeper understanding of the social determinants of poor women's access to maternal health services

Am J Public Health. 2014 Feb;104 Suppl 1(Suppl 1):S17-24. doi: 10.2105/AJPH.2013.301377. Epub 2013 Dec 19.


Evidence suggests national- and community-level interventions are not reaching women living at the economic and social margins of society in Pakistan. We conducted a 10-month qualitative study (May 2010-February 2011) in a village in Punjab, Pakistan. Data were collected using 94 in-depth interviews, 11 focus group discussions, 134 observational sessions, and 5 maternal death case studies. Despite awareness of birth complications and treatment options, poverty and dependence on richer, higher-caste people for cash transfers or loans prevented women from accessing required care. There is a need to end the invisibility of low-caste groups in Pakistani health care policy. Technical improvements in maternal health care services should be supported to counter social and economic marginalization so progress can be made toward Millennium Development Goal 5 in Pakistan.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Focus Groups
  • Health Services Accessibility / organization & administration*
  • Health Services Accessibility / standards
  • Humans
  • Interviews as Topic
  • Maternal Health Services / supply & distribution*
  • Maternal Welfare*
  • Pakistan / epidemiology
  • Poverty
  • Pregnancy
  • Qualitative Research
  • Quality Improvement
  • Social Class
  • Social Determinants of Health*
  • Stereotyping